Analysis of mental disorders in tinnitus patients performed with Composite International Diagnostic Interview.
Qual Life Res. 2013 Jan 5. [Epub ahead of print]
Known association between tinnitus and psychological distress prompted the authors to examine patients with chronic tinnitus by using the Composite International Diagnostic Interview, which is a standardized and reliable method used for the diagnosis of mental disorders as determined by the The World Health Organization.
One hundred patients with chronic tinnitus admitted to the Tinnitus Center, Charité-Universitätsmedizin Berlin, were included in this study. Data were collected between February 2008 and February 2009. Besides Composite International Diagnostic Interview, the Tinnitus Questionnaire according to Goebel and Hiller, the Hospital Anxiety Depression Scale, and the General Anxiety Disorder-7 were used.
Using Composite International Diagnostic Interview, the authors have identified one or more mental disorders in 46 tinnitus patients. In that group, they found persistent affective disorders (37 %), anxiety disorders (32 %), and somatoform disorders (27 %). Those patients who had affective or anxiety disorders were more distressed by tinnitus and were more anxious and more depressed than tinnitus patients without mental disorders. Psychological impairment positively correlated with tinnitus distress: Patients with decompensated tinnitus had significantly more affective and anxiety disorders than patients with compensated tinnitus.
Affective Disorders: Any of several mental disorders characterized by dramatic changes or extremes of mood. The major affective disorders include bipolar disorder—which may include manic and depressive episodes—and major depressive disorder. Among the symptoms of manic episodes are elevated, expansive, or irritable moods, with hyperactivity, pressured (rapid and forced) speech, and inflated self-esteem. Depressive episodes and major depressive disorder are characterized by dejected moods, lack of interest in life, sleep disturbances, agitation, and feelings of worthlessness or guilt.
Anxiety Disorders: Anxiety disorders are the most common form of mental disturbance in the United States population. It is estimated that 28 million people suffer from an anxiety disorder every year. The major anxiety disores are: Panic disorders with or without agoraphobia. Patients with agoraphobia are afraid of places or situations in which they might have a panic attack and be unable to leave or to find help. Phobias which include specific phobias and social phobia. A phobia is an intense irrational fear of a specific object or situation that compels the patient to avoid it. Some phobias concern activities or objects that involve some risk (for example, flying or driving) but many are focused on harmless animals or other objects. Social phobia involves a fear of being humiliated, judged, or scrutinized. It manifests itself as a fear of performing certain functions in the presence of others, such as public speaking or using public lavatories. Obsessive-compulsive disorder. This disorder is marked by unwanted, intrusive, persistent thoughts or repetitive behaviors that reflect the patient’s anxiety or attempts to control it. It affects between 2-3% of the population and is much more common than was previously thought. Stress disorders. These include post-traumatic stress disorder and acute stress disorder. Stress disorders are symptomatic reactions to traumatic events in the patient’s life. Generalized anxiety disorders are the most commonly diagnosed anxiety disorder and occurs most frequently in young adults.
Somatization disorders: Characterized by a history of multiple unexplained medical problems or physical complaints beginning prior to age 30. In the nineteenth and early twentieth centuries, somatization disorder was known as Briquet’s syndrome or hysteria—a more generic term for such a condition. People with somatization disorder report symptoms affecting multiple organ systems or physical functions, including pain, gastrointestinal distress, sexual problems, and symptoms that mimic neurological disorders. Although medical explanations for their symptoms cannot be identified, individuals with somatization disorder experience genuine physical discomfort and distress. Review of their medical histories will usually reveal visits to a number of medical specialists, and many patients take numerous medications prescribed by different doctors, running the risk of dangerous drug interactions.
In the present study, the authors have detected a high rate (almost half of the cases) of psychological disorders occurring in patients with chronic tinnitus. The patients diagnosed with psychological disorders were predominantly affected by affective and anxiety disorders. Psychological disorders were associated with severity of tinnitus distress. The authors findings imply a need for routine comprehensive screening of mental disorders in patients with chronic tinnitus.
