The distinction between state and trait anxiety levels in patients with BPPV in comparison with healthy controls

Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes

PURPOSE

To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients.

METHODS

Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment.

RESULTS

The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04).

CONCLUSIONS

Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

Associations between benign paroxysmal positional vertigo and seven mental disorders: a two-sample Mendelian randomization study

Background

The association between benign paroxysmal positional vertigo (BPPV) and various mental disorders is still controversial. This study used the Mendelian randomization (MR) method to clarify the correlation between BPPV and seven mental disorders (bipolar disorder, depression, anxiety disorder, schizophrenia, suicidality, neuroticism, and mood swings) to aid in the exploration of BPPV complications and prevention and early treatment of mental disorders.

Methods

The datasets for BPPV and seven mental disorders were obtained from genome-wide association studies (GWASs). Two-sample MR was used to analyze the correlation between exposure (BPPV) and various outcomes (bipolar disorder, depression, anxiety disorder, schizophrenia, suicidality, neuroticism, and mood swings). A reverse MR study was also performed. The inverse variance weighting (IVW) method, the MR-Egger method, the simple mode method, the weighted mode method, and the weighted median method were selected.

Results

The MR analysis and the reverse MR analysis results did not reveal significant associations between BPPV and bipolar disorder, depression, anxiety disorder, schizophrenia, suicidal tendencies, neuroticism, and mood swings. Interestingly, neuroticism (IVW: OR = 1.142, 95% CI: 1.059-1.231, P = 0.001; P-MR-PRESSO adjustment = 0.0002) and mood swings (IVW: OR = 3.119, 95% CI: 1.652-5.884, P = 0.0004) may have a significant association with BPPV. After MR-PRESSO adjustment, there was no horizontal pleiotropy or heterogeneity, and a significant association between neuroticism, mood swings, and BPPV has still been suggested.

Conclusion

We conducted MR analysis on genetic data from European populations and discovered a causal relationship between BPPV and the seven mental disorders. Our research findings suggest that BPPV may not have a significant causal relationship with bipolar disorder, depression, anxiety disorder, schizophrenia, or suicidal tendencies. However, neuroticism and mood swings may be risk factors for BPPV.

Associations between cognition, anxiety, depression, and residual dizziness in elderly people with BPPV

Objective

To investigate the associations between cognition, anxiety, depression, and residual dizziness after successful repositioning maneuvers in the elderly with benign paroxysmal positional vertigo (BPPV).

Methods

We enrolled 40 elderly patients with BPPV in our outpatient department. We used the Dizziness Handicap Inventory (DHI), Visual Analog Scale (VAS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Questionnaire-7 (GAD-7) to assess the degree of dizziness, anxiety, and depression of participants before repositioning therapy, respectively. At the 1-week follow-up after BPPV treatment, each participant will be reassessed and divided into a group with residual dizziness (RD) and a group without residual dizziness (NRD) based on the follow-up DHI score. The Mini-Mental State Examination (MMSE) evaluated the cognitive function of the participants.

Results

The age, gender, duration of BPPV, and involved semicircular canals in the two groups did not show a significant difference. The RD group scored significantly higher on the DHI (p = 0.006), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) before the repositioning treatment than the NRD group. The two groups had no significant difference in MMSE score (p = 0.381). Anxiety and depression scores before repositioning treatment significantly and positively correlated with follow-up DHI scores (r = 0.678 and 0.522, respectively), but the MMSE score did not significantly relate to it. The univariate linear regression showed that the DHI (p < 0.001), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) scores before treatment could predict residual dizziness. The multivariate linear regression showed that GAD-7 before treatment was the only significant predictor of residual dizziness (p < 0.001).

Conclusion

The level of dizziness, anxiety, and depression before treatment can predict residual dizziness after successful repositioning maneuvers in the elderly with BPPV. Anxiety may be the strongest predictor of residual dizziness after successful repositioning treatment in elderly BPPV patients.