PSYCHIATRIC-DISORDERS AND FUNCTIONAL IMPAIRMENT IN PATIENTS WITH PERSISTENT DIZZINESS

被引：48

作者：

KROENKE, K

LUCAS, CA

ROSENBERG, ML

SCHEROKMAN, BJ

机构：

[1] Department of Medicine, USUHS, Bethesda, 20814, MD

[2] the Walter Reed Army Medical Center, Washington, DC.

[3] Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1993年 / 8卷 / 10期

关键词：

depression; dizziness; health status; predictors; psychiatry; somatization; vertigo;

D O I：

10.1007/BF02599633

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective: To determine the prevalence and predictors of psychiatric dizziness and to measure functional impairment associated with dizziness. Design: Consecutive outpatients with a chief complaint of dizziness. Setting: Four outpatient clinics at a military teaching hospital. Patients. 100 dizzy patients and 25 control patients. Measurements and main results: Structured psychiatric interviews were conducted using the Diagnostic Interview Schedule, and functional status was assessed with the Sickness Impact Profile and the 20-item MOS (Medical Outcomes Study) Short-Form. Psychiatric disorders were a primary or contributory cause of dizziness for 40% of the dizzy patients. Compared with the control patients, the dizzy patients had a higher lifetime (46% vs 32%) as well as recent (37% vs 20%) prevalence of axis I disorders. The greatest differences were in disorders of depression and somatization. The dizzy patients had a higher lifetime prevalence (23% vs 8%) as well as recent history (11% vs 0%) of major depression or dysthymia. Also, somatization disorders were strikingly more common among the dizzy patients than among the control patients (37% vs 8%, p = 0.005), with the dizzy patients reporting more than three times as many psychiatric or unexplained physical symptoms (5.2 vs 1.5). Age <40 years, related complaints of weakness or headaches, and dizziness provoked by hyperventilation or standing were independent predictors of psychiatric dizziness. The dizzy patients reported moderate functional impairment, which was most severe among those with psychiatric disorders. Conclusions: Persistent dizziness is associated with increased functional impairment and psychiatric comorbidity, particularly depression and somatization. Moreover, psychiatric disorders aggravate the impairment that occurs with dizziness alone

引用

页码：530 / 535

页数：6

共 36 条

[1] Kroenke K., Lucas C.A., Rosenberg M.L., Et al., Causes of persistent dizziness: a prospective study of 100 patients in ambulatory care, Ann Intern Med, 117, pp. 898-904, (1992)
[2] Kroenke K., Mangelsdorff A.D., Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome, Am J Med, 86, (1989)
[3] Drachman D.A., Hart C.W., An approach to the dizzy patient, Neurology, 22, pp. 323-34, (1972)
[4] Nedzelski J.M., Barber H.O., McIlmoyl L., Diagnoses in a dizziness unit, J Otolaryngol, 15, pp. 101-4, (1986)
[5] Herr R.D., Zun L., Mathews J.J., A directed approach to the dizzy patient, Ann Emerg Med, 18, pp. 664-72, (1989)
[6] Lempert T., Dieterich M., Huppert D., Brandt T., Psychogenic disorders in neurology: frequency and clinical spectrum, Acta Neurol Scand, 82, pp. 335-40, (1990)
[7] Sloane P., Blazer D., George L.K., Dizziness in a community elderly population, J Am Geriatr Soc, 37, pp. 101-8, (1989)
[8] Afzelius L.E., Henriksson N.G., Wahlgren L., Vertigo and dizziness of functional origin, Larnyngoscope, 90, pp. 649-55, (1980)
[9] O'Connor K.P., Hallam R., Beyts J., Hinchlife R., Dizziness: behavioral, subjective and organic aspects, Journal of Psychosomatic Research, 32, pp. 291-302, (1988)
[10] Simpson R.B., Nedzelski J.M., Barber H.O., Thomas, Psychiatric diagnoses in patients with psychogenic dizziness or severe tinnitus, J Otolaryngol, 17, pp. 325-30, (1988)

← 1 2 3 4 →