The vestibular dysfunction and anxiety disorder interface: a descriptive study with special reference to the elderly

Vestibular abnormalities co-existing with anxiety disorders are not uncommon and there has been a renewal of interest in recent times. Although well known over centuries, there is often a delay in the recognition of this relationship by the primary care physician and the specialist alike. Dizziness embracing vertigo, unsteadiness and imbalance are common in the elderly, so is generalized anxiety disorder, which is a common psychiatric problem in later life. This is a retrospective study of eight patients with vestibular symptoms and an anxiety disorder present over several years with lack of awareness of their relationship. The diagnoses of the anxiety disorders were based on the Diagnostic and Statistical Manual (DSM-IV) criteria and the effect of treatment measured on a clinician-based impression interview. There was one male and seven females and the mean age was 72 years. Apart from the vestibular symptoms present in all the patients, the anxiety disorders comprised, generalized anxiety disorder in three, panic attacks in five and with agoraphobia in three. Four patients had hyperventilation, one sleep apnea, and two somatization disorders. They had all presented to clinicians in different disciplines and had had several investigations. Five had been treated in this study with alprazolam and three with citalopram, with modest to good results. Two had rehabilitation therapy as well. The cases described mirror the well-documented co-existence of vestibular and anxiety disorders together with hyperventilation and sleep apnea. The positive findings associated with vestibular dysfunction need recognition in addition to the non-specific psychiatric and behavioral symptoms. We emphasize this relationship and review the literature to alert the clinician.