title: Depressive symptoms and neurocardiogenic syncope in children: a 2-year prospective study.
abstract: OBJECTIVE
  To evaluate prospectively the relationship between neurocardiogenic syncope (NCS) and depressive symptoms in pediatric patients.
  
  
  METHODS
  Forty-five patients (aged 12.3 ± 2.9 years) with NCS (diagnosed as ≥ 1 syncopal episodes with typical symptoms, reproduced by tilt-table testing, in the absence of structural or primary electrical heart disease) were compared with 45 age- and gender-matched control subjects. Assessment was performed at baseline and 2 years thereafter. Depressive symptoms and self-perception profile of participants were evaluated, along with their parents' psychological distress, defensive profile and hostility. Family cohesion and adaptability, as well as the opinion of parents and teachers on children's strengths and difficulties, were also examined.
  
  
  RESULTS
  At baseline, patients showed more (P = .008) depressive symptoms than controls, correlating with the number of syncopal episodes, impaired relationship with parents and poor family cohesion. A conservative management strategy of NCS was adopted and psychological counseling was offered, focusing on patients with clinically significant depressive symptoms and their families. During follow-up, depressive symptoms decreased in patients (P < .001), but remained stable in controls. Child-parent relationship, family cohesion and family adaptability improved at follow-up in patients. No recurrent syncope was noted during follow-up and this along with improvement in child-parent relationship were associated with depressive symptoms improvement.
  
  
  CONCLUSIONS
  Depressive symptomatology is common in pediatric patients with NCS. Our findings call for additional investigation in larger controlled clinical interventional studies that will enhance understanding of the possible pathophysiological association between depressive symptomatology and NCS in pediatric populations.
authors.affiliation: Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece. tyfantis@cc.uoi.gr
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Hyphantis
authors.forename: Argiro-Irene
authors.initials: AI
authors.lastname: Pappas
authors.forename: Antonios P
authors.initials: AP
authors.lastname: Vlahos
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
authors.forename: James L
authors.initials: JL
authors.lastname: Levenson
authors.forename: Theofilos M
authors.initials: TM
authors.lastname: Kolettis
mesh_terms: D002648:Child; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019462:Syncope, Vasovagal / Q000150:complications*; D013997:Time Factors