Imipramine for vestibular dysfunction in panic disorder: a prospective case series.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and effectiveness of imipramine on the treatment of comorbid chronic dizziness and panic disorder. METHOD: Nine patients with panic disorder and agoraphobia associated with chronic dizziness underwent otoneurological screening and were treated with a 3-months course of imipramine. Anxiety levels were measured with the Hamilton Anxiety Scale (HAM-A), dizziness levels were evaluated using the Dizziness Handicap Inventory (DHI), and panic severity and treatment outcome were assessed with the Clinical Global Impression Scale (CGI). RESULTS: At the baseline 33.3% (n=3) had a bilateral peripheral deficit vestibulopathy, the mean scores for HAM-A were 27.2±10.4, for DHI were 51.7±22.7, and for CGI-S were 4.8±0.9. All patients had a significant reduction in their HAM-A (11.1±5.5, p=0.008), DHI (11.5±8.1, p=0.008) and CGI-I (1.8±0.7, p=0.011) levels after 3-months imipramine treatment (mean=72.2±23.2 mg/day). CONCLUSION: This study found a decrease in anxiety levels and in the impact of dizziness in the patients' quality of life after a 3-months treatment course with imipramine.

Imipramine for vestibular dysfunction in panic disorder: a prospective case series / Imipramina para disfunção vestibular em transtorno do pânico: uma série de casos prospectiva

OBJECTIVE: The purpose of this study was to evaluate the efficacy and effectiveness of imipramine on the treatment of comorbid chronic dizziness and panic disorder. METHOD: Nine patients with panic disorder and agoraphobia associated with chronic dizziness underwent otoneurological screening and were treated with a 3-months course of imipramine. Anxiety levels were measured with the Hamilton Anxiety Scale (HAM-A), dizziness levels were evaluated using the Dizziness Handicap Inventory (DHI), and panic severity and treatment outcome were assessed with the Clinical Global Impression Scale (CGI). RESULTS: At the baseline 33.3 percent (n=3) had a bilateral peripheral deficit vestibulopathy, the mean scores for HAM-A were 27.2±10.4, for DHI were 51.7±22.7, and for CGI-S were 4.8±0.9. All patients had a significant reduction in their HAM-A (11.1±5.5, p=0.008), DHI (11.5±8.1, p=0.008) and CGI-I (1.8±0.7, p=0.011) levels after 3-months imipramine treatment (mean=72.2±23.2 mg/day). CONCLUSION: This study found a decrease in anxiety levels and in the impact of dizziness in the patients' quality of life after a 3-months treatment course with imipramine.

OBJETIVO: O objetivo deste estudo foi avaliar a eficácia e efetividade da imipramina no tratamento da tontura crônica e do transtorno de pânico comórbidos. MÉTODO: Nove pacientes com transtorno do pânico e agorafobia associada com tontura crônica foram submetidos à avaliação otoneurológica e tratados durante 3 meses com imipramina. Os níveis de ansiedade foram medidos através da Escala Hamilton de Ansiedade (HAM-A); os de tontura foram avaliados usando o Dizziness Handicap Inventory (DHI), e a gravidade do pânico e sua resposta pela Escala de Impressão Clínica Global (CGI). RESULTADOS: Na avaliação inicial, 33,3 por cento (n=3) da amostra apresentavam vestibulopatia periférica deficitária bilateral; as médias foram: da HAM-A 27,2±10,4, do DHI 51,7±22,7 e do CGI-S 4,8±0,9. Todos tiveram uma redução significativa nos escores de HAM-A (11,1±5,5, p=0,008), DHI (11,5±8,1, p=0,008) e CGI-I (1,8±0,7, p=0,011), após 3 meses de tratamento com imipramina (média=72,2±23,2 mg/dia). CONCLUSÃO: Este estudo encontrou uma diminuição dos níveis de ansiedade e do impacto da tontura na qualidade de vida dos pacientes após um curso de 3 meses de tratamento com imipramina.

Prevalência de transtorno de pânico em pacientes com zumbidos / The prevalence of panic disorder in patients with tinnitus

CONTEXTO: Estudos sugerem associação entre zumbidos e transtornos psiquiátricos. OBJETIVO: Identificar a presença de transtorno de pânico em uma amostra de pacientes com queixas de zumbido. MÉTODO: Foram avaliados 50 pacientes com queixa primária de zumbido de um serviço ambulatorial de otorrinolaringologia, durante um período de dois meses. A identificação de transtornos psiquiátricos e do impacto do zumbido na qualidade de vida foi feita por meio do Mini International Neuropsychiatric Interview (MINI versão 5.0) e do Tinnitus Handicap Inventory. Todos os pacientes foram submetidos à avaliação audiológica e responderam a um questionário clínico-demográfico desenvolvido para este estudo. RESULTADOS: Vinte (40 por cento) pacientes apresentaram transtorno de pânico, sendo 8 com e 12 sem agorafobia; 41 (82 por cento) pacientes apresentaram pelo menos um diagnóstico psiquiátrico, sendo os mais prevalentes: transtorno de pânico (40 por cento), depressão maior (40 por cento) e transtorno de ansiedade generalizada (34 por cento). CONCLUSÃO: A prevalência de transtorno de pânico em nossa amostra de pacientes com zumbidos foi elevada, o que ratifica a importância da avaliação psiquiátrica nesses pacientes.

BACKGROUND: Many studies suggest there is an association between tinnitus and psychiatric disorders. OBJECTIVE: To identify the prevalence of panic disorder in a tinnitus patients' sample. METHOD: We evaluated 50 patients with the main complaint of tinnitus of an Otorhinolaryngology outpatient unit for two consecutive months. The evaluation of psychiatric disorders was made with the Mini International Neuropsychiatric Interview (M.I.N.I version 5.0) and the evaluation of the tinnitus' impact was made with the Tinnitus Handicap Inventory. All patients also were submitted to an audiological evaluation and answered a clinical-demographic questionnaire elaborated for this study. RESULTS: Twenty (40 percent) patients had panic disorder, 8 with agoraphobia and 12 without agoraphobia; 41 patients (82 percent) had at least one psychiatric disorder, and the most prevalent were: panic disorder (40 percent), major depression (40 percent) and generalized anxiety disorder (34 percent). DISCUSSION: The prevalence of panic disorder in this sample of tinnitus' patients was high, which reinforces the importance of a psychiatric evaluation on these patients.