Relationship among nausea, anxiety, and orthostatic symptoms in pediatric patients with chronic unexplained nausea.
This study evaluated the relationship among nausea, anxiety, and orthostatic symptoms in pediatric patients with chronic unexplained nausea. We enrolled 48 patients (36 females) aged 15 ± 2 years. Patients completed the Nausea Profile, State-Trait Anxiety Inventory for Children and underwent 70° head upright tilt testing (HUT) to assess for orthostatic intolerance (OI) and measure heart rate variability (HRV). We found nausea to be significantly associated with trait anxiety, including total nausea score (r = 0.71, p < 0.01) and 3 subscales: somatic (r = 0.64, p < 0.01), gastrointestinal (r = 0.48, p = 0.01), and emotional (r = 0.74, p < 0.01). Nausea was positively associated with state anxiety, total nausea (r = 0.55, p < 0.01), somatic (r = 0.48, p < .01), gastrointestinal (r = .30, p < .05), and emotional (r = .64, p < .01) subscales. Within 10 min of HUT, 27 patients tested normal and 21 demonstrated OI. After 45 min of HUT, only 13 patients (27%) remained normal. Nausea reported on the Nausea Profile before HUT was associated with OI measured at 10 min of tilt (nausea total r = 0.35, p < 0.05; nausea emotional subscale r = 0.40, p < 0.01) and lower HRV at 10 min of HUT (F = 6.39, p = 0.01). We conclude that nausea is associated with both anxiety symptoms and OI. The finding of decreased HRV suggests an underlying problem in autonomic nervous system function in children and adolescents with chronic unexplained nausea.
Department of Child Psychiatry and Behavioral Sciences, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, B130, 13123 E. 16th Ave., Aurora, CO, 80045, USA, Sally.Tarbell@childrenscolorado.org.
Sally E
SE
Tarbell
Hossam A
HA
Shaltout
Ashley L
AL
Wagoner
Debra I
DI
Diz
John E
JE
Fortunato
D000293:Adolescent; D000704:Analysis of Variance; D001007:Anxiety / Q000150:complications*; D002648:Child; D002908:Chronic Disease; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D009325:Nausea / Q000150:complications*; D054971:Orthostatic Intolerance / Q000150:complications* / Q000175:diagnosis; D010372:Pediatrics; D011569:Psychiatric Status Rating Scales; D018667:Tilt-Table Test; D013997:Time Factors; D055815:Young Adult