Phobic postural vertigo: a new proposed entity.
BACKGROUND
Dizziness and vertigo can be a complaint in various psychiatric conditions where it usually constitutes only one of the features of the syndrome. Lately, a somatoform disorder characterized by almost mono-symptomatic dizziness and unsteadiness has been described. Since phobic postural vertigo usually presents without anxiety or other psychological symptomatology, patients with this condition seek help at neurologic and otolaryngologic clinics where they are often misdiagnosed as suffering from organic vertigo.


OBJECTIVE
To present the clinical features of 55 consecutive patients diagnosed with phobic postural vertigo at our clinic during 1998-2002.


METHODS
We conducted a retrospective review of patients' medical records and report two typical cases for illustration.


RESULTS
The patients presented with complaints of unsteadiness with or without dizziness, and attacks of sudden veering that caused them to grasp for support. Accompanying anxiety was admitted by only 5% and vegetative symptoms were reported in 18%. In 16% the symptoms resulted in avoidance behavior. A stressful life event or an unrelated somatic disease triggered the onset of PPV in 35% of patients, whereas a vestibular insult preceded the symptoms in 13%. The mean duration of symptoms was 26.7 +/- 39.1 months (range 0.5-20 years). In 72% of patients the symptoms resolved after the psychological mechanism of their symptoms was explained to them; 24% improved with antidepressant treatment (selective serotonin reuptake inhibitors or tricyclic antidepressants), and only in 4% did the symptoms persist.


CONCLUSIONS
Since PPV is a frequently encountered diagnosis at some specialized dizziness clinics, familiarity with this entity resulting in early diagnosis can avoid unnecessary examinations and lead to effective treatment.
Pollak
Lea
L
Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel. lpollak@asaf.health.gov.il
Klein
Colin
C
Stryjer
Raphael
R
Kushnir
Mark
M
Teitler
Jacques
J
Flechter
Shlomo
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010200:Panic; D017374:Paroxetine / Q000627:therapeutic use; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014717:Vertigo / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology
D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors