Phobic postural vertigo in Japan

Introduction: Dizziness and vertigo are symptoms of various psychiatric conditions like major depression, somatoform disorder, anxiety disorders, and so on. Phobic postural vertigo (PPV) was first reported by Brandt T et al. in 1994. PPV occurs chiefly in patients with an obsessive-compulsive or narcissistic personality. The diagnosis is based on six characteristics proposed by Brandt et al. The key for a correct diagnosis is spontaneous (sometimes stimulus-induced) postural vertigo and unsteadiness in maintaining an upright position and walking. Methods: The characteristics of patients with PPV were reviewed in 16 patients from June 2002 to November 2006 in our hospital. Some psychological evaluations were preformed by a self-rating questionnaire. MAS (Manifest Anxiety Scale) was used to evaluate the level of anxiety, and the Japanese version of MOCI (Maudsley's Obsessional Compulsive Inventory) was employed to evaluate the obsessive-compulsive personality. Results: We encountered 16 PPV patients. Fourteen were female and 2 were male. The average age was 55±15.5 years old. Many of the patients showed depression and a high level of anxiety. The average MOCI score was 10.8, and this indicated an obsessive-compulsive or narcissistic personality. Treatment involved drug therapy with SSRI (Selective serotonin reuptake inhibitors), antidepressants, anxiolytics like benzodiazepine (BZD), and psychotherapy including cognitive behavior therapy and autogenic training. Conclusion: The diagnosis of PPV was important to improve the prognosis. The key for a correct diagnosis is not anxiety but the subjective dizziness itself. An obsessional personality is often observed.