It is currently estimated that 50 million American adults have tinnitus to some degree. Tinnitus is a subjective experience. It is often referred to as a “phantom sound” because one hears sound when there is no external physical sound present. People experience it as head noise or ear-ringing and use a variety of terms to describe it, such as hissing, rushing, ringing, roaring or chirping. The most common cause of tinnitus is exposure to excessively loud noise, either a single intense event (like a shotgun blast) or long-term exposure either on the job (musicians, carpenters, pilots) or during recreational activities (shooting, chain saws, loud music). Tinnitus can also result from physical trauma to the head or neck. A small percentage of tinnitus cases arise from medical conditions. Hypertension (high blood pressure), acoustic neuroma (tumor on the hearing nerve), thyroid disease, vascular disorder, temporomandibular joint (TMJ) disorder, ear infection, impacted cerumen (ear wax), nutritional deficiency, aneurysm, multiple sclerosis and other disorders can produce the symptom of tinnitus. Prescription and over-the-counter drugs can cause or exacerbate tinnitus. Several hundred drugs listed in the Physician’s Desk Reference (“PDR”) cite tinnitus as a side effect! In some of these cases, the tinnitus will lessen or disappear when the offending drug is discontinued.
The authors suggest a need for routine and comprehensive screening of mental disorders in patients with chronic tinnitus? Based on a study of 100 subjects where tinnitus symptoms were severe enough to be admitted to a Tinnitus Center? They did not suggest further studies related to their findings? Are they implying that tinnitus is a result of a mental disorder? Were the mentally affected patients treated for mental disorders to see if their tinnitus symptoms decreased with treatment of the mental disorder? Were the mental disorders diagnosed specifically or generally? Does tinnitus cause distress and anxiety? And to what degree? This is a disturbing recommendation from these authors, who are not indicated to have undergone mental disorder testing. Should 50 million American adults be routinely and comprehensively screened for mental disorders because they have tinnitus?
The most common cause of tinnitus is exposure to excessively loud noise, either a single intense event or long term low level exposure. Should we ban guns, musicians, carpenters, pilots, chain saws and loud music because they may lead to mental disorders via tinnitus? Considering the complexity of “mental disorders”, are they indicating tinnitus causes mental disorders or maybe people with mental disorders should be routinely and comprehensively tested for tinnitus?
It is clear there is an association between tinnitus and anxiety/depression. This is a logical conclusion and is similar to other conditions that impact a patient’s life. There are obviously many causes of anxiety and depression and in today’s society, it appears ubiquitous. Does this lead to recommending everyone should be routinely and comprehensively screened for mental disorders? How an age of anxiety became an age of depression, “Various factors combined between the 1970s and the 1990s to transform conditions that had been viewed as “anxiety” into “depression.” New interests in the twenty-first century, however, might lead to the reemergence of anxiety as the signature mental health problem of American society.” How many Americans would be diagnosed with a mental or psychological disorder and what implications would that pose?
Relationship between tinnitus severity and psychiatric disorders
“Various measures found significant correlations between the severity of tinnitus and the severity of depression and anxiety. We conclude that the severity of tinnitus is associated with psychiatric disorders, as well as with the severity of anxiety and depression in tinnitus patients, and may account for approximately 20% of the variance of the observed association.” So now it is 50%?
According to Psychological comorbidity in patients with chronic tinnitus: analysis and comparison with chronic pain, asthma or atopic dermatitis patients – “Patients with chronic tinnitus had a stronger SOC [sense of coherence] and better subjective mood, stronger commitment, and less anger and anxious depression than the patients with chronic pain, chronic asthma or atopic dermatitis.” So we can assume the authors would similarly and more aggressively recommend routine comprehensive screening of mental disorders in patients with chronic pain, chronic asthma or atopic dermatitis?
Why not just recommend that anyone with a health problem be routinely and comprehensively screened for mental disorders? Why not recommend that everyone be routinely and comprehensively screened for mental disorders? Why not make it mandatory? I recommend that authors of scientific journals who recommend routine and comprehensive screening for mental disorders be routinely and comprehensively screened for mental disorders themselves, prior to making any recommendations. The implications of their recommendations are precarious and disturbing.
