Psychological and Physiological Factors Associated with Tilt Table Testing for Neurally Mediated Syncopal Syndromes

Abstract

This study investigated psychological and physiological factors in two groups of patients who had tilt table testing for autonomic dysfunction. The first group of 61 patients completed assessments of depression, anxiety, and symptom effects on lifestyle. The 25 patients identified as tilt positive were younger (30.5 years) and had higher mean depression scores (7.6) compared to the tilt-negative response group (n = 36); the latter averaged 40 years of age and had mean depression scores of 4.6. These differences were statistically significant. Women testing tilt positive were significantly more depressed than tilt-negative women (P = 0.02). More severe depressive symptoms were associated with lower blood pressure (BP) (P < 0.05). A second group of 52 patients was monitored during tilt for BP, heart rate (HR), skin temperature (TEMP), skin conductance level (SCL), and forehead muscle tension (EMG). Twenty-seven tested positive and 23 were negative. There were statistically significant group differences in systolic BP and diastolic BP (P < 0.05). There was a significant interaction between tilt status (positive or negative) and time (P = 0.03) in HR. TEMP increased 2 degrees over time in both groups (P < 0.05). The decrease in SCL from 13.7 to 10.4 mu omega in the tilt-positive response group compared to the slight increase in the tilt-negative group was significantly different (P < 0.05). Identification of psychological factors correlated with BP and physiological changes that accompany decreases in BP in tilt-positive response patients could guide management of patients with autonomic dysfunction.

Association between psychological complaints and recurrence of vasovagal syncope

“…The pathophysiological mechanisms for the relation between VVS and other general psychological complaints are far less clear. Although patients with higher scores on a scale assessing symptoms of depression did have a more pronounced decrease in blood pressure upon tilt testing [18], the pathophysiological basis for this relation is unknown.…”

Childhood Depression As Emerging Public Health Problem: A Systematic Review

“…Several studies [153][154][155][156][157][158][159][160] in adults have shown that patients with syncope exhibit high levels of psychological distress, including anxiety and depression. HypHantiS et al [153] reported an incidence of 35% in clinically significant depressive symptoms in children and adolescents with Neurocardiogenic Syncope, a 2.6-fold higher rate compared with healthy control subjects.…”

Psychological Factors Associated with a Better Quality of Life Following Head-Up Tilt Testing

“…While the cause is often benign, morbidity is considerable. Psychiatric disorders, psychological distress (D'Antono et al 2009;Kapoor et al 1995;Kouakam et al 1996Kouakam et al , 2002Linzer et al 1992) as well as physical, social and professional limitations (Linzer et al 1988;McGrady et al 2001) are common in patients with recurrent syncope.…”