Psychiatric considerations in the management of dizzy patients

Research over the last 4 decades has revealed a great deal of information about psychiatric and functional causes, consequences, and comorbidity of vestibular syndromes. Primary care clinicians, neurologists, and otologists who are willing to set aside the 20th century notion of "psychogenic dizziness" and incorporate 21st century concepts about 5 behavioral entities into their practices will be rewarded for their efforts with a marked improvement in diagnostic acumen and therapeutic effectiveness. Panic attacks may cause or contribute to acute or episodic vestibular symptoms. Generalized anxiety and depression do the same for chronic vestibular symptoms. Fear of falling causes considerable functional impairment, particularly in the elderly. Persistent postural-perceptual dizziness, a newly defined functional vestibular disorder that was 145 years in the making, is the most common cause of chronic dizziness in neurotologic practice. These 5 disorders are the primary diagnoses in 8-10% of patients who consult neurologists or otologists for vestibular symptoms and may be present in up to 50% of patients with structural vestibular disorders. They affect the clinical course of other illnesses and outcomes of medical and surgical interventions. Fortunately, when recognized properly, they are among the most treatment responsive of all conditions that cause vestibular symptoms.