What is the best approach to managing this woman, who has been feeling unsteady, dizzy and increasingly worried about falling since an episode of psychological stress?
Laine, a 55-year-old woman, presented with a complaint of dizziness. A few months previously she had caught her husband having a brief flirtatious texting f ling with an overseas colleague whom he had met at an international conference. Nothing physical had resulted, he assured her, and he seemed sincerely to regret his silly behaviour (which is the only time he has done such a thing).
Afterwards, Laine began to find herself becoming unsteady and ‘dizzy’. She is also worried about falling, and she experienced a single fall shortly after the conversation in which she confronted her husband about the text messages. As a result, for the past few months she has relied on him or another family member for physical support whenever she has left the house. She is becoming increasingly isolated.
A neurological referral and appropriate scans have been arranged and found no cause for Laine’s constant unsteadiness and dizziness. She denies depression and is convinced she has a real, undiagnosed medical condition; indeed, she is cross with the neurologist for not confirming it. She does not want to see a psychiatrist but is willing to see a balance physiotherapist, as long as her husband will accompany her. Her husband is concerned about Laine and wants her to get better.
What is the best approach for managing this patient?
Picture credit: © Roy McMahon/Corbis.