Psychogenic causes of vertigo
Many types of vertigo can occur due to and be aggravated by psychological stress or in the context of mental illness, such as depression, anxiety disorders or psychosis. Psychogenic dizziness is usually described as diffuse, accompanied by insecurities in standing and walking, as well as a tendency to fall. The most common form of phobic vertigo is phobic swindling, which often occurs in the case of anxiety disorders or depression.
In stressful situations (e.g. high workload, conflicts between partners or being in large crowds), this leads to a strong feeling of swaying and dizziness. Psychogenic dizziness can often be accompanied by circulatory reactions, such as palpitations, shortness of breath and feelings of fainting. Nausea and vomiting are rather rare.
In women, psychogenic dizziness occurs mainly between the ages of 30 and 40, in men rather between the ages of 40 and 50. In most cases, psychogenic dizziness has no organic cause. However, the patients’ fear of the next dizziness attack leads to withdrawal and to a worsening of their mental illness. Patients often no longer dare to leave the house, avoid all triggers for their dizzy spells and become pathologically more anxious. Therapeutically, behavioral therapy, in which the cause of the dizziness is tackled together with the therapist, and behavioral measures are discussed in order to counteract the next dizziness attack.
Forms of positional vertigo
In the case of positional vertigo, a distinction is made between benign positional vertigo and malignant positional vertigo. The benign positional vertigo is very unpleasant for the patient, but harmless in itself. The cause is usually a detachment of the otholiths (small ear stones) from the organs of equilibrium.If the stones get into the archways, they irritate the organ of equilibrium there and sudden dizziness occurs.
The dizziness usually occurs in attacks and when the position of the head changes, such as when turning around, bending over or getting up from bed. Therapeutically, positioning exercises can help, which can lead to an improvement until the disease is cured. The positioning vertigo should always be clarified by an ENT specialist and neurologist.
In malignant positional vertigo, the cause of the vertigo is not in the inner ear, as in benign positional vertigo, but in the central nervous system. The causes can be diseases of the brain stem or the cerebellum, such as multiple sclerosis, bleeding into the brain area, a cerebral infarction or a tumor. Here too, as in benign positional vertigo, dizziness and nausea occur when taking up certain positions of the head.
More precise causes should be investigated by a neurologist. Medical history:When taking the history, the physiotherapist or doctor will ask about the symptoms typical of benign positional vertigo. Important for the assessment of the clinical picture and treatment is information from: by the vertigo Since the dizziness triggering process in the inner ear occurs more frequently due to the aging process, mainly older (rarely before the age of 35) people are affected by the problem.
Dizziness attacks are highly anxiety-inducing and, especially in older patients, lead to reduced everyday activities and falls with serious complications, which can lead to further impairment of quality of life. Depending on the age structure affected, various concomitant diseases occur more frequently, which either indicate a different cause of the dizziness or are a contraindication for therapy. These include: The information collected in the initial survey (especially about the causes) about the symptoms and impairments of everyday life serve as a benchmark for the success of the therapy.
- Daily activities
- Inclination to falland
- The impairment of everyday life and work
- Uncompensated heart disease (cardiac insufficiency)
- Vascular occlusion diseasesand
- Severe movement restrictions in the cervical spine, caused by rheumatism or degeneration processes (age-related wear and tear)
Dix-Hallpike Test = provocation maneuver The Dix-Hallpike Test is a meaningful test for checking benign posture vertigo if the cause lies in the posterior archway. Before performing the test (vertigo provocation), the patient should be thoroughly informed about the procedure and the effects of the test. This is the only way to achieve trusting cooperation.
The typical symptoms of dizziness, eye movements and possible nausea are triggered by a quick turn of the head by 45° and rapid lying down of the patient on a bench in supine position with head overhang. The symptoms begin approx. 10 sec.
after turning the head and depend on the speed of the induced movement. The patient has to describe the symptoms in their different intensity (beginning, increase, subsidence of dizziness and nausea), the therapist examines the eye movements after turning the head and lying down. After the symptoms have subsided, the patient is slowly put back on the chair. If the positioning test is repeated several times, the symptoms are exhausted.
