0000000000059863
AUTHOR
Annegret Eckhardt-henn
Neurologische und somatoforme Schwindelsyndrome
Schwindel ist eines der haufigsten Leitsymptome in der Allgemeinmedizin und nach dem Kopfschmerz das haufigste Leitsymptom in der Neurologie. Die verschiedenen Schwindelsyndrome sollten nach organischen und somatoformen Syndromen unterschieden werden. Leider werden somatoforme Schwindelerkrankungen oft nicht oder verspatet in die Differenzialdiagnose einbezogen, weshalb die Diagnose verzogert gestellt wird. Dies tragt zu der ohnehin schnellen Chronifizierung dieser Schwindelerkrankungen bei und fuhrt haufig zu einer enormen Beeintrachtigung der Lebensqualitat bis hin zur Fruhberentung der Patienten und zu hohen Krankenkassenkosten. Daher ist bei komplexen Schwindelerkrankungen eine fruhe in…
Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder?
Patients with vestibular vertigo syndromes often suffer from anxiety and depression, whereas patients with psychiatric disorders often experience subjective unsteadiness, dizziness, or vertigo. Thus, it has been hypothesized that the vestibular system may be interlinked with the emotion processing systems. The aim of the current study was to evaluate this hypothesis by correlating vestibular and psychiatric symptoms with the course of the disease over 1 year. This interdisciplinary, prospective, longitudinal study included a total of 68 patients with acute vestibular vertigo syndromes. Four subgroups of patients with benign paroxysmal positioning vertigo (BPPV, n=19), acute vestibular neuri…
Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness.
Two hundred and two consecutive patients with dizziness were evaluated using blind neuro-otological testing and examination, blind psychiatric examination, including structured interviews (according to DSM-IV), the Symptom Check-List (SCL 90 R), and the State-Trait Anxiety Inventory (STAI). In 28% of the patients (N=50) dizziness was of organic origin (O group); in 55.3% (N=99) of psychogenic origin (P group) and in 16.8% comorbid psychiatric disorders were found (Mixed group). In 5.3% (N=10) neither organic nor psychiatric results could be found, which could explain the dizziness (Ideopathic group). Compared with the Organic group the patients with psychiatric disorders (P and Mixed group)…
Standfest? Erste Ergebnisse der Entwicklung eines kognitiv-verhaltenstherapeutischen Gruppenschulungsprogramms zur Behandlung des somatoformen Schwindels
Anhand einer explorativen Fragestellung soll der Einfluss eines Schulungsprogramms fur somatoforme Schwindelpatienten auf dysfunktionale Krankheitsreprasentationen, Symptomstarke und psychische Komorbiditat uberpruft werden. Randomisiertes Wartekontrollgruppen-Design: 10 Patienten wurden der Kontrollgruppe zugewiesen; 14 Patienten der Interventionsgruppe durchliefen die Diagnostik im Pratest, Posttest und eine 3- bzw. 12-Monats-Katamnese. Die Fragebogenbatterie umfasste den Illness Perception Questionnaire, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, Hospital Anxiety and Depression Scale und Physical Health Questionnaire. Hypothesenkonform verbesserte sich die personliche Kontrol…
Persistence of symptoms in primary somatoform vertigo and dizziness: a disorder "lost" in health care?
The aim of this study was to perform a 3-year follow-up of primary somatoform vertigo and dizziness (SVD) regarding health care use and treatment. Ninety-two patients with dizziness underwent detailed vestibular neurophysiological testing and a Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Psychometric assessments comprised the Vertigo Symptom Scale, the Vertigo Handicap Questionnaire, the SCL-90-R, and the Short-Form-36 Health Survey. At the 3-year follow-up, 65 patients with primary SVD (anxiety, n = 29; depression, n = 14; somatoform disorders, n = 22) were reassessed (70.7% response). The patients improved in symptom severity (p…
Dizziness: Anxiety, health care utilization and health behavior—
Background: Due to the lack of epidemiological data on the relation of dizziness and anxiety, we investigated the prevalence of dizziness and anxiety in a representative sample of the German population. We explored the consequences of comorbid anxiety for emotional distress, functional impairment, health care utilization, and health behavior in dizziness. Methods: By the end of 2006, we surveyed a total of 1287 persons between 14 and 90 years of age in their homes by trained interviewers with standardized self-rating questionnaires on anxiety (Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Mini-Social Phobia Inventory) and dizziness (Vertigo Symptom Scale). The sample was…
Symptom course in inpatient and day clinic treatment of depression: Results from the INDDEP-Study.
