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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Autorotation test abnormalities of the horizontal and vertical vestibulo-ocular reflexes in panic disorder. 813 36

Seventy-six in- and outpatients seeking help for complaints of dizziness in a neurological clinic were assessed by the Structured Clinical Interview for DSM III (SCID). Neurological assessment included electrophysiological and otological examination. We established criteria to differentiate between dizziness as a symptom of panic disorder and dizziness as a symptom of neurological illness. Criteria for dizziness as a symptom of panic disorder are: adverse life events before the onset of dizziness, current comorbidity with depression, a high number of vegetative symptoms typical for panic attacks, a specific cluster of symptoms and little evidence of a neurological illness. We conclude that patients with complaints of dizziness often suffer from anxiety disorders. Thus we describe a vestibular subtype and contribute to the classification of panic disorder.
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PMID:[Panic disorder and vertigo. On the psychopathologic differentiation between neurologic and psychiatric disease]. 833 30

Individuals with panic attacks evaluate physical anxiety symptoms as dangerous and tend to respond to them with fear. In a retrospective questionnaire study, we explored childhood and adolescent learning experiences with respect to somatic symptoms of panickers. Compared to normal controls (N = 61), patients with panic disorder (N = 121), infrequent panickers (N = 86) and patients with other anxiety disorders (N = 38) reported more frequent instances prior to age 18 when they had experienced symptoms like dizziness, shortness of breath, palpitations or nausea, accompanied by special attention from their parents and instructions to restrain from strenuous or social activities. The differences were due to higher symptom frequencies in the anxiety groups. All anxiety groups reported more frequent uncontrolled behavior of their parents than controls. Patients with panic disorder and infrequent panickers reported that their parents had suffered more frequently from physical symptoms typical of anxiety than patients with other anxiety disorders or normal controls. Panickers, but not patients with other anxiety disorders, had observed sick-role behavior related to panic symptoms in their parents more often than controls. Panic attack Ss reported a higher number of household members suffering from chronic illnesses than controls and patients with other anxiety disorders. No group differences were found in the reported behavior of parents when Ss had colds. Overall, the results point to the role of severe illnesses and physical symptoms typical of anxiety in significant others in the history of Ss with panic attacks. These experiences during childhood and adolescence may contribute to their belief that physical symptoms are dangerous. In contrast, there was no specificity for panic with respect to the Ss' own physical symptoms or cold-related symptoms.
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PMID:Somatic symptoms and panic attacks: a retrospective study of learning experiences. 847 1

Psychogenic dizziness is defined as recurring or persistent symptoms of balance dysfunction, inconsistent with organic vestibular disease as determined by history, clinical examination and pertinent investigations, and consistent with emotional origin. Of 1,335 patients seen in our dizziness clinic between January 1988 and August 1991, psychogenic dizziness was diagnosed in 180 (13.5%) patients. There were 67 men and 113 women aged from 12 to 77 years (mean age 40.2 years). The characteristics of psychogenic dizziness are: (1) continuous dizziness for long periods of time; (2) younger patients; (3) predominant female; (4) associated symptoms of panic attack, such as headache, breathlessness, nausea, sleep disturbance, paresthesias, anxiety and palpitation; (5) symptoms of aggravation due to stressful life events; (6) normal neurotological bedside examination; (7) hyperventilation reproduced accurately. The electronystagmographic results of 74 patients show normal bithermal caloric responses in 47 patients (63.5%), caloric hyperactivity in 21 patients (28.4%), canal paresis in four patients (5.4%), canal paresis with directional preponderance in two patients (2.7%), large random voluntary eye swings or severe blinking in 35 patients (47.3%), and spontaneous nystagmus (slow phase velocity < 6.5 degrees/s) in four patients (5.4%). There were 31 patients who consulted psychiatrists with diagnoses of anxiety (51.6%), depression (16.1%), insomnia (12.9%), psychosomatic disorder and adjustment disorder. Treatment of patients with psychogenic dizziness must be directed at the underlying anxiety. Psychiatric consultation is necessary.
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PMID:[Psychogenic dizziness]. 848 48

