Functional (psychogenic) dizziness
Functional (psychogenic) dizziness
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DOI：
10.1016/b978-0-12-801772-2.00037-0
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发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
Brandt, T.
中科院分区：
文献类型：
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作者：
Dieterich, M.;Staab, J. P.;Brandt, T.
引起前庭症状的功能性和精神疾病（即，眩晕、不稳定和头晕）是常见的。事实上，它们比许多众所周知的结构性前庭障碍更常见。神经科医生和耳科医生更有可能遇到因持续姿势知觉头晕或恐慌症而出现前庭症状的患者，而不是梅尼埃病或双侧前庭丧失的患者。识别前庭症状的功能和精神原因的成功方法可以被纳入现有的实践中，没有太大的困难。最大的挑战是要摒弃强调结构性疾病研究的二分法思维，转而采用三管齐下的方法，即同时评估结构性、功能性和精神性疾病。前庭症状的功能性和精神性病因背后的病理生理机制比许多临床医生认识到的要好。先进的姿势分析和功能性脑成像等研究方法将在未来几年内进一步推动这方面的知识。包括患者教育、前庭康复、认知和行为治疗以及药物治疗在内的治疗计划可大幅降低发病率，并在系统应用时提供持续缓解的潜力。诊断和治疗方法在本质上必然是多学科的，但它们完全在与患者首先咨询的神经科医生和耳科医生协调的临床医生合作护理团队或网络的范围内。
Functional and psychiatric disorders that cause vestibular symptoms (i.e., vertigo, unsteadiness, and dizziness) are common. In fact, they are more common than many well-known structural vestibular disorders. Neurologists and otologists are more likely to encounter patients with vestibular symptoms due to persistent postural-perceptual dizziness or panic disorder than Meniere's disease or bilateral vestibular loss. Successful approaches to identifying functional and psychiatric causes of vestibular symptoms can be incorporated into existing practices without much difficulty. The greatest challenge is to set aside dichotomous thinking that strongly emphasizes investigations of structural diseases in favor of a three-pronged approach that assesses structural, functional, and psychiatric disorders simultaneously.The pathophysiologic mechanisms underlying functional and psychiatric causes of vestibular symptoms are better understood than many clinicians realize. Research methods such as advanced posturographic analysis and functional brain imaging will push this knowledge further in the next few years. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically. Diagnostic and therapeutic approaches are necessarily multidisciplinary in nature, but they are well within the purview of collaborative care teams or networks of clinicians coordinated with the neurologists and otologists whom patients consult first.