Autorotation test abnormalities of the horizontal and vertical vestibulo-ocular reflexes in panic disorder.
Patients with panic disorder often describe dizziness as a disturbing symptom, with more severe episodes reported than in other psychiatric populations. Nineteen patients diagnosed as having a panic disorder were tested for vestibulo-ocular (VOR) abnormalities with the Vestibular Autorotation Test (VAT), a computerized test of the high-frequency (2 to 6 Hz) VOR. The patients were unselected for the presence or absence of balance disorders. Results showed VOR abnormalities, relative to a normal population, in the horizontal and/or vertical VORs of all 19 patients. Vestibulo-ocular reflex asymmetries were commonly present. Because the VAT tested the VOR over a frequency range encountered during common daily activities, the observed abnormalities could result in a perceptually moving visual field (oscillopsia). We hypothesize that the resulting experience of a visual-vestibular disturbance--perhaps in a biologically or psychologically predisposed individual--is catastrophically misinterpreted, leading to more bodily symptoms and anxiety. These could then contribute to more misinterpretation in a positive feedback sense, ultimately leading to a panic attack.
Hoffman
D L
DL
Department of Otolaryngology-Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles 90033.
O'Leary
D P
DP
Munjack
D J
DJ
D000328:Adult; D000379:Agoraphobia / Q000503:physiopathology; D004244:Dizziness / Q000503:physiopathology; D004585:Electrooculography; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006257:Head / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D016584:Panic Disorder / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology; D011187:Posture / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D012399:Rotation; D012678:Sensation Disorders / Q000503:physiopathology; D014724:Vestibular Function Tests / Q000379:methods; D014794:Visual Fields / Q000502:physiology