精神性眩晕临床诊疗初探

Diagnosis and Treatment of Patients with Psychogenic Vertigo:A Preliminary Study

目的:研究轻中症精神性眩晕的临床评价与干预方法。方法选取精神性眩晕患者37例,平均年龄46.1(20~68)岁,采用症状自评量表(Self-reporting Inventory),即90项症状清单(Symptom Checklist-90,SCL-90)、抑郁自评量表(Self-rating Depression Scale,SDS)和焦虑自评量表(Self-rating Anxiety Scale,SAS)评定为轻中度异常。对患者进行乌灵菌粉药物干预和心理干预,持续28天;安排2次随访(基线和第28天),随访中评估眩晕的症状(包括严重程度、持续时间及发作频率、伴随症状等)并进行精神心理评价。结果①原发性精神性眩晕17例,继发性精神性眩晕20例。原发性精神性眩晕主要表现为不稳感和漂浮感,而旋转感、倾倒感和站立困难均为继发性精神性眩晕;②治疗后,患者不稳感和漂浮感改善,与治疗前比较差别显著(P〈0.05);③治疗前,SCL-90躯体化障碍患者占91.9%(34/37),焦虑自评异常患者占91.9%(34/37),抑郁自评异常患者占56.8%(21/37);心理评价为轻度异常的占86.5%(32/37),中度异常占13.5%(5/37);治疗后躯体化障碍、焦虑和抑郁的异常率都有下降,且差别显著(P〈0.05)。结论乌灵菌粉制剂可改善轻中症的精神性眩晕症状,对出现的轻中度焦虑和抑郁状态、躯体症状(本文主要为眩晕)有一定疗效;必要的心理干预有助于建立医患互信,实现良好的医嘱依从性。

Objective To study the clinical diagnosis and intervention strategies for mild and moderate psychogenic vertigo. Methods Thirty-seven patients with psychogenic vertigo aged between 20 and 68(mean age, 46.1 years) were included in the study. They received the Self-reporting Inventory(SCL-90),Self-rating Depression Scale(SDS) and Self-rating Anxiety Scale (SAS) tests. All the patients were diagnosed with mild to moderate psychogenic vertigo. They were given Wuling powder and psychological intervention for 4 weeks and assessed at the baseline and 28 days after intervention to evaluate the symptoms of vertigo (including severity, duration, frequency, accompanying symptoms) and psychological status. The results were analyzed with SPSS software. Results (1)There were 17 cases of primary psychogenic vertigo and 20 cases of secondary psychogenic vertigo in this study. The primary psychogenic vertigo was mainly manifested by unsteadiness and floating, while the secondary psychogenic vertigo was characterized by rotational vertigo, falling sensation and difficulty standing. (2)28 days after the administration of Wuling powder, the sensation of unsteadiness and floating in patients was significantly improved as compared with that before the treatment. (3)At the baseline,91.9%(34/37)of the patients had somatoform disorders according to SCL-90,91.9%(34/37)had anxiety and 56.8%(21/37)had depression. As for the severity, 86.5%(32/37)were mildly abnormal and 13.5%(5/37)were moderately abnormal. After intervention, the percentages of somatoform disorders, anxiety and depression were all decreased and a statistically significant difference (P<0.05) was found between the percentages at the baseline and those after intervention. Conclusion Wuling powder, a kind of traditional Chinese medicine, is found effective in treating patients with mild to moderate psychogenic vertigo. Appropriate psychological intervention can help establish the doctor-patient trust and improve patient compliance.