Neurological or Psychological??

[Nestor]

I am a 53 yr old man with type-II diabetes, overweight but otherwise in good health.  Since 5 weeks I suffer prolonged periods of intense fear and panic, for no good reason.  It started with dizziness and losing my balance, lasting no more than 5-10 seconds, followed by a profound feeling that the world around me is unreal and fake, set up by someone as a bad joke.  This is very unnerving and leads me to think that something extremely bad is about to happen.  During these episodes I appear absentminded ("spaced-out") but I respond to questions and have all my mental faculties.  Just when I am doing nothing else, I am not really there.  My breathing is superficial but fast, or so others tell me.
My doctor sent me for an MRI scan of the head and neck, all normal, and for an stress ECG, also all normal.  Then he sent me to a neurologist who tentatively diagnosed BPPV (vertigo) although neither my own doctor nor the neurologist could elicit any symptoms with a Hallpike test (see, I picked up a lot of lingo in 5 weeks...).  The neurologist referred me to a physiotherapist for neuro-rehab.  She made an independent assessment and did find I responded to a Hallpike test.  She then tried the Epley manoever but interrupted it as my reaction was pretty bad: crying, enormous panic and anxiety and feeling of impending disaster (all absolutely without any reason, as I knew very well at the time; it was as if someone else had pressed the panic buttons of my mind without consulting me).
Initially the panic, anxiety and derealisation (another term I picked up from the doctors..) came right after a spell of dizziness (and nausea!) but now they come spontaneously and last for 4-6 hours.  I become extremely exhausted and cannot concentrate on simple tasks: I used to do 3 crosswords a day but have almost totally lost this skill.  I simply refuse to acknowledge that a tentative answer may be the right one and doubt the reality of everything.
In addition to the above symptoms I have a high-pitched noise in the right ear (tinnitus) which sometimes combines with real ambient noise, say, a ticking clock or the motor of the fridge, to form a deafening kakophonic background noise.
Both my own doctor and the neurologist referred me to a psychiatrist for an initial assessment.  The possible diagnoses being considered are atypical BPPV (neurologist) or Meniere's Disease (neurologist), temporal lobe epilepsy (psychiatrist, as a child I had narcoleptic attacks but they disappeared spontaneously and I was never treated), "some anxiety disorder" (general practitioner/neurologist) either as a prime cause or triggered by a vestibular condition.

How the **** am I going to get a real diagnosis with such vague symptoms that seem to fit many physical and not a few mental conditions??  And how do I prevent to become the victim of self-fulfilling prophesies? I have decided to go back to work and start driving again (after more than a month of doing precious little) Please try help!

[Roger Gould, M.D.]

I appreciate your quandry but obviously can not make a diagnosis at this distance. I think you should start with the presumption that you are having an equivalent to a panic attack and anxiety and start getting that treated with a combination of counseling and medication.  You have to keep alert to the other possibilities, but that will give you the base you  need. Driving and going back to work is the perfect thing to do.