Abstract
Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (Q H/V), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: Q H/V = 0.31 versus controls: Q H/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles.
Highlights
Nonorganic vertigo disorders are the focus of an ongoing debate on various concepts, definitions, and diagnostic criteria
The effects of psychoeducational short-term intervention (PTI) on somatoform vertigo and dizziness (SVD) were evaluated with quantitative static posturography
Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI
Summary
Nonorganic vertigo disorders are the focus of an ongoing debate on various concepts, definitions, and diagnostic criteria. Well established concepts are represented by phobic postural vertigo, space and motion phobia, and visual vertigo [1,2,3]. Due to various underlying causal psychopathological mechanisms (e.g., phobia, anxiety, and depressive disorders; cognitive-behavioral and psychological mechanisms, role of attention, and perception) [4], patients with nonorganic vertigo disorders present with a broad variety of signs and symptoms. Johansson and coworkers performed a cognitive behavioural therapy in a group of rather unselected patients with recurrent vertigo, including somatoform disorders. Patients experienced an improvement of walking and of dizziness associated handicap, notwithstanding that anxiety and depression remained unchanged [7].
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