Psychogenic dizziness

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vendhan Ramanujam M.B.B.S [2]

Synonyms and Keywords: Functional dizziness; hyperventilation syndrome; nonspecific dizziness; phobic postural vertigo; psychiatric dizziness; psychic dizziness; psychophysiologic dizziness; somatization

Overview

Psychogenic dizziness is a dizziness which is not characterized by true vertigo and it can be replicated by hyperventilation and psychiatric symptoms that usually precede its onset. It occurs in anxious or phobic individuals and do not include any specific symptoms.[1][2][3] A new proposal narrowly defines psychogenic dizziness as the dizziness which occurs exclusively in combination with other symptoms as part of a recognized psychiatric symptom cluster and this symptom cluster is not itself related to vestibular dysfunction.[4][5] Psychogenic dizziness should not be confused with the phenomenon of psychogenic overlay where the preexisting nucleus of nonpsychiatric dizziness is augmented by psychiatric factors that occur along with them. None of the personality disorders (DSM-IV Axis II psychiatric disorders) are characterized by dizziness or imbalance and thus they do not justify a diagnosis of psychogenic dizziness.

Classification

The following classification has been proposed according to the newly proposed narrow definition of psychogenic dizziness:

  • A psychiatric condition that entirely accounts for the patient’s dizziness like the panic disorder
  • A cluster of anxiety disorders where dizziness is a part of their symptom cluster like the generalized anxiety disorder
  • Psychiatric disorders where the psychiatric symptoms are vaguely described as having dizziness or imbalance by the patients like the description of poor concentration as swimming sensation in depressive disorders
  • Psychiatric disorders which present with neurological symptoms including the symptom of imbalance which would fit in the narrow definition of psychogenic dizziness like the conversion disorder[5]

Pathophysiology

The following mechanisms mediate the relationship between anxiety disorders and vestibular disorders leading to a state of dizziness in psychiatric patients.

Psychological Mechanism

Somatopsychic

Patients may catastrophically interpret vestibular sensations as implying immediate danger and develop panic disorder which persists even after the resolution of the original vestibular disorder. Thus a somatic sensation becomes a psychic sensation.[6]

Psychosomatic

Increased arousal and hyperventilation leads to the occurrence of increased vestibular responses which are commonly seen in panic disorder with agoraphobia. Thus a psychic sensation turns into a somatic sensation.[6]

Neurophysiological Mechanism

Evidences suggest a neuroanatomic or neurophysiologic basis for the linkage between panic disorder and vestibular dysfunction. The current principal theory includes the dysregulation of brainstem noradrenergic systems, involvement of central serotonergic pathways and respiratory dyscontrol. The relationships between the structures of interest for panic disorder and vestibular system include the connections between locus coeruleus and lateral vestibular nucleus, the significant vestibular input to the raphe nuclei, the serotonergic effects on vestibular processes and vestibular-respiratory connection. Also, the nucleus parabrachialis receives vestibular and visceral input and is connected with the limbic system, including the amygdala which coordinates the autonomic and behavioral responses to emotional stimuli and is essential for the conditioning of fear responses.[7]

Causes

References

  1. Drachman, DA.; Hart, CW. (1972). "An approach to the dizzy patient". Neurology. 22 (4): 323–34. PMID 4401538. Unknown parameter |month= ignored (help)
  2. Nedzelski, JM.; Barber, HO.; McIlmoyl, L. (1986). "Diagnoses in a dizziness unit". J Otolaryngol. 15 (2): 101–4. PMID 3712537. Unknown parameter |month= ignored (help)
  3. MOORE, BE.; ATKINSON, M. (1958). "Psychogenic vertigo; the importance of its recognition". AMA Arch Otolaryngol. 67 (3): 347–53. PMID 13507801. Unknown parameter |month= ignored (help)
  4. Gresty, MA.; Bronstein, AM.; Brandt, T.; Dieterich, M. (1992). "Neurology of otolith function. Peripheral and central disorders". Brain. 115 ( Pt 3): 647–73. PMID 1628197. Unknown parameter |month= ignored (help)
  5. 5.0 5.1 Furman, JM.; Jacob, RG. (1997). "Psychiatric dizziness". Neurology. 48 (5): 1161–6. PMID 9153437. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 Jacob, RG. (1988). "Panic disorder and the vestibular system". Psychiatr Clin North Am. 11 (2): 361–74. PMID 3047705. Unknown parameter |month= ignored (help)
  7. Charney, DS.; Heninger, GR. (1986). "Abnormal regulation of noradrenergic function in panic disorders. Effects of clonidine in healthy subjects and patients with agoraphobia and panic disorder". Arch Gen Psychiatry. 43 (11): 1042–54. PMID 3021083. Unknown parameter |month= ignored (help)



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