title: The role of psychological factors in response to treatment in neurocardiogenic (vasovagal) syncope.
abstract: OBJECTIVE
  Studies have established a link between vasovagal syncope (VVS) and anxiety, depression, and functional impairment. This study examines the prevalence of psychological problems in patients with VVS and whether non-responders are psychologically different from those whose symptoms respond to conservative treatment.
  
  
  RESULTS
  Subjects with tilt-confirmed VVS completed the hospital anxiety and depression scale (HADS) (measures current levels of anxiety and depression) and the syncope functional status questionnaire (SFSQ) (syncope-specific quality-of-life measure) and participated in a semi-structured interview to ascertain potential triggers, thought content, and coping strategies. In this study, 41 subjects participated. There was no difference in gender and age duration of symptoms between responders (n=21) and non-responders (n=20). Non-responders were significantly more anxious (P=0.003) and depressed (P=0.003) and had a higher level of state (P=0.008) and trait (P=0.004) anxiety than responders. Non-responders reported more fear/worry (P=0.02), a significantly higher degree of impairment owing to syncope (P=0.01), and a greater number of perceived triggers (P=0.039); on average, participants reported eight negative thoughts about the consequences of VVS, with particular emphasis on threats of physical harm or death. Non-responders had higher levels of avoidance/protection coping and rumination.
  
  
  CONCLUSIONS
  This study has confirmed that patients with VVS have a significant degree of psychological distress, which is worthy of consideration in its own right, out with management purely aimed at reducing syncopal or pre-syncopal symptoms. Further, this distress may actually influence the natural history of what is a chronic relapsing condition and may in fact be more relevant to the patient than the number of syncopal episodes that they are experiencing.
authors.affiliation: Department of Psychology, Royal Victoria Infirmary, Newcastle NE1 4LP, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gracie
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
authors.forename: Michael
authors.initials: M
authors.lastname: Norton
authors.forename: Christine
authors.initials: C
authors.lastname: Baker
authors.forename: Mark
authors.initials: M
authors.lastname: Freeston
mesh_terms: D000223:Adaptation, Psychological / Q000187:drug effects / Q000502:physiology; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005239:Fear / Q000502:physiology / Q000523:psychology; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D019462:Syncope, Vasovagal / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D018667:Tilt-Table Test; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008879:Midodrine; D005438:Fludrocortisone