Equilibrium Res Vol.

75 ( 2) 33 to 40,2016

Series education course "dizziness and the Environment"

1. Dizziness and stress

- Barany Society new classification and psychogenic dizziness, On Meniere's disease -

Shin Horii

Stress-associated vertigo / dizziness

Arata Horii

Department of Otolaryngology Head and Neck Surgery, Niigata University.

Graduate School of Medical and Dental Sciences

It is well known that stress induces or aggravates vertigo / dizziness and that dizzy patients have often comorbid
psychiatric diseases such as anxiety and depression. Dizzinessassociated psychiatric disease is not idiopathic but is
usually an adjustment disorder to stressful life events. Stress can be divided into two groups:.. physical and
psychological stress Psychological stress activates the amygdala, which is a center for emotion discriminating
discomfort from comfort, followed by hypothalamic-pituitary-adrenal axis (HPA axis) activation In dizzy patients, sensory
mismatch signals arising from multimodal sensory systems , including the vestibular, visual, and proprioceptive systems,
would also activate the amygdala. Together with psychological stress,sensory mismatch signals judged as discomfort
signals by the amygdala may drive the HPA axis and bring about dizziness. This scheme can well explain why
psychological stress induces or aggravates vertigo and dizziness. In treating dizzy patients with stress-induced anxiety
and depression, it is important to take care of comorbid psychiatric diseases and the cause of stress regardless of the
existence or absence of organic vestibular diseases.

Key words: stress, dizziness, anxiety, depression, Persistent postural and perceptual dizzi-
ness (PPPD)

Introduction It caused can 1) 2) . Believed to have been complicated by a high rate to anxiety

That dizziness in stress to or deteriorated onset, experience well and disorders and depressive symptoms, mental illness was onset by the stress is

has a vertigo clinic. In addition, excessive or mental disorders such as in the dizziness of the cause or worsening factor in dizzy patients 3) . In this

anxiety disorders and depression as adjustment disorder is argument to paper, we explain the pathology raised Ri taken a psychogenic vertigo and

chronic stress Meniere's disease as a typical licking Mai diseases caused by brain changes

and stress that cause stress.

Niigata University Graduate School of Medical and Dental Sciences of Otolaryngology-Head

and neck outsiders science

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Figure 1 Physical stress and mental stress

Stress and stressors It is.

The medical definition of stress there is confusion. Cannon Is, cold, System which responds to physical stress sympathetic - an adrenal medulla

exercise, bleeding, low oxygen, disturb the homeostasis of good sea system, increase in heart rate and blood pressure, blood sugar increase pressure,

urchin living body of low blood sugar (homeostasis), distortion in the raw are called emergency reaction in the sense that correspond to mydriasis occurs crisis 7)

body ( strain It called stress the events that give rise to). It states that . Is mainly a reaction to acute stress, blood pressure, body fluid volume, information

adrenal medulla system activation of Ru important - biological This strain such as the digestive tract is input in the medulla oblongata through the splanchnic

has kept homeostasis by adapted to repair, this over-degree sympathetic 4) nerve afferents via the hypothalamus stimulates the sympathetic nervous system.

. Selye 5) Was a "reaction" indicated by the living body when the stimulus is

applied is referred to as stress, it is defined as a stressor a "stimulus" to Meanwhile, psychological stress is inputted as sensory information,

induce stress. The hypothalamic seen as a reaction commonly found in cortex - limbic system - hypothalamic - pituitary - stimulates the adrenal

stress - that cite the activation of the adrenal - pituitary. Stress response cortex system 8) . In this paper, we change and mental illness to give mental

is a defense mechanism of the organism to environmental changes, and stress in the brain, or is caused by the impact, it explains about dizziness

to be useful in the least short term for the maintenance of homeostasis. exacerbated.

