心因性めまいの分類（バラニー学会案）と治療

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  • 堀井 新
    新潟大学大学院医歯学総合研究科耳鼻咽喉科・頭頸部外科学分野

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タイトル別名
  • Classification and Treatment of Psychiatric Disease-associated Dizziness
  • シンインセイメマイ ノ ブンルイ(バラニー ガッカイアン)ト チリョウ

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The behavioral subcommittee of International Classification of Vestibular Disorders (ICVD for Barany Society) identified eight psychiatric disorders that cause vestibular symptoms and one disorder at the interface of neuro-otology and psychiatry. Basically, anxiety and depressive disorders are the two major psychiatric disorders that cause vestibular symptoms. Both are the primary disorders that cause episodic and chronic dizziness and they are also disorders secondary to organic vestibular diseases which are responsible for episodic or chronic dizziness. Vestibular health anxiety, which is categorized as somatoform disorders, has characteristic features such as excessive seeking for reassurance about vestibular symptoms. Persistent Postural and Perceptual Dizziness (PPPD) is a newly defined inclusive term that is a synonym encompassing the previously-termed Phobic Postural Vertigo (PPV), Chronic Subjective Dizziness (CSD), Space Motion Discomfort (SMD), and Visual Vertigo (VV). The characteristic symptom of PPPD is chronic dizziness that is related to posture (severe when upright) and is exacerbated by active or passive motion, complex visual stimuli, or by performance of small-field, precision visual activities such as using a computer. PPPD patients sometimes have comorbid anxiety and depression. In all cases except for vestibular health anxiety, treatment for anxiety and depression with minor tranquilizers or SSRIs is effective for both vestibular and psychiatric symptoms. In treating dizzy patients, careful investigation of psychiatric disorders is important especially in the case of secondary psychiatric comorbidities since clinicians often treat only for vestibular disorders. In our study, SSRIs were exclusively effective for chronic dizziness patients with highly anxious and depressive patients with or without organic vestibular diseases (Horii A et al. 2004, 2007). A simple interview using the Hospital Anxiety and Depression Scale (HADS) is useful to judge the existence or absence of psychiatric comorbidities.

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