Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Abstract

Background: A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasovagal syncope (VVS). However, the relationship between the psychiatric substrate and syncope remains unclear. Methods: In order to test the hypothesis that MPDs may predispose to VVS, we assessed the prevalence of syncope, the response to head-up tilt test (HUTT) and the efficacy of psychiatric drug treatment in reducing syncopal episodes, in patients with recently diagnosed MPDs. The response to HUTT was compared with that in an equal number of matched (a) patients with VVS and (b) healthy controls. Results: A high rate of patients with MPDs (58%) had a positive HUTT. Additionally, 45% had a history of syncope; among them, the rate of positive HUTT was identical to that in the VVS group (83%). Following psychiatric drug treatment, the number of patients with syncope decreased in the MPD group (6/67 from 30/67, p < 0.01). Psychiatric symptoms and quality of life were also improved. The number of syncopal spells decreased equally in the MPD and VVS groups (0.6 ± 0.5 from 2.5 ± 1.4, p < 0.01, and 0.7 ± 0.5 from 2.7 ± 1.3, p < 0.01, respectively). Conclusion: A high proportion of patients with MPDs experience syncope, associated with a high rate of positive HUTT, comparable to that observed in VVS. Psychiatric treatment results in the improvement of syncopal and psychiatric symptoms. These findings suggest involvement of co-occurring MPDs in the pathogenesis of VVS. Therefore, the diagnosis and treatment of MPDs, when present, may be crucial for the effective therapy of vasovagal syndrome.

The Relationship Between Clinical Characteristics and Psychological Status and Quality of Life in Patients with Vasovagal Syncope

“…It has also been reported that the psychiatric disorder prevalence was 80% in patients with syncope [15,30,32]. Recently, a prospective study found that 45% of adult patients with depression or anxiety disorders had a history of syncope episode [33]. Similarly, anxiety [34], depression [35] and somatization disorder [30] prevalence were reported in patients with positive tilt table test and recurrent syncope episodes.…”

Association between psychological complaints and recurrence of vasovagal syncope

“…Treatment of general psychological complaints has been found to affect syncope-recurrence as well [16].…”

Neurovisceral phenotypes in the expression of psychiatric symptoms

“…Psychiatry, neurology and cardiology research groups have found psychiatric conditions are over-represented in patients with vasovagal syncope, particularly anxiety, depression and somatization disorders (Giada et al, 2005 ). In psychiatry, a survey of 67 patients (Leftheriotis et al, 2008 ) identified 58% as showing a vasovagal episode during head up tilt and 45% had a history of syncope. Interestingly, vasovagal syncope patients who do not respond to treatment are more anxious on rat and depressed (on rating scales) than normal vasovagal syncope treatment responders and also report more negative thoughts regarding threats to physical harm or death as well as higher levels of avoidance/protection coping and rumination (Gracie et al, 2006 ).…”