Phobic Postural Vertigo

Abstract

Psychogenic vertigo, particularly phobic postural vertigo (PPV), [1,2] is common. Of 768 consecutive neurologic patients presenting at our dizziness unit in Munich between 1989 and 1992 Table 1, 158 (21%) had benign paroxysmal positioning vertigo and 129 (17%) had PPV, whereas less than 10% had other well-known disorders such as Meniere's disease and vestibular neuritis. The frequency of psychogenic vertigo and the diagnostic uncertainties prompt this review. View this table: Table 1. Frequency of different kinds of vertigo syndromes in 768 patients seen in a dizziness unit (1989-1992) Patients with somatization symptoms consult specialists for their symptom of primary concern; with vertigo, it is the neurologist or otolaryngologist. I will discuss the interrelationship between psychiatric disorders and vestibular function and different forms of psychogenic vertigo before defining the clinical entity of PPV. Attempts to define a neurophysiologic link between psychiatric disorders and somatic symptoms have concentrated on vertigo for centuries, [3-5] even before the remarkable group of 19th century scientists discovered the functions of the labyrinths and laid the foundation of modern vestibular and ocular motor research. [6-7] The vestibular-psychiatric interrelationships include the following: (1) schizophrenic patients often have abnormal responses in vestibular testing; [8] (2) patients with anxiety neurosis exhibit greater sensitivity and directional preponderance in vestibular testing; [9] (3) psychiatric, in particular schizophrenic, patients are more susceptible to motion sickness; [10] (4) patients with vestibular symptoms, particularly Meniere's disease, have a high frequency of abnormalities on psychometric tests; [11-13] (5) feeling dizzy or unsteady are among the 13 cardinal symptoms of panic attacks as defined in DSM-IV, [14] and the dizziness may even be present between attacks; [15] (6) psychiatric morbidity is high in unselected patients with vestibular disorders and remains high on strictly selected patients with documented organic vestibular dysfunction; [16] and (7) organic vestibular disease may precipitate as …