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June 28, 1993

Psychiatric and Otologic Diagnoses in Patients Complaining of Dizziness

Author Affiliations

From the Division of Consultation-Liaison Psychiatry, Departments of Psychiatry and Behavioral Sciences (Drs Sullivan, Katon, and Russo and Mr Fischl) and Otolaryngology-Head and Neck Surgery (Dr Voorhees), University of Washington, Seattle; the Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Hospital, Baltimore, Md (Dr Clark); and the Department of Otolaryngology, University of Texas, San Antonio (Dr Dobie).

Arch Intern Med. 1993;153(12):1479-1484. doi:10.1001/archinte.1993.00410120059008

Background:  Dizziness is a common and disabling symptom in primary care practice, especially among the elderly. Though there are many organic causes of dizziness, the results of medical workups are negative in the majority of patients.

Methods:  A total of 75 patients with dizziness who were referred to a community otolaryngology practice received a structured psychiatric diagnostic interview (National Institute of Mental Health Diagnostic Interview Schedule) and questionnaires that assessed psychological distress as well as a complete otologic evaluation, including electronystagmogram. Patients with evidence of a peripheral vestibular disorder were compared with those without such evidence.

Results:  While psychiatric diagnoses were present in both those with and without evidence of a peripheral vestibular disorder, those without such evidence had a greater mean number of lifetime psychiatric diagnoses as defined by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, and specifically, a greater life-time prevalence of major depression and panic disorder. This group also more frequently met criteria for somatization disorder, had more current and lifetime unexplained medical symptoms, and had more severe current depressive, anxiety, and somatic symptoms.

Conclusions:  Psychiatric diagnoses are common among patients with dizziness referred for otologic evaluation who do not show evidence of a peripheral vestibular disorder. Specific psychiatric disorders should be part of the differential diagnosis of patients who present with dizziness.(Arch Intern Med. 1993;153:1479-1484)