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Predicting Continued Dizziness After an Acute Peripheral Vestibular Disorder

From the Institute of Psychology (N.H., C.E., S.E.), Technical University of Braunschweig; Clinic of Neurology (M.M.M., C.M.), Municipal Hospital of Braunschweig; Research Institute of Cognitive Neurology (C.M.), Technical University of Braunschweig, Braunschweig, Germany.

Address correspondence and reprint requests to Nina Heinrichs, Institute of Psychology, Technical University of Braunschweig, Spielmannstr. 12a, 38106 Braunschweig, Germany. E-mail: n.heinrichs{at}tu-bs.de

Objective: To identify individuals at risk of developing ongoing dizziness 3 months after an acute peripheral vestibular disorder episode, which is usually functionally compensated or even healed within a few weeks.

Methods: In a prospective longitudinal study, we assessed fear of bodily sensations and cognitions related to anxiety at the time of hospital admission and 3 months later in 43 patients with an episode of vestibular neuritis (VN) or benign paroxysmal positional vertigo (BPPV). All participants were assessed for mental disorders using a structured clinical interview.

Results: Only the interaction between fear of bodily sensations within the first 2 weeks after admission and the type of vestibular disorder predicted the extent of dizzy complaints 3 months later; this accounts for 21% of the variance in a multiple regression analysis. Specifically, the prediction was valid only in patients with VN but not in patients with BPPV. Further analysis demonstrated that the interaction was not due to the peripheral vestibular disorder per se but rather determined by the initial severity of dizziness, which was significantly different in BPPV and VN patients.

Conclusions: The present study demonstrates that, for the development of persistent psychogenic dizziness after a peripheral vestibular disorder, the fear of bodily sensations is only relevant in interaction with the initial severity of dizziness experienced during the acute organic episode. To prevent development of persistent psychogenic dizziness, we feel that our results indicate the need to screen patients with vestibular disorders for at-risk status and offer them psychological support to deal with their symptoms.

Key Words: panic • agoraphobia • depression • dizziness • vertigo

Abbreviations: VN = vestibular neuritis; BPPV = benign paroxysmal positional vertigo; ACQ = Anxiety Cognitions Questionnaire; BSQ = Body Sensation Questionnaire; BAI = Beck Anxiety Inventory; MI = Mobility Inventory; BDI = Beck Depression Inventory; SCL-90-R GSI = Symptom Checklist Revised Global Severity Index; RC = (at least partially) recovered group; CC = continuously complaining group.