Bilateral Dorsomedial Prefrontal Cortex rTMS for Tinnitus Treatment: A Successful Case.

We present a successful tinnitus treatment case with intensity and distress reduction in a patient subjected to bilateral 10 Hz repetitive transcranial magnetic stimulation (rTMS) to the dorsomedial prefrontal cortex (DMPFC). Subjective tinnitus is the perception of sound in the ears or head when no corresponding external stimulus exists. Approximately 1%-2% of the population report severe tinnitus with daily life impairment. Sham-controlled studies have revealed benefits using rTMS in tinnitus, although the improvement is moderate or temporary, indicating the need for new strategies. Evidence that the DMPFC is important in tinnitus pathophysiology makes this area a promising target. A 51-year-old male patient with a 4-year history of treatment-resistant moderate bilateral tinnitus was treated with 20 sessions of bilateral 10 Hz DMPFC rTMS. The patient showed important reduction and sustained 4-month response in tinnitus loudness and annoyance, 24 point drop in tinnitus handicap inventory, visual analog scale reduction to zero, and tinnitus loudness of 1 dB compared to baseline 15 dB. Tinnitus treatment is challenging and new alternatives are needed. To our knowledge, this is the first report using rTMS to the DMPFC for tinnitus. In this protocol, important and sustained reduction of tinnitus annoyance and loudness was obtained. This outcome of the case suggests that this approach is promising for treating tinnitus and is worth further investigation.

Tinnitus: The Sound of Stress?

BACKGROUND: Emotional stress is frequently associated with otologic symptoms as tinnitus and dizziness. Stress can contribute to the beginning or worsening of tinnitus. OBJECTIVE: The objective of the study is to evaluate the presence of stress symptoms in patients with chronic, subjective tinnitus, and correlate its presence to annoyance associated with tinnitus. METHODS: This is a cross-sectional study. One hundred and eighty patients with chronic, subjective tinnitus were included. Patients answered the Tinnitus Handicap Inventory (THI) to evaluate the impact of tinnitus in the quality of life and answered the Lipp's inventory symptoms of stress for adults (ISSL). The data obtained was organized using Excel® 2010, mean values, linear regression and p-value were calculated. RESULTS: Of the 180 patients included in the study, 117 (65%) had stress symptoms, 52 of the 117 (44%) were in the resistance phase and 23 of the 117 (20%) in the exhaustion phase, the remaining was in the alert phase. There was a clear progressive increase in stress as THI raised, with more impact of tinnitus in quality of life. CONCLUSION: The presence of stress symptoms, measured by ISSL was observed in most of our patients with chronic subjective tinnitus, specially in the resistance and exhaustion phases and it is directly associated with tinnitus annoyance.

The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype.

OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD). The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features. METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ) scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score. RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD. CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype

OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD). The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features. METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ) scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score. RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD. CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial.

CONTEXT AND OBJECTIVE: Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. DESIGN AND SETTING: Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS: A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). RESULTS: Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy. CONCLUSION: Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.

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.

Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial / Eficácia de um modelo específico de terapia cognitivo-comportamental em pacientes com transtorno de pânico com agorafobia: um ensaio clinico randomizado

CONTEXT AND OBJECTIVE: Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. DESIGN AND SETTING: Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS: A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). RESULTS: Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8 percent to 72.5 percent among the patients in the group with therapy, thus differing from the group without therapy. CONCLUSION: Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.

CONTEXTO E OBJETIVO: A terapia cognitivo-comportamental é frequentemente indicada para o transtorno de pânico. O objetivo foi avaliar a eficácia de um modelo de terapia cognitivo-comportamental no tratamento do transtorno de pânico com agorafobia. TIPO DE ESTUDO E LOCAL: Ensaio clínico aleatório no Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. MÉTODOS: Um grupo de 50 pacientes com diagnóstico de transtorno de pânico com agorafobia foi randomizado em dois grupos para receber a) terapia cognitivo-comportamental com medicação ou b) medicação (antidepressivos tricíclicos ou inibidores seletivos da recaptação da serotonina) sem terapia. RESULTADOS: Embora não se tenha observado diferença entre os grupos após o tratamento em quase todas as variáveis, com exceção de alguns itens da Escala de Incapacitação de Sheehan e da Escala de Problemas Psicossociais e Ambientais, ao final do estudo os pacientes que receberam a terapia específica apresentaram significativa redução dos ataques de pânico, ansiedade antecipatória, esquiva agorafóbica e medo das sensações corporais em relação ao grupo sem a terapia. Na escala de avaliação global do funcionamento aumentou o bem-estar global de 60,8 por cento para 72,5 por cento entre os pacientes do primeiro grupo, diferentemente do segundo grupo. CONCLUSÃO: Embora ambos os grupos tenham respondido ao tratamento e melhorado, observamos diferença significativa entre as duas intervenções apenas em poucas escalas. A associação de terapia cognitivo-comportamental específica centrada nas queixas corporais, associada ao tratamento farmacológico, foi eficaz nesta amostra de pacientes com transtorno de pânico e agorafobia e semelhante ao grupo apenas com tratamento farmacológico.

