COURSE OF ILLNESS IN PHOBIC POSTURAL VERTIGO

Forty-two patients with phobic postural vertigo took part in a neurolo gical and psychiatric follow-up study. During the follow-up time of ab out 2.5 years the neurological diagnosis remained stable (41 of 42 pat ients). PPV can be assigned to various psychiatric categories accordin g to DSM-III-R. Although an association of PPV with anxiety disorders is evident, not all patients present with symptoms of anxiety or panic during attacks of vertigo. However most patients develop a disabling ''phobic-avoidance pattern'' with recurrent attacks. Important psychos ocial stressors can be identified at the onset of the condition. Motiv es of secondary gain have also to be taken into consideration. The cou rse of illness varies depending on the neurological syndrome of vertig o, on the one hand, and concomitant psychopathological syndromes, on t he other. Despite a considerable rate of improvement in vertigo compla ints (79%), the group of patients with phobic postural vertigo as a wh ole presented with significant psychological problems at follow-up ter m (74%), requiring specific psychiatric and/or psychotherapeutic inter ventions. Dependent or avoidant personality, and hypochondria were pro gnostic of a more negative course of illness.