The effects of i.v. administered flumazenil (3.0 mg) were studied in healthy male subjects who received pretreatment with p.o. placebo or lorazepam. The duration of placebo or lorazepam (3.0 mg single p.o. daily dose) pretreatment before a flumazenil or placebo injection was 1, 3, 7 or 14 days in four sequential groups of subjects. Initial administration of lorazepam produced a classic sedative profile of effects on various psychomotor/behavioral performance, observer-rated and subject-rated measures. Tolerance to repeated daily administration of lorazepam was suggested by a progressive diminution of performance disrupting effects. In subjects pretreated with placebo, flumazenil increased subject-ratings of dizziness over preinjection ratings. Flumazenil produced an immediate reversal of lorazepam effects in subjects who were not tolerant to lorazepam (1- and 3-day pretreatment groups). Flumazenil did not precipitate withdrawal symptoms in subjects who received a single administration of lorazepam. Precipitated withdrawal symptoms were evident after 3 and 7 days of lorazepam pretreatment, and there was a tendency toward precipitated withdrawal symptoms (that included one panic attack) after 14 days of lorazepam pretreatment. Precipitated withdrawal was characterized by an elevation in subject-rated symptoms including dizziness, tenseness, tachycardia, perceptual disturbance and sweating. Symptoms were maximal immediately after injection, usually mild in severity and usually resolved within 1 hr. There was no evidence of precipitated withdrawal on psychomotor/behavioral performance or observer ratings. The present study provides the strongest human experimental evidence to date that flumazenil can precipitate withdrawal symptoms after a history of repeated benzodiazepine exposure.
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PMID:Intravenous flumazenil following acute and repeated exposure to lorazepam in healthy volunteers: antagonism and precipitated withdrawal. 851 1

Using cluster analysis of 207 patients with panic disorder (PD), we investigated the relationships between several panic symptoms at the time of panic attacks, which included anticipatory anxiety, agoraphobia, and 13 clinical symptoms based on the Diagnostic and Statistics Manual-III-Revised. Cluster analysis revealed three panic symptom clusters: cluster A (dyspnea, choking, sweating, nausea, flushes/chills); cluster B (dizziness, palpitations, trembling or shaking, depersonalization, agoraphobia, and anticipatory anxiety); and cluster C (fear of dying, fear of going crazy, paresthesias, and chest pain or discomfort). Generally, cluster A was comprised exclusively of physiological symptoms, among which respiratory symptoms were prominent, cluster B included both panic and non-panic symptoms such as agoraphobia and anticipatory anxiety, and cluster C was comprised chiefly of fear symptoms.
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PMID:The symptom structure of panic disorder: a trial using factor and cluster analysis. 868 87

We report on subjective ratings and symptoms experienced before and during sodium lactate infusion by patients with panic disorder or agoraphobics with panic attack (DMS-III-R criteria). Symptoms were assessed using the Acute Panic Inventory (API). During the lactate infusion 59% of the patients were rated by an attending psychiatrist as having experienced lactate-induced panic attacks. Patients experiencing lactate-induced panic attacks overwhelmingly rated this experience as very similar to their typical naturally occurring attacks. Among the individual API symptoms items at baseline (prelactate) only Afraid in general (r = 0.26) was significantly, but not strongly, correlated with the panic response. Controlling for baseline symptom levels, the most robust partial correlations of symptomatic increment with panic were Desire to flee (0.70), Fear of losing control (0.57), Afraid in general (0.49), and Dyspnea (0.48). Using a dichotomized symptom increment greater than 1, 13 of 29 API items indicated a panic response to lactate infusion; the best were Dyspnea, Feeling confused, Afraid in general, Difficulty speaking, Difficulty concentrating, Desire to flee, and Fear of losing control. A logistic regression analysis showed that among baseline measures, Afraid in general and Feeling confused significantly predicted panic. For dichotomized change scores, Afraid in general, Dyspnea, and Dizziness/lightheadedness significantly indicated panic. In these analyses three symptom items stand out as the most predictive and revealing of panic to lactate infusion: Afraid in general, Dyspnea, and Desire to flee. These results are discussed in the context of Klein's (1993) suffocation false alarm theory of panic.
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PMID:Symptoms essential to the experience of sodium lactate-induced panic. 870 4

