Mood and Anxiety Disorders

Article Critique: Mood and Anxiety Disorders
Just like certain psychological disorders like depression and anxiety are frequently comorbid, certain physical conditions are associated with psychological problems. A good example of this is benign paroxysmal positional vertigo, which is caused by “abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canal” (Kozak et al. 2018, p. 49). The association between the physical disorder and the psychological disorders may be due to both physical and psychological factors. The sensation of vertigo itself can be destabilizing and anxiety-provoking. Additionally, it may also stimulate neuronal circuits in the parabrachial nucleus which trigger feelings of anxiety.
The study involved a comparison of an experimental group of 49 individuals suffering from paroxysmal positional vertigo and a control group of 74 members of hospital workers and relatives from the hospital at which the vertigo sufferers were receiving treatment. Overall, the group of vertigo sufferers had a higher rate of major depression, generalized anxiety disorder, and obsessive-compulsive disorder versus the control group. Major depression might also partially be explained by some of the social effects of vertigo, given that social isolation may result from the physical incapacitation generated by the disorder, thus resulting in or exacerbating existing depression. Depression has been found to be comorbid with a number of physical illnesses, both because of the physical imbalances in neurotransmitters generated by physical illnesses, as well as the depressing aspects of suffering from a debilitating physical condition itself.
Interestingly enough, dysthymia or mild depression was present at the same rates in both experimental and control groups. Also, more specific forms of anxiety disorders such as panic disorder, phobias, and PTSD, were not manifested in greater numbers in the experimental or control groups and bipolar disorder was entirely absent. This suggests that vertigo may have a role in triggering specific types of mood and anxiety conditions but does not reflect an overall worsened state of mental health in a generalized fashion for all conditions. The findings would have implications for treatment, given that generalized anxiety disorder is more apt to be treated with psychotropic medications versus desensitization therapy for phobias. Similarly, mild depression is less likely to be responsive to antidepressants versus major depression.
But other findings were not completely explained by the physical association of vertigo and mood disorders alone. For example, Axis II personality disorders such as obsessive-compulsive personality disorder were found to be more prevalent among vertigo sufferers, despite the fact that personality disorders are not usually associated with physical disorders. This suggests that the relationship between vertigo, anxiety, and mood disorders is still evolving. Furthermore, the study was relatively small and homogenous. It was all drawn from the same hospital, including the control group, and all of the sufferers from vertigo were experiencing the condition in a severe enough manner to have been hospitalized at some point in their treatment.
The relationship between anxiety and depression may itself need to be better understood, as both psychological disorders are frequently comorbid, even in patients without vertigo. Greater understanding between the physical and psychological interplay of the disorders is needed, although it is clear that the specific neurological triggers of vertigo are very similar to those triggered in patients with anxiety. It is still unclear if the anxiety is the primary trigger of depression, however, or if conditions unrelated to anxiety trigger major depression (but not dysthymia) in vertigo patients.


References
Kozak, H., Dundar, M., Uca, A., Uguz, F., Keziban, T., Atlas, M….Aziz, S. (2018). Anxiety,
mood, and personality disorders in patients with benign paroxysmal positional vertigo. Archives of Neuropsychiatry, 55:49?53