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

Summary & key facts

This paper describes a 23-year-old woman whose recurring dizziness was linked to panic attacks and agoraphobia and who got better after medicine and therapy. The authors review studies showing that many people who complain of dizziness have anxiety or panic disorders, that routine ear and balance tests can be normal, and that treatments such as SSRIs, benzodiazepines, vestibular rehabilitation, and cognitive-behavioral therapy have been reported to help. They also note dizziness causes many medical visits, is often expensive to investigate, and that the connection between dizziness and psychiatric problems is known but still not well studied.

Key facts:

• Dizziness leads to over 8 million medical visits per year in the United States, and diagnostic workups can cost up to US$2,532 and are often inconclusive (as reported in the article).
• In the reported case, a 23-year-old woman had instability-type dizziness about once a week for one year, normal ear and balance exams, normal blood and vestibular tests, and symptoms tied to panic spells; her dizziness went into full remiss
• Initial treatment for that patient was alprazolam 0.5 mg/day, followed by fluoxetine 20 mg/day with total symptom remission; after 6 months she remained symptomless while tapering to 10 mg/day of fluoxetine and attending weekly cognitive-be
• The review cites studies that found anxiety or avoidance behaviour rates in people with vestibular disorders ranged from 22% to 67%.
• The review reports that rates of vestibular disorders among patients with panic are between 39% and 88% in different studies.
• In one cited non-randomized study of 17 patients labeled with “psychogenic dizziness,” 76% had panic disorder and/or agoraphobia; by comparison, 8% of a sample of 24 patients with severe tinnitus had panic disorder or agoraphobia.
• A self-help group study of 103 patients with dizziness found 20.4% had panic syndrome (with or without agoraphobia) and 8.7% had agoraphobia alone, so almost 30% had an anxiety disorder in that sample.
• One study noted that patients with panic-related dizziness who were employed had a high job-loss burden: about half left their jobs, roughly 10 times the rate found in patients with dizziness alone and about twice the rate found in patients
• The authors state that the link between dizziness and psychiatric disorders is well known but has been little studied, that psychiatric causes are often considered diagnoses of exclusion, and that a truly integrated multidisciplinary approa

Topics

Hearing, Cochlea, Tinnitus, Genetics Heart Rate Variability and Autonomic Control Vestibular and auditory disorders

Categories

Life Sciences Neurology Neuroscience

Tags

Agoraphobia Anxiety Family medicine Medicine Panic Panic disorder Pediatrics Primary care Psychiatry