[Phobic orthostatic insecurity]

The authors attempt to expand knowledge about a subjective balance disorder they have called phobic orthostatic insecurity, a condition representing the second cause of medical visits (22.3 %) to their ENT and neuro-otology clinic, and attempt to identify relationships with similar conditions described in psychiatry (agoraphobia, somatoform vertigo, and space-phobia) and in neurology (phobic postural vertigo). They also propose a simple diagnostic method and present their therapies and results.

A total of 151 patients with an indefinite symptomatology of "dizziness" "vertigo" or "insecurity" were evaluated (from 1999 to 2005) by means of a full medical history and an appropriate neurological examination, pharmacological treatments with anxiolytics-antidepressives, a measurement of the degree of depression with the Beck test (a kind of psychiatric benchmark) and with a specific standardized test.

Three symptoms and one exploratory condition, among others, were found in all 151 patients studied; these constitute the four bases for a positive diagnosis. This is confirmed if the treatment achieves total remission (this occurred in 69.53 % of all patients) or a sub-total remission (24.49 %), according to valuation scale for insecurity in all situations.

The statistical analysis showed a symptomatic concordance within the group analyzed, a syndromic equivalence between patients and satisfactory results with the antidepressive treatments (94 %), thus confirming the diagnostic and aetiopathogenic hypotheses for the disorder and, later, providing a logical method for diagnosis. The authors propose to assimilate this diagnostic protocol (and therapeutic when no specialist psychotherapy teams are available) to most of the psychogenic insecurity syndromes described.