Barbara Scherokman

Psychiatric disorders and functional impairment in patients with persistent dizziness

Objective: To determine the prevalence and predictors of psychiatric dizziness and to measure functional impairment associated with dizziness.Design: Consecutive outpatients with a chief complaint of dizziness.Setting: Four outpatient clinics at a military teaching hospital.Patients: 100 dizzy patients and 25 control patients.Measurements and main results: Structured psychiatric interviews were conducted using the Diagnostic Interview Schedule, and functional status was assessed with the Sickness Impact Profile and the 20-item MOS (Medical Outcomes Study) Short-Form. Psychiatric disorders were a primary or contributory cause of dizziness for 40% of the dizzy patients. Compared with the control patients, the dizzy patients had a higher lifetime (46% vs 32%) as well as recent (37% vs 20%) prevalence of axis I disorders. The greatest differences were in disorders of depression and somatization. The dizzy patients had a higher lifetime prevalence (2 3% vs 8%) as well as recent history (11 % vs 0%) of major depression or dysthymia. Also, somatization disorders were strikingly more common among the dizzy patients than among the control patients (37% vs 8%, p=0.005), with the dizzy patients reporting more than three times as many psychiatric or unexplained physical symptoms (5.2 vs 1.5). Age <40 years, related complaints of weakness or headaches, and dizziness provoked by hyperventilation or standing were independent predictors of psychiatric dizziness. The dizzy patients reported moderate functional impairment, which was most severe among those with psychiatric disorders.Conclusions: Persistent dizziness is associated with increased functional impairment and psychiatric comorbidity, particularly depression and somatization. Moreover, psychiatric disorders aggravate the impairment that occurs with dizziness alone.

Longitudinal study of EEG and evoked potentials in neurologically asymptomatic HIV infected subjects

Serial electroencephalograms (EEGs) and multimodality evoked potentials (EPs) were performed along with neurological and neuropsychological evaluation, cerebrospinal fluid assessment and magnetic resonance imaging at 6 month intervals in 73 neurologically asymptomatic HIV infected subjects. The results were compared with 50 age- and sex-matched controls. EEG was abnormal in 2 subjects (3%) initially and was abnormal in 7 (9%) subjects by the last examination. EEG abnormality (diffuse slowing) correlated significantly with slowed reaction time in neuropsychological testing (P < 0.05). VEP and BAEP provided low yields of 1.3% and 4% respectively. SEP was abnormal in 7 (9%) of the subjects initially and in 10 (13%) subjects by the last testing, with 80% of the abnormalities seen on the posterior tibial study. In 3 subjects, initial SEP abnormalities predicted later development of myelopathy and peripheral neuropathy. Event-related auditory evoked potentials were performed in 39 subjects. They were abnormal in 5 subjects initially (12%) and in 6 subjects (15%) by the last examination and more commonly in advanced stages of the illness with lower T4 counts. This data shows the evolution and association of electrophysiological abnormalities in early HIV infection and suggests a predictive value for SEP in HIV infected asymptomatic individuals.

One-year outcome for patients with a chief complaint of dizziness.

Objective: To determine the one-year outcome for patients with a chief complaint of dizziness that had persisted at least two weeks.Design: Prospective cohort study.Setting: Federal teaching hospital.Patients: 100 dizzy patients and 25 control subjects.Measurements: The primary outcome was dizziness status (improved or not improved); the secondary outcomes were morbidity and health care utilization.Results: The dizziness resolved for 18 patients, whereas the status improved for 37, stayed the same for 32, and worsened for 11, with two patients lost to follow-up. Thus, 55% of patients whose dizziness had not resolved two weeks after their initial visits improved over the subsequent 12 months. Logistic regression revealed four independent predictors of persistent dizziness at one-year follow-up: dizziness due to psychiatric causes, dysequilibrium, vertigo other than benign positional vertigo, vestibular neuronitis, or migraine (odds ratio, 6.3; 95% CI, 2.1–18.6); daily dizziness (odds ratio, 6.4; 95% CI, 2.0–21.0); dizziness worse with walking (odds ratio, 3.0; 95% CI, 1.1–9.0); and patient had initially feared a serious illness (odds ratio, 0.25; 95% CI, 0.10–0.74). These four factors could be used to classify patients as having either a high (82%), medium (47%), or low (0%) likelihood of improvement at one-year follow-up. One patient died from heart failure, and none developed a serious disease for which dizziness had been a harbinger. Dizziness was not associated with an increased number of clinic visits.Conclusions: Among patients with a chief complaint of dizziness who are still symptomatic at two-week follow-up, more than half improve within a year. Clinical factors identify patients at higher risk for persistent dizziness.

Objective‐structured teaching of undergraduate neurology

Summary. Medical students at two teaching institutions were given an objective list containing information thought to be of maximum neurological teaching value. The usefulness of the objective list was assessed by giving the students pre‐ and post‐tests containing questions that were derived from the objective list. Irrespective of the disparity in the clinical teaching programme, there was no significant difference between test scores of students who rotated at the two institutions. Comparison of pre‐and post‐test scores showed a highly significant improvement (P<0.005) in test scores. An objective list should be part of an effective undergraduate teaching programme in neurology.

Subcutaneous sumatriptan reduced pain and functional disability in migraine

Source Citation The Subcutaneous Sumatriptan International Study Group. Treatment of migraine attacks with sumatriptan. N Engl J Med. 1991 Aug 1;325:316-21.1647495

Tapered antiepileptic drug withdrawal increased the risk for seizure recurrence

Source Citation Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet. 1991 May 18;337:1175-80.