Chronic dizziness: can this be psychiatric?

To the Editor—In a recent article ‘Diagnosing the cause of vertigo: a practical approach’,1 Dr Lee has outlined a sound and practical approach to dealing with dizziness and vertigo. However, I would like to point out that dizziness is actually a much more common symptom than true vertigo. About 80% of complainants referring to dizziness do not have a ‘spinning’ sensation. In Chinese, ‘dizziness’ 暈眩 is a very vague and subjective term. It is therefore important to ask the patient to describe the exact feeling using words other than ‘dizziness’. The meaning of ‘vertigo’ should be used more specifically to mean an illusion of movement (horizontal, vertical, or oblique).2 Vague symptoms such as light-headedness, pre-syncope and dysequilibrium should be grouped into dizziness. Whilst dizziness can have various causes, vertigo commonly results from disturbance in the vestibular system. Among my patients with dizziness, about 80% actually had anxiety neurosis, phobic neurosis or depression; none had any neurological abnormality, and most had normal magnetic resonance imaging of the brain. Moreover, their symptoms were controlled with minor tranquillizers such as alprazolam. Staab3 in 2006 reviewed ‘chronic dizziness’ and ‘chronic subjective dizziness’ (CSD). The latter syndrome was defined as persistent (>3 months) non-vertiginous dizziness, light-headedness, heavy-headedness or subjective imbalance on most days, not attributable to neurotological illness, medical conditions, or medications. Conditions easily confused with CSD include vestibular migraine, traumatic brain injury, and dysautonomia.