But whether stress in this good sea urchin strict sense that refers to the

"stimulus", "reaction" or refer to is a state of confusion, Change that mental stress has on the brain

Mental stress, but it itself is not to disturb the homeostasis, which is Oh Ru

stimulation of the possibility of giving a future impact. For example, small and weak

animals by visual stimuli that the sight of carnivorous animals, blood pressure rises

Charousos 6) Are not such might disturb homeostasis endogenous or and stress reaction occurs. Which is equipped to attack by may not carnivores may

exogenous "force" stressor chromatography, which might disturb the happen in the future. Such a reaction is not always that occurs only in the visual

homeostasis of the "state" is defined as stress. In this paper Cannon In information, is its meaning with injury important. The first time visual information

accordance of the definition, I want to handle the stimulus disturbing visual information that the appearance of the carnivorous animal is determined to be

the homeostasis as stress. a danger to recall the experience, which was attacked in the past is semantics is

given. Chi words, visual information to be stress are checked against the previous

Physical stress and mental stress (Fig. 1) memorize been recognized, as a result of receiving the high-level information

The stress is mental stress the biological and physical stress disturbing processing, such as receiving a comparison, stress reaction is induced when it is

the actual Homeosu Tashisu such as bleeding or low oxygen, "Do not the determined that to be provided to the enemy. This information processing cerebral

homeostasis is disturbed" is expected. The latter is the sensory information, level involved is the cerebral cortex and the limbic system, and eventually the

for example the figure of carnivorous animals appeared before weak hypothalamus ( hypothalamus ) - pituitary ( pituitary gland ) - adrenal ( adrenal gland )

animals, such as fear and conditioned stimulus (electric shock and System is activated (= HPA axis Activation of).

conditioned sound stimulus). Stress associated with dizziness mental

disorders such as anxiety Utsuya the latter of mental stress

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Gating out

Figure 2 The role of stress and amygdala in motion sickness, vertigo onset

Mental stress become sensory information limbic system for processing at Although failure is considered to be the cause of motion sickness and vertigo 13) , We

cerebral level, especially the amygdala plays an important role. Amygdala Ri can cause motion sickness in rats in the sense of confusion due to excessive gravity

central der of emotional expression, that plays an important role in the reaction load and amygdala central nucleus neurons was reported that the activity of 14) . This

formation against the free-discomfort of discrimination and mental stress of sense of confusion stimulus from that is believed to trigger the unpleasant emotions

sensory stimulation 9) 10) . For impaired humans and animals the amygdala can not to activate the amygdala, is considered or not is Runode exacerbate the symptoms of

determine the free and non-free, being attacked in easily without having to escape this unpleasant emotional and spatial cognitive impairment is attached relationships

from the enemy will not be able to Rukoto feel the fear the enemy. That is, when motion sickness and dizziness . As aforementioned

the amygdala is impaired fires the free emotion made to his interests, can not be

normal emotional expression that triggered the unpleasant emotion those that PTSD Studies in patients, mental stress enhances the reaction of the amygdala.

result in the disadvantage gains. Imposition of unpleasant emotions induced by Thus, described below and triggered strengthening of stress under the

mental stress that foreign enemy of the appearance is, prior to receiving the unpleasant emotions gating out Furthermore, motion sickness and dizziness in

physical stress that bleeding being attacked by the enemy if example example, the the attenuation of believes that it would be worse. Moreover, the inner ear

system and ideas to prepare leads to a reaction by the advance mental stress It is. electrical stimulation, caloric stimulation, vestibular stimulation seen

That blood flow in the amygdala is increased by emotional stimuli, such as hypothalamic neurons, such as hyper-gravity, in particular reported that activate

unpleasant photos and events even humans fMRI Ya PET It has been reported in histamine nervous system 14) to 16) . Therefore, subsequent activation of the

experiments using 11) . In addition, post-traumatic stress disorder ( PTSD In patients subthalamic unit and the activation and its downstream amygdala even when

with) it has been reported that the reaction was enhanced this amygdala 12) . As dizziness onset disease HPA axis It is considered possible that activation is

described in the next section, we have reported that the activation of the amygdala occurring

is involved in the development of rat motion sickness, it and considered Together

picture amygdala is involved in the development of anxiety disorders, psychotic the Dizziness no maladjustment and mental disease, the findings of the

amygdala, which is induced by stress and its downstream of the excessive stress

reaction or will not are you involved in the development of mental disorders and Stress reactions to acute stress as described above for the living body,

dizziness, such as anxiety disorders and depression. in the short term is useful defense mechanism. But chronic stress is

frequently repeated Accordingly, it is difficult to adapt to stress. Kitashi

abnormalities in mental function by this adaptation collapse PTSD Developing

and anti refractory depression. Although mental stress are to be typed as

sensory information, when to recognize the sensory information, to the brain sensory

gating system It works. Sensory gating system A, it is for an important

The role of the amygdala in motion sickness, vertigo onset (Fig. 2) sensory information to living organisms to increase the reaction ( gating in ),

