Causes of Persistent Dizziness

Kroenke, Kurt; Lucas, Chris; Rosenberg, Michael L.; Scherokman, Barbara; Herbers, Jerome E.; Wehrle, Paul A.; Boggi, Joseph O.

doi:10.7326/0003-4819-117-11-898

Cited by 230 publications

(58 citation statements)

References 25 publications

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“…This finding is congruent with research (e.g., Kroenke et al, 1992;Sullivan et al, 1993) that has found a large percentage of dizzy patients to have psychiatric diagnoses or psychological symptoms or that psychiatric and autonomic symptoms are more important diagnostically than dizziness quality (Clark et al, 1994). These findings point to the importance of psychosocial factors in the assessment and treatment of the dizzy patient.…”

Section: Discussionsupporting

confidence: 87%

“…As many as 80% of patients with dizziness seen in a general outpatient clinic go undiagnosed, and there is a high prevalence of unrecognized mood and psychiatric problems in dizzy patients (Sullivan et al, 1993). In one multidisciplinary study, psychiatric disorders were diagnosed in 40% of the dizzy patients seen (Kroenke et al, 1992). Clark et al (1994) found that autonomic and psychiatric questionnaire items were more useful in classifying dizzy patients according to the presence or absence of a peripheral vestibular disorder or a psychiatric disorder than dizziness symptoms like vertigo and lightheadedness.…”

Section: Introductionmentioning

confidence: 99%

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Development of an inventory for dizziness and related factors

1996

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Dizziness is an extremely common complaint of patients, yet often goes unexplained after medical evaluation, which can lead to inappropriate treatment. There is a lack of psychometrically sound self-report instruments that measure dizziness and related factors. This study describes the application of factor analytic procedures with 184 dizzy patients' responses to develop the Dizzy Factor Inventory (DFI), a 44-item inventory divided into three sections and modeled after the Multidimensional Pain Inventory. The first section consists of symptom factors, the second concerns responses of significant others to the dizzy patient, and the third section assesses activity level. This inventory groups symptoms into empirically distinct factors that could be related in clinical and research applications to physiological and psychological processes, and could be useful for treatment planning and measuring treatment progress. Factors derived with dizzy patients are compared to factors found with chronic pain patients.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Development of an inventory for dizziness and related factors

1996

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“…These findings match other reports on the pivotal diagnostic contribution of careful history taking and physical examination alone in various patient populations. 1,[4][5][6][7][8][11][12][13]22 Medical practitioners often rely on experience and feelings that are described as "probable" or "undoubted." Here we provide some evidence concerning the adequacy of such terms in the context of nonorganic versus organic abdominal and chest pain.…”

Section: Discussionmentioning

confidence: 99%

“…1 An extensive workup in patients with abdominal or chest pain suspected of having nonorganic causes may identify only a few patients with organic causes and may therefore have a very low diagnostic yield. [4][5][6][7][8] This suggests that additional and sometimes costly investigations might be unnecessary. 1,5,[9][10][11][12][13] There are a few studies on the diagnostic accuracy of physicians' initial assessments of nonorganic versus organic diagnoses in patients with abdominal or chest pain in primary care.…”

mentioning

confidence: 99%

First clinical judgment by primary care physicians distinguishes well between nonorganic and organic causes of abdominal or chest pain

et al. 1997

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OBJECTIVE:To evaluate the accuracy of a preliminary diagnosis based solely on patient history and physical examination in medical outpatients with abdominal or chest pain. DESIGN:Prospective observational study. SETTING:General medical outpatient clinic in a university teaching hospital. PARTICIPANTS:One hundred ninety new, consecutive patients with a mean age of 44 years (SD ‫؍‬ 14 years, range 30-58 years) with a main complaint of abdominal or chest pain. MEASUREMENTS AND MAIN RESULTS:The preliminary diagnosis, established on the basis of patient history and physical examination, was compared with a final diagnosis, obtained after workup at completion of the chart. A nonorganic cause was established in 66 (59%) of 112 patients with abdominal pain and in 65 (83%) of 78 with chest pain. The preliminary diagnosis of "nonorganic" versus "organic" causes was correct in 79% of patients with abdominal pain and in 88% of patients with chest pain. An "undoubted" preliminary diagnosis predicted a correct assessment in all patients with abdominal pain and in all but one patient with chest pain. Overall, only 4 patients (3%) were initially incorrectly diagnosed as having a nonorganic cause of pain rather than an organic cause. In addition, final nonorganic diagnosis ( n ‫؍‬ 131) was compared with long-term follow-up by obtaining information from patients and, if necessary, from treating physicians. Follow-up information, obtained for 71% of these patients after a mean of 29 months (range 18-56 months) identified three other patients that had been misdiagnosed as having abdominal pain of nonorganic causes. Compared with follow-up, the diagnostic accuracy for nonorganic abdominal and chest pain at chart completion was 93% and 98%, respectively. CONCLUSIONS:A preliminary diagnosis of nonorganic versus organic abdominal or chest pain based on patient history and physical examination proved remarkably reliable. Accuracy was almost complete in patients with an "undoubted" preliminary diagnosis, suggesting that watchful waiting can be recommended in such cases. bdominal and chest pain are among the most frequent main complaints of patients in ambulatory care.

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“…Among these, a variety of diagnoses are represented, most of them benign, whereas life-threatening conditions are rare [2]. Dizziness can originate from peripheral structures, have a central origin or can be caused by other diseases such as multiple sensory deficits or cardiac disease [3].…”

mentioning

confidence: 99%