Skip to main content
Log in

Psychiatric disorders and functional impairment in patients with persistent dizziness

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

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 (2 3% 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The National Ambulatory Medical Care Survey: 1975 Summary. U.S. Dept. of Health and Human Services publication. (PHS) 78-1784, 1978.

  2. Kroenke K, Lucas CA, Rosenberg ML, et al. Causes of persistent dizziness: a prospective study of 100 patients in ambulatory care. Ann Intern Med. 1992;117;898–904.

    PubMed  CAS  Google Scholar 

  3. Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989;86:2626.

    Article  Google Scholar 

  4. Drachman DA, Hart CW. An approach to the dizzy patient. Neurology. 1972;22:323–34.

    PubMed  CAS  Google Scholar 

  5. Nedzelski JM, Barber HO, McIlmoyl L. Diagnoses in a dizziness unit. J Otolaryngol. 1986;15:101–4.

    PubMed  CAS  Google Scholar 

  6. Herr RD, Zun L, Mathews JJ. A directed approach to the dizzy patient. Ann Emerg Med. 1989;18:664–72.

    Article  PubMed  CAS  Google Scholar 

  7. Lempert T, Dieterich M, Huppert D, Brandt T. Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand. 1990;82:335–40.

    Article  PubMed  CAS  Google Scholar 

  8. Sloane P, Blazer D, George LK. Dizziness in a community elderly population. J Am Geriatr Soc. 1989;37:101–8.

    PubMed  CAS  Google Scholar 

  9. Afzelius LE, Henriksson NG, Wahlgren L. Vertigo and dizziness of functional origin. Larnyngoscope. 1980;90;649–55.

    CAS  Google Scholar 

  10. O’Connor KP, Hallam R, Beyts J, Hinchlife R. Dizziness: behavioral, subjective and organic aspects. J Psychosom Res. 1988;32:291–302

    Article  PubMed  CAS  Google Scholar 

  11. Simpson RB, Nedzelski JM, Barber HO, Thomas MR. Psychiatric diagnoses in patients with psychogenic dizziness or severe tinnitus. J Otolaryngol. 1988;17;325–30.

    PubMed  CAS  Google Scholar 

  12. Kroenke K, Wood DR, Mangelsdorff AD, Meier MJ, Powell JB. Chronic fatigue in primary care: prevalence, patient characteristics, and outcome. JAMA. 1988;260:929–34.

    Article  PubMed  CAS  Google Scholar 

  13. Deyo RA, Diehl AK. Measuring physical and psychosocial function in patients with low-back pain. Spine. 1983;8:635–42.

    Article  PubMed  CAS  Google Scholar 

  14. Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA 1989;262:914–9.

    Article  PubMed  CAS  Google Scholar 

  15. Robins LN, Helzer JE, Croughan J, et al. National Institute of Mental Health Diagnostic Interview Schedule: the history, characteristics, and validity. Arch Gen Psychiatry 1981;38:381–9.

    PubMed  CAS  Google Scholar 

  16. Anthony JC, Folstein M, Romanoski AJ, et al. Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis: experience in eastern Baltimore. Arch Gen Psychiatry. 1985;42:667–75.

    PubMed  CAS  Google Scholar 

  17. Helzer JE, Spitznagel EL, McEvoy L. The predictive validity of lay Diagnostic Interview Schedule diagnoses in the general population: a comparison with physician examiners. Arch Gen Psychiatry. 1987;44:1069–77.

    PubMed  CAS  Google Scholar 

  18. Spitzer RL, Williams JB, Gibbon M, First MB. Structured Clinical Interview for DSM-III-R. Biometrics Research Department, New York State Psychiatric Institute, 722 West 168th Street, New York, NY 11032; 1988.

    Google Scholar 

  19. Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res. 1967;ll:213–9.

    Article  Google Scholar 

  20. Bergner M, Bobbitt RA, Carter WB, et al. The sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981;19:787–805.

    Article  PubMed  CAS  Google Scholar 

  21. Stewart AL, Hays RD, Ware JE. The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care. 1988;26:724–35.

    Article  PubMed  CAS  Google Scholar 

  22. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA. 1989;262:907–13.

    Article  PubMed  CAS  Google Scholar 

  23. Johnson JE, Pinholt EM, Jenkins TR, Carpenter JL. Content of ambulatory internal medicine practice in an academic Army medical center and an Army community hospital. Milit Med. 1988;153:21–5.

    CAS  Google Scholar 

  24. Swartz M, Landerman R, George LK, Blazer DG, Escobar J. Somatization disorder. In: Robins LN, Regier DA (eds). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: The Free Press, 1991;220–57.

    Google Scholar 

  25. Escobar JI, Rubio-Stipec M, Canino G, Karno M. Somatic Symptom Index (SSI); a new and abridged somatization construct: prevalence and epidemiologic correlates in two large community samples. J Nerv Ment Dis. 1989;177:140–6.

    Article  PubMed  CAS  Google Scholar 

  26. Katon W, Lin E, Von Korff M, Russo, J, Lipscomb P, Bush T. Somatization: a spectrum of severity. Am J Psychiatry. 1991;148:34–40.

    PubMed  CAS  Google Scholar 

  27. Kaplan C, Lipkin M, Gordon GH. Somatization in primary care: patients with unexplained and vexing medical complaints. J Gen Intern Med. 1988;3:177–90.

    PubMed  CAS  Google Scholar 

  28. Smith GR, Monson RA, Ray DC. Psychiatric consultation in somatization disorder. N Engl J Med. 1986;314:1407–13.

    Article  PubMed  Google Scholar 

  29. Attkisson CC, Zich JM (eds). Depression in Primary Care: Screening and Detection. New York: Routledge, 1990.

    Google Scholar 

  30. Brody DS, Larson DB. The role of the primary care physician in managing depression. J Gen Intern Med. 1992;7:243–7.

    Article  PubMed  CAS  Google Scholar 

  31. Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Am J Med. 1982;72:127–35, 241–7.

    Article  PubMed  CAS  Google Scholar 

  32. Barsky AJ. Patients who amplify bodily sensations. Ann Intern Med. 1979;91:63–70.

    PubMed  Google Scholar 

  33. Wells KB, Golding JM, Burnam MA. Psychiatric disorder limitations in a sample of the Los Angeles general population. Am J Psychiatry. 1988;145:712–7.

    PubMed  CAS  Google Scholar 

  34. Anderson SM, Harthorn BH. Changing the psychiatric knowledge of primary care physicians: the effects of a brief intervention on clinical diagnosis and treatment. Gen Hosp Psychiatry. 1990;12:177–90.

    Article  Google Scholar 

  35. Sriram TG, Moily S, Uday Kumar GS, Chandrashekar CR, Isaac MK, Murthy RS. Training of primary health care medical officers in mental health care: errors in clinical judgement before and after training. Gen Hos Psychiatry 1990:12:394–9.

    Google Scholar 

  36. Brody DS, Lerman CE, Wolfson HG, Caputo GC. Improvement in physicians’ counseling of patients with mental health problems. Arch Intern Med. 1990;150:993–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Supported in part by grant G183DP-01 from the Henry M. Jackson Foundation for the Advancement of Military Medicine.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kroenke, K., Lucas, C.A., Rosenberg, M.L. et al. Psychiatric disorders and functional impairment in patients with persistent dizziness. J Gen Intern Med 8, 530–535 (1993). https://doi.org/10.1007/BF02599633

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02599633

Key words

Navigation