Too heavy

Sense of confusion ( sensory mismatch ) Spatial cognition by

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V2AQP2

Figure 3 Meniere's disease pathogenesis caused by stress

Table 1 A new classification of psychogenic dizziness

Ⅰ. Diseases associated with anxiety New disease name

Resulting in a) acute or paroxysmal vertigo

Causes and anxiety of vestibular symptoms ⇒ 1. Paroxysmal vestibular symptoms caused by anxiety

· Merger anxiety to vestibular symptoms ⇒ 2. Anxiety to complications in paroxysmal vestibular symptoms

Resulting in b) chronic dizziness

Causes and anxiety of vestibular symptoms ⇒ 3. Chronic vestibular symptoms caused by anxiety

· Merger anxiety to vestibular symptoms ⇒ 4. Anxiety comorbid chronic vestibular symptoms

Dizziness, which fall within the scope of c) phobia ⇒ 5. Fear of falling

Ⅱ. Diseases associated with depression

a) the merger of the depression to the vestibular symptoms ⇒ 6. It complicated the depression in vestibular symptoms

b) the cause of depression is vestibular symptoms ⇒ 7. Vestibular by depressive symptoms

Ⅲ. Diseases associated with physical symptoms disease ⇒ 8. Vestibular disease anxiety

Ⅳ. The middle of the characteristics of vestibular disease and mental disease ⇒ 9. Sustainability awareness of posture-induced fluctuations

To reduce the reaction to the sensory information that is not required ( gating out ) Is Rimotarasa the irritability, hypersensitivity excessively senses an abnormal

an information processing process. When the stomach mentally there is the addition sense of balance that can not be felt in the normal, we believe that it would

of physical stress, gating out It has been reported that but attenuated 17) , Is to stress be tied to the subjective symptoms of Fu variability.

the acute phase is considered that if the purpose of work in the sense that Ru in

preparation for the crisis to obtain a variety of sensory information from the outside Stress of the involved dizziness: psychogenic dizziness (Table 1)

world. If only you, stress has become chronic, gating out

2006, is the world's largest conference on dizziness

Attenuation of the will be the original is exposed to the normal to the outside world Barany Society dizziness of international diagnostic criteria ( International

stimulation may be suppressed. This irritability, hypersensitivity, is considered the Classification of Vestibular Disorders ,

essence of affective disorders that put in anxiety disorders induced by stress
maladaptive.
In chronic dizziness patients with no findings, reported that the merger the
Somosomou luster anxiety disorders in about 70% 18) . Of these, due to the sky
rather than chronic stress, particularly in anxiety disorders merger examples gating
ICVD It embarked on the creation of). In 2010 ICVD Psychiatrist in
the committee, neurologists, working group was launched on
otolaryngologist or Ranaru psychogenic vertigo. Mayo Clinic of J.
Staab (Seminal Kamika) becomes the group leader, A. Bronstein (neurology),

