Neuro-otological findings in psychiatric patients with nystagmus

Kiyomizu, Kensuke; Matsuda, Keiji; Torihara, Koji; Nakayama, Meiho; Ishida, Yoshiteru; Yoshida, Kensei; Tono, Tetsuya

doi:10.1007/s00405-011-1524-z

Eur Arch Otorhinolaryngol

2011

DOI: 10.1007/s00405-011-1524-z

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Neuro-otological findings in psychiatric patients with nystagmus

Kensuke Kiyomizu

Keiji Matsuda

Koji Torihara

et al.

Abstract: To evaluate whether neuro-otological tests have clinical significance in psychiatric patients with nystagmus who have inner ear and/or brain dysfunction, we performed neuro-otological tests on 56 psychiatric patients with nystagmus (38 men, 18 women) (age range 40-97; mean age ± SD 61.6 ± 10.5 years). Patients were classified according to the underlying diseases: schizophrenia (25 cases), organic psychiatric disorders (14 cases), alcoholism (16 cases) and excited mental retardation (1 case). Caloric test resul… Show more

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Cited by 6 publications

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Psychiatric comorbidity in patients with dizziness

Kiyomizu¹,

Torihara²,

Nakayama³

et al. 2012

Equilibrium Res

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We report herein on psychiatric comorbidity in patients with dizziness in a psychiatric hospital with an otolaryngologist. Psychiatric comorbidity was revealed in 270 (68.9) of 392 patients with dizziness. Of 270 patients with dizziness and psychiatric comorbidity, anxiety disorders were revealed in 149 (55.2), mood disorders in 36 (13.3), somatoform disorders in 5 (1.9) and adjustment disorders or post-traumatic stress disorder in 15 (5.5) but in addition organic mental disorders were also seen in 21 (7.8) and schizophrenia in 15 (5.6). Phobic postural vertigo was diagnosed in 30 (7.7). These patients were not only treated by otolaryngologists, but also received psychiatric therapy or were prescribed psychotropic drugs. We believe that cooperation between psychiatrists and otolaryngologists in hospitals or regions can improve the mental condition and quality of life in patients suffering from dizziness with psychiatric comorbidity.

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Psychiatric comorbidity in patients with dizziness

Kiyomizu¹,

Torihara²,

Nakayama³

et al. 2012

Equilibrium Res

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Psychiatric comorbidity in patients with dizziness

謙祐¹

2013

Equilibrium Res

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We classified psychogenic dizziness into 3 types, such as the narrow type, the wide type and psychiatric comorbidity. Among these, 69.1 (362/524) of our patients with dizziness were diagnosed as having psychiatric comorbidity, and independently in a German facility, similar number of 68.3 (129/189) of patients with dizziness were diagnosed as having psychiatric comorbidity. Therefore, in our hospital, psychological tests are routinely performed on our patients with dizziness. Patients with dizziness of unknown cause (DUC), otogenic vertigo (OV) and Meniere's disease (MD) exhibited a higher prevalence of psychiatric comorbidity (DUC 73.6 , OV 69.5 , MD 70.1). Of patients with dizziness and psychiatric comorbidity, various types of psychiatric disorders were found, such as anxiety or panic disorders (F 41), mood disorders (F 3), adjustment disorders or posttraumatic stress disorders (F 43), dissociative disorders (F 44), other neurotic disorders, organic mental disorders (F 0) and schizophrenia (F 2). These patients suffering from dizziness were not only treated by otolaryngologists, but also received psychiatric therapy, and 72.9 of these patients were prescribed psychotropic drugs in our hospital. We believe that psychotropic drugs should be prescribed according to the advice given from psychiatrists or the doctors who are familiar with these drugs. Patients with depression often complain of somatic symptoms. In clinical practice 90 of these patients with depression are in general examined by physicians (non-expert psychiatrists) for their primary medical examination. However, it is not easy to distinguish patients with depression from those with bipolar disorder. Recently, serotonin selective re-uptake inhibitors (SSRI) have been prescribed more frequently by physicians, but caution should be exercised in the treatment of patients with depression when physicians prescribe SSRI because these patients may have bipolarity or mild manic symptoms. To reduce the risk of these incidents of misdiagnosis, physicians are strongly encouraged to consider referring these patients with psychiatric disorders to psychiatrists. We believe that collaboration between psychiatrists and physicians in the hospital and/or local doctors can improve the mental condition and the quality of life (QOL) of patients who are suffering from dizziness with psychiatric comorbidity.

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Selective serotonin reuptake inhibitor (SSRI) and vestibular function

et al. 2020

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Selective serotonin reuptake inhibitors (SSRIs) are well-known to be effective in patients with dizziness and depression. However, there are only few papers about the effects of SSRIs on vestibular function in these patients. We therefore performed vestibulo-ocular reflex in rotation (VOR tests) and administered the Dizziness Handicap Inventory (DHI) questionnaire to patients with dizziness before and after SSRI therapy. Of the 716 patients with dizziness at our psychiatric hospital, 86 had depression; of these 86 patients with coexistent dizziness and depression, we selected 7 patients (1 men, 6 women) (mean age, 56.87 years) who fulfilled the following conditions for this study; 1) regular treatment including anti-vertiginous drugs, physical therapy, minor tranquilizers and/or sleep medications were ineffective, 2) the diseases were not in the acute phase, 3) no antidepressants had been prescribed, and 4) willing to sign the consent form approved by the ethics committee in University of Yamaguchi for participation in this study. The VOR tests were performed using video-oculography (Nystamo 21 type 2, IRN 2, Morita Manufacturing corporation, Tokyo). After about 4 weeks of additional SSRI (sertraline) treatment, the DHI scores improved significantly (57.4 31.8). In the VOR tests, the DP% (vestibular function) improved significantly (26.6 9.46). Herein, we report the case of a 44-year-old woman with dizziness and depression who showed marked improvement with SSRI therapy. In regard to basic research, Dr. Shimogori of our group used a guinea pig model to examine how SSRI (sertraline) affects the vestibular system. From this clinical research, we believe that SSRIs could possibly affect the vestibular system directly by the activation of cyclic AMPresponsive element blinding protein-brain-derived neurotrophic factor (CREB-BDNF) system signaling.

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Neuro-otological findings in psychiatric patients with nystagmus

Cited by 6 publications

References 10 publications

Psychiatric comorbidity in patients with dizziness

Psychiatric comorbidity in patients with dizziness

Psychiatric comorbidity in patients with dizziness

Selective serotonin reuptake inhibitor (SSRI) and vestibular function

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