Anxiety affects vestibulospinal function of labyrinthine-defective patients during horizontal optokinetic stimulation.

Comorbidity of vestibular and anxiety disorders was suggested by epidemiological studies and, recently, new insights into potential neural circuits which subserve both balance control and emotions, appear to support this hypothesis. In particular, disorienting visual surroundings, such as those generated by full-field moving scenes, equally disrupt postural control of patients with vestibular or panic disorders. In the present study, behaviour of body sway was assessed in response to an optokinetic stimulation by means of static posturography in 20 patients with vestibular neuritis (10 patients with normal affect and 10 with generalized anxiety disorders, as diagnosed according to the American Psychiatric Association criteria), and 20 normal subjects who served as controls. Optokinetic responses and vestibulo-spinal function during a full-field, bi-directional horizontal optokinetic stimulation, were recorded simultaneously. Labyrinthine-defective patients with low and high level of anxiety showed a common pattern of asymmetric optokinetic reflexes. On the contrary, body sway was found to be increased more by eye closure and optokinetic stimulation towards the defective labyrinth in patients affected by high level of anxiety as compared to those with normal affect and controls. These data confirm the combined effect of anxiety and labyrinthine dysfunction on vestibulo-spinal function which is disclosed by both visual suppression and disorienting visual contexts.

A follow-up study of psychiatric consultations in the general hospital: What happens to patients after discharge?

BACKGROUND: An appropriate follow-up is considered essential in the consultation-liaison psychiatry setting, but it is often neglected. This study evaluated the effectiveness of the psychiatric consultation process in the general hospital, by investigating what occurred to patients 3-5 months after discharge. METHODS: We used a three-part questionnaire: (1) the results of the consultation process; (2) a telephone interview with patients, and (3) a telephone interview with the patients' primary care physician, to whom the patients were referred after discharge from hospital. We contacted all consecutive, unselected patients referred to psychiatric consultation from January to July 1999. Complete data were available for 119 patients from an initial group of 318. RESULTS: The consultation process was well accepted by patients and useful to general hospital physicians to complete the final diagnosis of the patient when discharged from hospital. In most cases (78.9%), the psychiatric letter was attached to the discharge letter. The second part of the questionnaire indicated that most patients were satisfied with the consultation process. They thought it helped focus their problems and 60% asserted that they felt better after following their psychiatrists' instructions or therapy. The primary care physicians agreed with the diagnostic results of the psychiatric consultation, mainly followed the psychiatrists' advice, and generally expressed positive comments about the consultation-liaison service. CONCLUSIONS: Compliance of hospital physicians, patients, and primary care physicians was good. Follow-up studies on outcome of psychiatric consultations are few and further analysis is strongly recommended.

Psychological distress and disability in patients with vertigo.

OBJECTIVE: Vertigo is an extremely debilitating experience for the patient, especially during attacks; it is neither easy to identify nor control. The importance of psychosomatic factors has already been widely studied and discussed. In particular, it has been shown that stress factors are relevant in setting off episodes of dizziness, but there is no agreement if the presence of distress might influence the vestibular disability. METHODS: This study is concerned with evaluating the quality of life (QOL) in a group of 206 patients suffering from vertigo and 86 control patients, using the UCLA-Dizziness Questionnaire (UCLA-DQ) scale. The results were correlated with those achieved using the Hospital Anxiety and Depression Scale (HADS) psychometric test. RESULTS: What is clear is that, in patients suffering from vertigo as regards those who are not, there is a significant amount of anxiety and depression distress, especially in female subjects. There appears to be no relationship between psychological change and the various forms of clinical vertigo. In terms of the QOL parameter, what emerges is that, from a statistical point of view, fear of becoming dizzy is most closely correlated with the perception of disability. CONCLUSIONS: There is a also a need for psycho-education here in collaboration with the E.N.T. specialist so that the patient can learn to recognise his/her medical condition and be aware of the factors that primarily contribute to the deterioration of their QOL.

Psychosomatic study of 60 patients with vertigo.

The authors examined 60 consecutive patients hospitalized in Modena University Otorhinolaryngological Clinic for vertigo by means of an interview and of three self-rating scales (Zung's SDS, SAS and the Middlesex Hospital Questionnaire). The control group was composed of an equal number of patients hospitalized in the same ward and period for different nonsurgical otiatric diseases; the two groups were matched for age, sex, residential area, sociocultural conditions, duration of hospitalization and disease. According to the clinical diagnosis carried out when discharged from hospital, the patients where divided into five groups (Ménière's disease, neuronitis, vertebrobasilar insufficiency, neurosensorial deafness, nucleoreticular syndrome of Ararslan). The data regarding depression (MHQ and SDS), anxiety (MHQ and SAS), neuroticism, somatization (MHQ) and the prevailing of hysterical personality traits in women (MHQ) resulted particularly relevant from a statistical viewpoint (p less than 0.01).