Comportamento violento, gênero e psicopatologia / Violent behavior, gender and psychopathology / Comportement violent, sexes et psychopathologie / Comportamiento violento, género e psicopatología

A violência cometida por indivíduos com transtornos mentais graves tem se tornado um foco crescente de interesse entre profissionais de saúde, autoridades policiais e outros segmentos da sociedade. Na população geral, os homens são mais agressivos do que as mulheres. Entretanto, tem sido encontrado que a diferença de gênero em relação ao comportamento violento é menor entre os indivíduos que apresentam transtornos mentais, comparados àqueles que não apresentam estes transtornos.

Violence committed by individuals with severe mental disorders has come under considerable scrutiny recently by mental health professionals, police authorities and other segments of society. Men are more aggressive than women among the general population. In contrast, however, it has been found that the difference between the genders in terms of violence is smaller among individuals with mental disorders than among people in general.

Les actes de violence commis par des personnes atteintes de graves troubles mentaux attirent de plus en plus l'intérêt des professionnels de santé, des autorités policières et d'autres segments de la société. Dans la population normale, les hommes sont d'habitude plus agressifs que les femmes. Cependant, on observe que le décalage entre les sexes par rapport au comportement violent est moins prononcé parmi les individus porteurs de troubles mentaux que dans la population normale.

La violencia cometida por los individuos con trastornos mentales graves ha despertado el interés creciente de los profesionales de la salud, autoridades policiales y otros estratos de la sociedad. Si bien que en la población común, los hombres son más agresivos que las mujeres, se ha encontrado que las diferencias de género relacionadas al comportamiento violento son menores entre individuos que presentan trastornos mentales que de aquellos que no presentan esos trastornos.

Evaluation of major depression in a routine clinical assessment.

BACKGROUND: Major depression is a disorder that significantly worsens a patient's morbidity and mortality. The association of depression and diabetes is well documented and has clinical impact in diabetes treatment's outcome. Patients usually aren't evaluated initially by a psychiatrist, so it is important that non-psychiatrists learn to evaluate major depression and its impact. CONCLUSIONS: Major depression can and should be evaluated on a routine clinical assessment. Depression's impact on the patients' quality of life, productivity and social interactions is well documented. The initial diagnosis of depression should lead to its prompt treatment, and it has to be emphasized that the incorrect treatment can lead to worsening of the condition, relapses, recurrences or even chronification of major depression.

Comportamento violento, gênero e psicopatologia / Violent behavior, gender and psychopathology

A violência cometida por indivíduos com transtornos mentais graves tem se tornado um foco crescente de interesse entre profissionais de saúde, autoridades policiais e outros segmentos da sociedade. Na população geral, os homens são mais agressivos do que as mulheres. Entretanto, tem sido encontrado que a diferença de gênero em relação ao comportamento violento é menor entre os indivíduos que apresentam estes transtornos.AU

Violence committed by individuals with severe mental disorders has come under considerable scrutiny recently by mental health professionals, police authorities and other segments of society. Men are more aggressive than women among the general population. In contrast, however, it has been found that difference between the genders in terms of violence is smaller among individuals with mental disorders than among people in general.AU

La violencia cometida por los individuos con trastornos mentales graves ha despertado el interés creciente de los profesionales de la salud, autoridades policiales y otros estratos de la sociedad. Si bien que en la población común, los hombres son más agresivos que las mujeres, se ha encontrado que las diferencias de género relacionadas al comportamiento violento son menores entre individuos que presentan trastornos mentales que de aquellos que no presentan esos trastornos.AU

Les actes de violence commis par des personnes atteintes de graves troubles mentaux attirent de plus en plus l’intérêt des professionnels de santé, des autorités policières et d’autres segments de la société. Dans la population normale, les hommes sont d’habitude plus agressifs que les femmes. Cependant, on observe que le décalage entre les sexes par rapport au comportment violent est moins prononcé parmi les individus porteurs de troubles mentaux que dans la population normale.AU

Matricídio e transtorno bipolar / Matricide and bipolar disorder

CONTEXTO: Matricídio é o assassinato de uma mãe pelo filho ou filha, uma forma de homicídio raramente vista na prática psiquiátrica. Estudos de casos de matricídio têm revelado a presença de transtornos mentais, tais como esquizofrenia, transtorno bipolar, transtornos de personalidade e alcoolismo, assim como casos em que não há evidência de transtorno mental. OBJETIVO: Tem-se como objetivo relatar o caso de uma mulher com transtorno bipolar que assassinou a sua genitora e que foi avaliada em perícia psiquiátrica para avaliação da responsabilidade penal. MÉTODOS: Foi realizada entrevista psiquiátrica, sendo o diagnóstico psiquiátrico estabelecido com base na entrevista e observação dos registros periciais e hospitalares, utilizando-se os critérios diagnósticos DSM-IV-TR. RESULTADOS: A examinanda foi considerada inimputável, em virtude da presença de doença mental que afetou inteiramente o seu entendimento e determinação em relação ao delito praticado. Ela cumpre medida de segurança em Hospital de Custódia e Tratamento Psiquiátrico há dois anos. CONCLUSÃO: É importante que psiquiatras e outros profissionais da saúde mental estejam atentos para risco de comportamento violento em pacientes que apresentam história de doença mental de longa duração, com episódios de violência durante a fase aguda, ameaças contra familiares ou amigos e falta de tratamento psiquiátrico regular.

