Skip to main content

Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes

Results of a prospective longitudinal study over one year

Journal of Neurology volume 256, pages 58–65 (2009)Cite this article

Abstract

Objectives

High rates of coexisting vestibular deficits and psychiatric disorders have been reported in patients with vertigo. Hence, a causal linkage between the vestibular system and emotion processing systems has been postulated. The aim of this study was to evaluate the impact of vestibular function and vestibular deficits as well as preexisting psychiatric pathologies on the course of vestibular vertigo syndromes over 1 year.

Methods

This interdisciplinary prospective longitudinal study included a total of 68 patients with vestibular vertigo syndromes. Four subgroups were compared: benign paroxysmal positioning vertigo (BPPV, n = 19), vestibular neuritis (VN, n = 14), vestibular migraine (VM, n = 27), and Menière’s disease (MD, n = 8). All patients underwent neurological and detailed neurootological examinations as well as two standardized interviews and a psychometric examination battery at five different times (T0–T4) over 1 year.

Results

The prevalence of psychiatric disorders at baseline (T0) did not differ between the four subgroups. Only patients with VM showed significantly higher rates of psychiatric disorders (p = 0.044) in the follow-up over 1 year. Patients with a positive history of psychiatric disorders before the onset of the vestibular disorder had significantly increased rates of psychiatric disorders compared to patients with a negative history of psychiatric disorders (T1: p = 0.004, T3: p = 0.015, T4: p = 0.012). The extent of vestibular deficit or dysfunction did not have any influence on the further course of the vestibular disease with respect to the development of psychiatric disorders.

Conclusion

A positive history of psychiatric disorders is a strong predictor for the development of reactive psychiatric disorders following a vestibular vertigo syndrome. Especially patients with vestibular migraine are at risk of developing somatoform dizziness. The degree of vestibular dysfunction does not correlate with the development of psychiatric disorders.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. (1995) Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease.American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113:181–185

  2. Aurora SK, Wilkinson F (2007) The brain is hyperexcitable in migraine. Cephalalgia 27:1442–1453

    PubMed  Article  CAS  Google Scholar 

  3. Bag B, Hacihasanoglu R, Tufekci FG (2005) Examination of anxiety, hostility and psychiatric disorders in patients with migraine and tension-type headache. Int J Clin Pract 59:515–521

    PubMed  Article  CAS  Google Scholar 

  4. Baier B, Dieterich M (2007) Vestibular Migraine – A follow up study. Akt Neurologie 34:77

    Google Scholar 

  5. Bernardy K, Lehmann K, Einsle F, Gossrau G, Michel S, Kollner V (2007) Predictors of migraine attacks. Psychother Psychosom Med Psychol 57:281–288

    PubMed  Article  Google Scholar 

  6. Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M (2006) Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry 77:658–664

    PubMed  Article  CAS  Google Scholar 

  7. Brandt T (1999) Vertigo. Its Multisensory Syndromes. Springer, London

  8. Clark DB, Hirsch BE, Smith MG, Furman JM, Jacob RG (1994) Panic in otolaryngology patients presenting with dizziness or hearing loss. Am J Psychiatry 151:1223–1225

    PubMed  CAS  Google Scholar 

  9. Eagger S, Luxon LM, Davies RA, Coelho A, Ron MA (1992) Psychiatric morbidity in patients with peripheral vestibular disorder: a clinical and neuro-otological study. J Neurol Neurosurg Psychiatry 55:383–387

    PubMed  Article  CAS  Google Scholar 

  10. Eckhardt-Henn A, Best C, Bense S, Breuer P, Diener G, Tschan R, Dieterich M (2008) Psychiatric comorbidity in different organic vertigo syndromes. J Neurol 255:420–428

    PubMed  Article  Google Scholar 

  11. Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC (2003) Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord 17:369–388

    PubMed  Article  CAS  Google Scholar 

  12. Furman JM, Balaban CD, Jacob RG, Marcus DA (2005) Migraine-anxiety related dizziness (MARD): a new disorder? J Neurol Neurosurg Psychiatry 76:1–8

    PubMed  Article  CAS  Google Scholar 

  13. Godemann F, Siefert K, Hantschke- Bruggemann M, Neu P, Seidl R, Strohle A (2005) What accounts for vertigo one year after neuritis vestibularis – anxiety or a dysfunctional vestibular organ? J Psychiatr Res 39:529–534

