Abstract 2317: The Role of Psychiatric Substrate in the Expression of Vasovagal Syncope, and the Therapeutic Effect of Psychiatric Treatment
A high prevalence of minor psychiatric disorders (MPD) has been reported in patients (pts) with vasovagal syncope (VVS). However, it is unclear whether psychiatric disorders are the cause or a consequence of recurrent VVS.
Aim: To investigate the relationship between VVS and MPD, and test the hypothesis that MPD may predispose to VVS.
Methods: In a cohort analysis among 586 pts referred to the Outpatient Psychiatric Department, we evaluated the excitability of the vasovagal reflex in 67 pts with recently diagnosed MPD (DSM-IV-TR TM criteria) and compared the results with those in an equal number of matched
pts with VVS and
We also assessed the effect of psychiatric treatment on the recurrence of syncope in those pts with MPD who also reported syncope.
Results: All pts underwent cardiologic and psychiatric evaluation (SCID interview), quality of life assessment (SF-36 questionnaire), and head-up tilt test (HUTT). Out of the 67 pts with MPD, 12 refused treatment or follow-up. Half of the remaining 55 pts had a positive HUTT (Table 1⇓). Thirty pts with MPD (55%) had a history of syncope. The rate of positive HUTT among them was 83% (25/30) almost identical to that in the VVS group (47/55, 85%). After 12 months of psychiatric treatment, pts with syncope decreased in the MPD group (8/55 from 30/55, p<0.01). Psychiatric symptoms and quality of life were also improved (Health Changes: from 39±4 to 64±4, p<0.01). The number of syncopal spells decreased equally in the MPD and VVS groups (0.56±0.14 from 2.5±0.32, p<0.01, and 0.65±0.13 from 2.7±0.40, p<0.01, respectively).
Conclusion: A high proportion of pts with MPD experience syncope, associated with a high rate of positive HUTT, comparable to that in pts with VVS. This implies that MPD may contribute in the pathogenesis of VVS. Psychiatric treatment reduces the recurrence of syncope, suggesting that the diagnosis of MPD (when present) in pts with VVS may be crucial for the effective treatment of their syncopal events.