title: Prevalence and prognostic significance of psychiatric disorders in patients evaluated for recurrent unexplained syncope.
abstract: We aimed to assess the psychiatric profile and prognostic value of psychiatric disorders (PDs) in patients presenting with unexplained syncope. Forty patients with recurrent unexplained syncope referred for head-up tilt testing were compared with age- and sex-matched patients free of known chronic PDs referred for arrhythmia. All patients underwent a semistandardized psychiatry questionnaire (Mini-International Neuropsychiatric Interview) to assess their profile. Additional stress coping was performed to study adaptational processes to stressful situations. After tilt testing and psychiatric evaluation, a drug-free follow-up was performed in patients with syncope. Of the 80 patients who referred to the psychiatric interview, 40 had evidence of at least 1 psychiatric disorder. They were 26 patients (65%) in the syncope group and 14 patients (35%) in the control group (p = 0.01). Detailed analysis revealed a more frequent subprofile of anxiety and panic disorders in patients with syncope than in controls (30% vs 12% and 20% vs 10%, respectively), whereas the subprofile of depression was similar in both groups. Moreover, those with syncope were more likely to have a high anxiety index (25 +/- 5 vs 22 +/- 4, p = 0.004), and were more prone to avoidance-oriented coping strategies when experiencing undesirable life events than controls. Considering syncope patients, no difference could be found between the 25 with a positive tilt test and the 15 with a negative tilt test with respect to the number of syncopal episodes and psychiatric profile. After a 3-year drug-free follow-up, 15 patients (37.5%) had at least 1 recurrent syncope. The recurrence rate was similar in patients with positive and negative head-up tilt test results (9 of 25 vs 6 of 15, respectively). In contrast, the syncopal recurrence rate was higher in patients who fulfilled criteria for affective disorders (13 of 26 vs 2 of 14, 95% confidence interval 1.09 to 2.55, relative risk 1.7, p = 0.04). Thus, patients with recurrent unexplained syncope are more anxious and are more prone to panic disorders and avoidance-oriented coping strategies than control patients with arrhythmia. The presence of a psychiatric disorder is associated with an increased risk of recurrence. The outcome of such patients may be improved with recognition and treatment of PDs.
authors.affiliation: Department of Cardiology, Lille University Hospital, Lille, France. c-kouakam@chru-lille.fr
authors.forename: Claude
authors.initials: C
authors.lastname: Kouakam
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.forename: Philippe
authors.initials: P
authors.lastname: Baux
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003674:Defense Mechanisms; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D010348:Patient Care Team; D012008:Recurrence; D012307:Risk Factors; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D013575:Syncope / Q000453:epidemiology / Q000523:psychology*; D018667:Tilt-Table Test