BACKGROUND: Matricide is the killing of one's own mother, and a type of homicide rarely seen on psychiatric practice. Matricide cases studies have shown the presence of mental disorders, such as schizophrenia, bipolar disorder, personality disorders and alcoholism, and have also found cases where there is no evidence of mental disorders. OBJECTIVE: We aim to report a case of a woman with bipolar disorder that murdered her own mother and had a psychiatric forensic evaluation to ascertain her penal imputability. METHODS: Psychiatric interview was carried out and the psychiatric diagnosis was established based on the interview and analysis of forensic and hospitalar records, using the DSM-IV-TR criteria. RESULTS: The examinee was considered not guilty by reason of insanity, due to the presence of a mental disorder that affected her entire understanding and determination of the practiced delict. She has been under inpatient forensic psychiatric care for two years. DISCUSSION: It is important that psychiatrists and other mental health professionals be alert to the risk of violent behavior in patients that present a long history of mental disorder and present episodes of violence during the acute phase, or threats against relatives and friends, or the lack of regular psychiatric treatment.

Equivalência semântica da versão brasileira da Social Avoidance and Distress Scale (SADS) / Semantic equivalence of the Brazilian Portuguese Version of the Social Avoidance and Distress Scale (SADS)

INTRODUÇÃO: É crescente a produção científica brasileira na adaptação de instrumentos internacionais da fobia social. A adaptação transcultural é o primeiro passo na realização de comparações entre diferentes populações e se apresenta como um método que envolve pouco custo financeiro. O presente estudo consistiu no processo de equivalência semântica da Social Avoidance and Distress Scale para sua utilização na população brasileira de diferentes níveis socioeconômicos. MÉTODOS: O processo envolve duas traduções e retrotraduções realizadas por avaliadores independentes, avaliação das versões com elaboração de uma versão sínteses e pré-teste comentado. RESULTADOS: Para cada item do instrumento, apresentam-se os resultados das quatro etapas. A maioria dos participantes não apresentou dificuldades na compreensão do instrumento. CONCLUSÃO: A utilização de duas versões de tradução e retrotradução, discussão sobre a versão síntese e a interlocução com a população-alvo proporciona maior segurança ao processo de equivalência semântica.

INTRODUCTION: There has been a growing scientific production on the adaptation of international instruments for social phobia. The cross-cultural adaptation is the first stage on the comparisons between different populations and presents the advantage of a low financial cost. This paper consisted in the process of semantic equivalence of the Social Avoidance and Distress Scale for the Brazilian population of different sociocultural levels. METHODS: The semantic equivalence involved two translations and back-translations performed by two independent evaluators, an evaluation of the versions and the development of a synthetic version, and a commented pretest. RESULTS: The results of the four stages were showed for each item of the instrument. Most participants had no difficulties in understanding the instrument. CONCLUSION: Use of two versions of translations, critical appraisal of the versions, and assessment of the target population provides more safety to the process of semantic equivalence.

Dizziness associated with panic disorder and agoraphobia: case report and literature review.

Dizziness is one of the most frequent complaints in both primary and specialized medical care facilities. Many dizzy patients, without a known organic cause, considered as having idiopathic dizziness, may have a psychiatric disorder. Besides, even organic dizziness may cause or exacerbate latent psychiatric alterations. One of the most common disorders associated with dizziness is Panic Disorder with or without Agoraphobia. The aim of this paper is to report a patients case and make a literature review on the subject.

Tontura associada a distúrbio do pânico e agorafobia: relato de caso e revisão da literatura / Dizziness associated with panic disorder and agoraphobia: case report and literature review

Tontura é uma das queixas mais freqüentes no consultório médico tanto primário quanto especializado. Muitos dos pacientes que se apresentam com tontura sem causa orgânica aparente, portanto considerados como portadores de tontura idiopática, podem ter um distúrbio psiquiátrico. Além disso, mesmo a tontura de causa orgânica pode desencadear ou exacerbar alterações psiquiátricas "latentes". Um dos distúrbios mais comumente associados à tontura é o Distúrbio do Pânico, com ou sem Agorafobia. O objetivo deste estudo é relatar o caso de uma paciente com essa associação e realizar uma revisão da literatura relacionada ao assunto.

Dizziness is one of the most frequent complaints in both primary and specialized medical care facilities. Many dizzy patients, without a known organic cause, considered as having idiopathic dizziness, may have a psychiatric disorder. Besides, even organic dizziness may cause or exacerbate latent psychiatric alterations. One of the most common disorders associated with dizziness is Panic Disorder with or without Agoraphobia. The aim of this paper is to report a patients case and make a literature review on the subject.