Abstract Background In major depression (MDD), hospital treatment is an option in more severe cases or if outpatient treatment failed. Psychosomatic hospitals in Germany provide treatment programs with multimodal psychotherapy, either in an inpatient or a day hospital setting. In the context of health care research, this study aimed (1) to compare characteristics of patients treated in psychosomatic day hospitals and inpatient units, (2) to compare the effectiveness of both treatment modalities. Methods A naturalistic design was chosen to achieve external validity. 604 consecutive patients were assessed at admission, discharge and a 3-month follow-up. Primary outcome was defined as a reduct…
Psychiatric Disorders in Otoneurology Patients
Nearly half the patients who are in specialized otoneurologic units exhibit psychiatric disorders. The disorders are most significant in patients who have the chief symptoms of dizziness, complex forms of tinnitus, or sudden and relapsing sensorineural hearing loss. If not properly diagnosed, these disorders can lead to improper treatment, particularly when the illness is a somatoform otoneurologic disorder. Patients who have comorbid symptoms, such as reactive anxiety or depressive disorders, may experience difficulties in coping with the illness. In many instances, reactive psychologic disorders can lead to severe impairment of daily life and work activities.
Why Do Subjective Vertigo and Dizziness Persist over One Year after a Vestibular Vertigo Syndrome?
The overlap and interlinkage of dizzy symptoms in patients with psychiatric and vestibular vertigo/dizziness disorders is the subject of an ongoing debate. In a one-year follow up in 68 patients with vestibular vertigo syndromes, the persistency of vertigo and dizziness symptoms was examined and correlated with vestibular parameters and results from a psychiatric evaluation. Patients with vestibular migraine showed poorest improvement of vertigo and dizziness symptoms over time. In addition, patients who developed anxiety or depressive disorder after the onset of the vestibular disorder showed poor improvement and high persistency of symptoms.
High Prevalence of Mental Disorders and Emotional Distress in Patients with Chronic Spontaneous Urticaria
Quality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. The aim of this study was to assess the prevalence and spectrum of mental disorders and to determine levels of emotional distress in patients with CSU. One hundred patients with CSU were investigated for mental disorders (by specialized diagnostic interviews and psychometric instruments), levels of emotional distress (by the Global Severity Index of the Symptom Check List; SCL-90R GSI) and underlying causes of their urticaria (by dermatological assessment). Forty-eight percent of patients with CSU were diagnosed with one or more psychosomatic disorders; most c…
Interaction of somatoform and vestibular disorders
The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders.To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study.Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Menière's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-ot…
Improved Postural Control after Behavioural Short Term Intervention in Patients with Psychiatric Dizziness
Background:Patients with psychiatric dizziness often report subjective instability of stance and gait and fear of falls. They showed increased activity of their body sway in static posturography compared to normals (1, 2). Aim of the present study was to evaluate the efficiency of a behavioural therapy by static posturography.Methods:14 patients with psychiatric dizziness were included in the prospective study on static posturography to quantify the postural sway (sway path) during upright stance under different conditions. the psychosomatic examination comprised of standardized interviews (SCID-Interview) and a psychometric examination battery (SCL-90, VSS, VHQ). Results of static posturog…
Deutschsprachige Validierung des Vertigo Handicap Questionnaire (VHQ) anhand einer Patientenstichprobe mit vestibulärem und somatoformem Schwindel
The Vertigo Handicap Questionnaire (VHQ) by Yardley (1992) assesses physical and psychosocial impairments of vertigo or dizziness. Our study examines the structure, reliability, and aspects of validity of the German version of the VHQ. 98 vestibular vertigo syndromes vs. 90 patients with somatoform vertigo and dizziness were evaluated with the VHQ, symptom severity (VSS), distress (GSI), anxiety and depression (HADS), catastrophizing beliefs (ACQ), fear of body sensations (BSQ), and quality of life (SF-36). For diagnostic classification detailed clinical neurological, neuro-otological and psychosomatic testing were conducted. Principal components analysis identified two factors, which could…
„Phobischer Schwankschwindel”
Due to the results of an interdisciplinary study on patients with vertigo as the chief symptom and on the background of psychodynamic theories concerning anxiety disorders the term of phobic postural vertigo (Brandt & Dieterich 1986) is discussed. It becomes obvious that phobic postural vertigo is a generalizing term which encompasses different forms of psychogenic vertigo. The authors plead for a more differentiated diagnosis and subgroup oriented classification of vertigo caused by psychiatric disorders.
Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity
Summary Background Chronic urticaria (CU), one of the most common skin disorders, is characterized by spontaneous recurrent bouts of weals and pruritus and associated with severely impaired quality of life (QoL). Objectives To determine what aspects of life quality are affected and to characterize the factors that impact on QoL in CU patients. Subjects and methods This interdisciplinary interview/questionnaire-based study included 100 patients admitted to a University Hospital Dermatology Department for the identification of underlying causes of CU; 96 healthy subjects matched for age and sex were used as controls. QoL was assessed using Skindex-29, a validated instrument to measure the …