Comorbid psychiatric symptoms and syndromes
Alcohol consumption has been described as a risk factor for tinnitus; however, most results have not been significant. There is very limited literature on the relationship between tinnitus and substance use, and most results are inconclusive. However, it is still recommended that patients abstain from substance use including alcohol and tobacco because of their negative effects on overall health.
• Affective disorders: there is a high prevalence of depressive disorder in tinnitus patients; in fact, a decrease in depression was associated with a decrease in tinnitus3
• Anxiety disorder: along with depression, anxiety is more prevalent among the tinnitus clinical population4
• Personality disorders: tinnitus distress is associated with high neuroticism, low extraversion, high stress reaction, higher alienation, worse social closeness, worsened well-being, lower self-control, lower psychological acceptance, type D personality, and externalized locus of control5
• Psychosis: patients with tinnitus have higher scores on paranoid ideation, psychoticism, and hostility6
• Somatoform disorder: findings from the World Health Organization indicate that 42% of the patients with somatization disorder had tinnitus with autonomic arousal as a common link7
• Cognitive impairment: tinnitus affects executive function and attention; patients also have slower cognitive processing speed and longer reaction times on brain speed test8
• Stress: emotional exhaustion is a strong predictor of the severity of tinnitus; exposure to high stress has the same incidence of tinnitus as exposure to occupational noise9; some people report that their first awareness of tinnitus coincides with a stressful event such as divorce, accident, surgery, loss of employment, or illness in the family
• Sleep: insomnia is a common complaint in tinnitus patients, in particular difficulty falling asleep; obstructive sleep apnea is a key factor to screen for during an evaluation for tinnitus10; achieving restorative sleep is a key element of tinnitus management.
Dr Chemali is Director, Neuropsychiatry Clinics; Director, Behavioral Neurology-Neuropsychiatry Fellowship; Director, Global Implementation Program in Neuropsychiatry, Behavioral and Social Sciences; Associate Professor, Harvard Medical School, Massachusetts General Hospital, Boston, MA. Dr Nehme is Psychiatry Fellow, Consult-Liaison Psychiatry, Cambridge Health Alliance, Cambridge, MA. The authors report no conflicts of interest concerning the subject matter of this article.
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