out The attenuation of A. Eckhardt-Henn (Psychiatry), R. Jacob (Psychiatry),

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M. Strupp (Neurology) with me (ENT) have also been participating in the
diagnostic criteria created as a team member. 28th that the final version
was held in 2014 in Argentina
Barany It was presented at the Society. In this class, defines the nine
shown in Table 1 as dizziness involved mental illness 3) . Point of this
international diagnostic criteria, not only vestibular symptoms caused by
traditional anxiety-depression (psychogenic Me Mai in a narrow sense),
by vestibular disease is mental illness, such as secondary to anxiety
and depression is caused to reverse and this that specify the presence
of pathology and classified by distinguishing them was, that there is
dizziness caused by depression, fear of falling as 1 pathogenesis of
anxiety ( Fear of falling ), Physical symptoms disease ( somatic symptom
disorder Vestibular disease anxiety as one of the) ( vestibular illness
anxiety ) Is such that it has listed the. Than before Phobic postural
vertigo ( Brandt ), Chronic subjective dizziness ( Staab ), Space motion
discomfort ( Jacob ), Visual vertigo ( Bronstein Group of diseases has been
known under the name) is also different parts in detail, but are
combined into one as many disease-overlapping, Persistent postural
and perceptual dizziness ( PPPD Name of) is given. PPPD
The definition does not is included in physical symptoms and mental symptoms of
mental illness, but a disease that often exhibit anxiety and depression trend.
These 9 to merge the anxiety disorders and depression in a number of diseases,
but we have anxiety disorders and depression in many vertigo patients be
encountered in many cases is the result of adjustment disorder to stress.
In the dizziness, which merged anxiety disorders and depression,
causes and stress as much as possible to remove that became, or if it is
not possible, it is important to teach to find a remedy Do was new for
diverging the stress. Furthermore, a sufficient explanation child that
anxiety and depression are exacerbated or provoked dizziness, be fully
explained to eliminate the fear of vertigo is important. If these is not
sufficient, or a combination of drug therapy if it is necessary to remove
the immediate anxiety. Ya anti-anxiety drugs, even anxiety when failure
or depression of the secondary property even in the case of primary
resistance SSRI Effective against but dizziness of subjective symptoms
not only mental illness 18) . SSRI It exerts its pharmacological action
increasing the inhibit serotonin levels the reabsorption of Seroto Nin in
synaptic cleft. It takes time until the clinical efficacy expression, serotonin
was inhibited resorption
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Equilibrium Res Vol. 75 ( 2)
But rather than to exert a direct effect, self-receptor of the presynaptic
membrane is desensitization ( down regulation ) Is, as a result serotonergic
nerves are believed to exert clinical effects are activated. Combines the
antidepressant action and the anti-anxiety effect, the site of action is said to
Bian Momotai. PPPD Even for SSRI Usefulness have been reported 19) .
Useful drugs rather than with respect to the vestibular disease anxiety,
which is a kind of physical symptoms disease, the patient doctor nurse
repeated the doctor shopping - it is also difficult to build patient
relationships.
Stress of the involved vertigo: Meniere's disease (Fig. 3)
Due to the stress in Meniere's disease patients HPA axis Of
activation results, ACTH And blood cortisol is high, also, it has
been reported that oxytocin and vasopressin, known as stress
hormone is also high 20) 21) . It also endolymphatic sac open
surgery and gentamicin intratympanic injection surgery, blood
vasopressin reported a decrease 22) . Et al is, each 40% refractory
Meniere's disease, neuroticism 60%, depression tended 23) .
Taken together, the results of a strong stress in Meniere's
disease patients, suggests that the stress hormones are caused
increases and nervous diseases and depression.
On the other hand, the psychosomatic diseases, "About your body
symptoms and physical disease, psychosocial factors in the onset and elapsed
closely involved, pathology is observed organic and functional disorders" is
defined as. There is an opinion that Meniere's disease is psychosomatic
diseases as well as peptic ulcers and bronchial asthma that develops in stress
from the previous 24) . The Meniere's disease = psychosomatic theory may
mechanisms: Description via vasopressin is one of the stress hormones as
follows recent data.
Recombinant transfer and arrangement as trigger attacks of vertigo
of Meniere's disease, Sutoresufu Le life events such as newly generated
human relations. Although the Meniere's disease in blood cortisol is
high, this is not a cause of the main Barbanniers disease, response to
stress
HPA axis That have but believed that the results that have been
activated 25) . In addition, in the Meniere's disease HPA axis With
activation, secretion of vasopressin, which is a kind of stress
hormones increases around the seizure life 26) . This is unlike the
cortisol, of Meniere's disease
Equilibrium Res Vol. 75 ( 2)

There is a possibility that is causing. That is, Vazo pressin be capable Treatment strategy was two wheels the treatment of mental disorders due to

exacerbate and the lymphedema promote fluid accumulation in the stress to merge with treatment that is Ru important.

body it has antidiuretic effects, vasopressin in Menie Lumpur disease

endolymphatic sac V 2 Receptor and its target molecule aquaporins ( AQP
2 ) Is overexpressed 27) 28) , In the blood due to stress vasopressin high
value is in Meniere's disease inner ear V 2
Receptor - AQP 2 Believed may exacerbate water reservoir i.e. the inner
lymphatic edema through. From the above, the increase in body fluids and
endolymphatic by stress Ri Oko induce endolymphatic hydrops as organic
abnormalities of the inner ear is considered that is causing or worsening
factor of Meniere's disease. In fact, it has been reported that most efficiently
by Conform set the vasopressin administration to the inner lymph sac
occlusion model in recent animal studies, and highly endolymphatic hydrops
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tol 27: 896 - 900, 2006 It does not matter to conflict of interest.

32) Naganuma H, Kawahara K, Tokumasu K, et

. Al .: Water may cure patients with Meniere disease Reprint billing: Shin Horii

Laryngoscope 116: 1455 - 1460, 2006

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