To investigate the role of serotonin (5-HT) in the pathophysiology of panic disorder (PD) a challenge test with L-5-hydroxytryptophan (5-HTP) was conducted. Seven patients suffering from PD and seven healthy controls received an i.v. challenge with 10 mg, 20 mg and 40 mg 5-HTP and placebo in random order on four different occasions. Before, during and until 2 h after 5-HTP administration anxious and depressive symptomatology was assessed. In addition, plasma levels of 5-HTP, cortisol, and 5-HIAA were measured at several timepoints. During and after infusion of placebo or any of the different dosages of 5-HTP, none of the patients or controls experienced a panic attack or showed an increase in anxiety or depressive symptoms. There was a dose-related increase in side effects, like nausea, dizziness and fatigue. Only infusion with 40 mg 5-HTP led to an increase in plasma cortisol in both patients and controls. The observed increase in plasma cortisol level was higher for patients compared to controls only at 30 min after infusion. In conclusion, stimulation of the serotonergic neuronal system by three different dosages of 5-HTP did not induce panic or anxiety in PD patients and healthy controls. The 5-HT hypersensitivity hypothesis of PD could not be confirmed in the present study.
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PMID:Behavioral, neuroendocrine and biochemical effects of different doses of 5-HTP in panic disorder. 879 Oct 35

The Beck Anxiety Inventory (BAI) has become a popular measure in anxiety assessment and the BAI does not overlap in content with measures of depression. There is also some factor analytic evidence to support this distinction. However, an inspection of the BAI's content indicates that many of its items resemble, or are identical to, the symptoms of panic attacks listed in the DSM-IV. Further empirical support for this suspicion is provided from the results of a factor analysis of the BAI items and the individual DSM-IV panic symptoms contained in the Panic Attack Questionnaire, using data from a sample of 157 panic disorder patients. A three-factor model (dizziness related, catastrophic cognitions/fear, cardiorespiratory distress) emerged that replicated a three-factor model of panic symptoms identified in earlier work with another panic disorder sample. All but one of the BAI items loaded highly on the three panic symptom clusters and no separate BAI factor was obtained. The BAI appears to be confounded with, or actually measures, panic attacks rather than anxiety in general. Several implications of this finding are discussed.
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PMID:Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms? 899 May 48

A 28-yr-old Naval F-14 aviator presented with complaints of flight-related anxiety occurring intermittently over an 18-mo period. Symptoms included sensation of strangeness, concern over the welfare of his radar intercept officer, flushing, nausea, and intense need to immediately land the aircraft. He also described a 6-mo history of episodes wherein he would see "shooting stars" in the periphery of his vision, accompanied by dizziness and disorientation. These latter attacks were always precipitated by head turning, usually in combination with positive Gz maneuvers, and were relieved by head straightening. The anxiety symptoms were consistent with a form of panic attack, but the neurological symptoms provoked further workup. Magnetic resonance cerebral angiogram demonstrated a dominant right vertebral artery and hypoplastic left vertebral artery. All symptoms resolved once the aviator was removed from flying the aircraft. After a year of follow-up with an aviation psychiatrist, he remained asymptomatic and was reassigned to maritime patrol aircraft. This case illustrates a difficult diagnostic, therapeutic, and disposition challenge. This aviator suffered from a complex interaction of neurologic and psychiatric manifestations having a common inciting stimulus, namely flying the F-14 Tomcat. A promising aviation career was preserved upon removal of that stimulus.
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PMID:Panic with a twist: an unusual presentation of combined psychiatric and neurologic symptoms in a tactical jet aviator. 905 30


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