It has also been suggested that because the vestibular system plays a role in controlling autonomic functions (e.g. heart rate, blood pressure) (Yates and Miller, 1998), alterations to these autonomic functions may also trigger a range of changes in cognition, emotion and personality. There are

several reports that suggest patients with vestibular disturbance experience symptoms of depression, anxiety and agoraphobia at higher rates than the general population (Eagger et al., 1992, Gazzola et al., 2009 and Guidetti et al., 2008). In a study of 93 patients with objective evidence of peripheral vestibular disorder two thirds of the patients reported symptoms of depression and/or anxiety since the onset of the vestibular symptoms. Fifty-four of these patients were

seen 3 to 5 years after their original referral and more than half the group (37 out of 54) were rated above the cut off point for GSK-3 inhibitor significant psychiatric disturbance when interviewed. Panic disorder with or without agoraphobia and major depression were the commonest psychiatric diagnoses. There is some evidence to suggest that these symptoms are more than a reaction to the symptoms of vestibular dysfunction (e.g. vertigo or dizziness). For example, Guidetti et al., (2008) reported significantly higher AZD4547 mw levels of anxiety and depression in 50 patients with well compensated (no vertigo symptoms) unilateral labyrinthine hypofunction as a consequence of previous vestibular neuritis

as compared to 50 age- and sex-matched healthy controls. Somewhat contrasting these findings is a recent prospective study that looked at predictors of anxiety (STAI) and depression (BDI) in 407 patients who presented with dizziness and vestibular disease (194 patients were diagnosed with BPPV, 75 with vestibular neuritis, 63 with Ménière′s disease, 58 with migrainous vertigo, and Clomifene 17 with presbystasis). Results suggested that rather than the type of vestibular disease, the best predictor of depression and anxiety was the patient′s level of distress associated with symptoms of dizziness or vertigo (dizziness handicap inventory scores) (Hong et al., 2013). A series of prospective, interdisciplinary studies were conducted to explore the relationship between comorbid psychiatric disorders and symptoms in patients with various organic vertigo syndromes (Best et al., 2006 and Eckhardt-Henn et al., 2008). Patients with organic vertigo syndromes (benign paroxysmal positioning vertigo—BPPV; vestibular neuritis; Menière′s disease; vestibular migraine), and healthy volunteers were assessed on the Symptom-Check List 90 (a standardised, self-reporting instrument that measures psychological strain) and The structural clinical interview for DSM-IV Axis I (SCID-I). Results of the initial study (Best et al.