    PubMed  Article  CAS  Google Scholar 

  14. Herrmann C, Brand-Driehorst S, Buss U, Ruger U (2000) Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing. J Psychosom Res 48:455–462

    PubMed  Article  CAS  Google Scholar 

  15. Huber D (2003) Migräne – Persönlichkeit und Stressbewältigung: Eine kritische Übersicht. Psychother Med Psych 53:432–439

    Article  Google Scholar 

  16. Jacob RG, Furman JM (2001) Psychiatric consequences of vestibular dysfunction. Curr Opin Neurol 14:41–46

    PubMed  Article  CAS  Google Scholar 

  17. Jacob RG, Furman JM, Durrant JD, Turner SM (1997) Surface dependence: a balance control strategy in panic disorder with agoraphobia. Psychosom Med 59:323–330

    PubMed  CAS  Google Scholar 

  18. Kaniecki RG (2002) Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology 58:S15–S20

    PubMed  Google Scholar 

  19. Katon W, Lin EH, Kroenke K (2007) The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 29:147–155

    PubMed  Article  Google Scholar 

  20. Lanteri-Minet M, Radat F, Chautard MH, Lucas C (2005) Anxiety and depression associated with migraine: influence on migraine subjects‘ disability and quality of life, and acute migraine management. Pain 118:319–326

    PubMed  Article  Google Scholar 

  21. McKenna L, Hallam RS, Hinchcliffe R (1991) The prevalence of psychological disturbance in neurotology outpatients. Clin Otolaryngol 16:452–456

    PubMed  Article  CAS  Google Scholar 

  22. Mongini F, Keller R, Deregibus A, Raviola F, Mongini T, Sancarlo M (2003) Personality traits, depression and migraine in women: a longitudinal study. Cephalalgia 23:186–192

    PubMed  Article  CAS  Google Scholar 

  23. Perozzo P, Savi L, Castelli L, Valfre W, Lo Giudice R, Gentile S, Rainero I, Pinessi L (2005) Anger and emotional distress in patients with migraine and tension-type headache. J Headache Pain 6:392–399

    PubMed  Article  Google Scholar 

  24. Staab JP, Ruckenstein MJ (2003) Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope 113:1714–1718

    PubMed  Article  Google Scholar 

  25. Stein MB, Asmundson GJ, Ireland D, Walker JR (1994) Panic disorder in patients attending a clinic for vestibular disorders. Am J Psychiatry 151:1697–1700

    PubMed  CAS  Google Scholar 

  26. Traue HC, Kessler M, Deighton RM, Eckenfels C (2005) Alltagsstress, Befindlichkeit, emotionale Hemmung und chronische Kopfschmerzen. Verhaltenstherapie und Verhaltensmedizin 25:213–238

    Google Scholar 

  27. Wittchen HU, Burke JD, Semler G, Pfister H, Von Cranach M, Zaudig M (1989) Recall and dating of psychiatric symptoms. Test-retest reliability of time-related symptom questions in a standardized psychiatric interview. Arch Gen Psychiatry 46:437–443

    PubMed  CAS  Google Scholar 

  28. Yardley L, Medina SM, Jurado CS, Morales TP, Martinez RA, Villegas HE (1999) Relationship between physical and psychosocial dysfunction in Mexican patients with vertigo: a cross-cultural validation of the vertigo symptom scale. J Psychosom Res 46:63–74

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Dept. of Neurology, Johannes Gutenberg-University, Langenbeckstraße 1, 55101, Mainz, Germany

    Christoph Best MD & Marianne Dieterich MD

  2. Dept. of Psychosomatic Medicine, Bürgerhospital Stuttgart, Tunzhofer Strasse 14–16, 70191, Stuttgart, Germany

    Annegret Eckhardt-Henn MD

  3. Dept. of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg-University, Langenbeckstrasse 1, 55101, Mainz, Germany

    Regine Tschan

Authors
  1. Christoph Best MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annegret Eckhardt-Henn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Regine Tschan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marianne Dieterich MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Best MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Best, C., Eckhardt-Henn, A., Tschan, R. et al. Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes. J Neurol 256, 58–65 (2009). https://doi.org/10.1007/s00415-009-0038-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-009-0038-8

Key words

  • vertigo
  • psychiatric comorbidity
  • depression
  • anxiety
  • vestibular disorders