Psychiatric traits in patients with vasovagal and unexplained syncope

Abdullah Alhuzaimi,1 Alwaleed Aljohar,2 Ahmad N. Alhadi,3,4 Abdulqudous Aljenedil,2 Ahmad S Hersi1 1Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 3Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 4SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia Purpose: Syncope is a common condition affecting almost one-third of the general population. The present study measures the prevalence of psychiatric traits in patients presenting with syncope (unexplained and vasovagal) and whether recurrent attacks have an impact on psychiatric profiles.Patients and methods: This is a case–control study in a tertiary hospital enrolling all patients aged ≥12 years with single or recurrent syncopal attacks. A self-reporting psychometric questionnaire (The Symptoms Checklist-90-Revised) was used to screen for depression, anxiety, somatization disorder, and phobia. Crude comparisons of average scores were done. Further, multiple logistic regression analyses were carried out to measure the impact of syncope on each psychiatric domain. The control group were matched for age, gender, and chronic illnesses with a ratio of 1:3.Results: There were 43 cases and 129 control subjects, with predominance of females (67.4%) and an average age of 33.8 years (standard deviation = 16). There were no significant differences in average scores of depression (13 vs 14.53, P = 0.31), anxiety (11.3 vs 10.4, P = 0.51), or phobia (5.4 vs 5.2, P = 0.88). However, the syncope group had a higher average score for somatization disorder (18.53 vs 13.66, P = 0.002). Binary logistic regression model showed that the association between syncope and somatization disorder was independent of competing confounders (odds ratio = 3.75, 95% confidence interval: 1.72, 8.15, P = 0.001). A sub-analysis of the case group showed that patients with multiple syncopal attacks (six or more) had higher average scores of depression, anxiety, phobia, and somatization disorder compared to those who had less than six attacks.Conclusion: Syncope was independently associated with somatization disorder traits. Further, recurrent syncope resulted in greater deterioration of patients’ psychiatric profiles. Thus, taking into account the psychiatric status in the management of such patients is crucial. Keywords: syncope, psychiatric disorders, anxiety, somatization disorder, phobia, depressio

11. Prevalence of psychiatric symptoms among patients with recurrent vasovagal and unexplained syncope

Syncope is defined as a transient loss of consciousness and absence of postural tone followed by spontaneous recovery. Neurally mediated syncope (vasovagal) and idiopathic unexplained syncope (US) are the most common causes of syncope. Syncope is a very limiting disease that, if recurrent, affects the patients’ physical and psychological health. Our objective from this study is to measure the prevalence of psychiatric symptoms among patients with US. All patients (>12 years) with vasovagal or US who were evaluated in King Khalid University Hospital were identified. Echocardiography and table tilt test reports were reviewed and patients who had cardiac syncope (due to arrhythmia or structural heart disease) were excluded (N = 18). Ninety-four patients were included for further psychiatric assessment. The patients were contacted to fill the Symptoms Checklist-90-Revised (SCL-90-R), which is a self-reporting questionnaire used to evaluate traits of depression, anxiety, somatization disorder and phobia. SCL-90-R scale has been translated to Arabic and validated in previous studies. Of the included cohort, 43 responded to fill the assessment scale, and 51 were excluded due to failure of communication (N = 41) or refusal to participate (N = 10). A control group was recruited with a case: control ratio of 1:3 matching for age, gender, and chronic illnesses.There were 43 patients and 129 control subjects, with predominance of females (67.4%) and an average age of 33.8 (SD = 16). There was no difference in average scores of depression (13 vs. 14.53, P = 0.31), anxiety (11.3 vs. 10.4, P = 0.51), or phobia (5.4 vs. 5.2, P = 0.88). However, the syncope group had a higher average score for somatization disorder (18.53 vs. 13.66, P = 0.002). Binary logistic regression model was measured after grouping the cohort into above and below median scores. After adjusting for age, gender, and chronic illnesses, the association between syncope and somatization disorder remained significant (OR = 3.75, CI; 1.72, 8.15, P = 0.001). Despite no statistical significance, when looking at the effect size, having an anxiety score above the median was 52% higher in cases compared to controls (OR = 1.52, CI; 0.74, 3.14, P = 0.255). A sub-analysis of the case group was applied and showed that patients who had multiple syncopal attacks (6 or more) had higher average scores of depression, anxiety, phobia and somatization disorder compared to those who had less than 6 attacks (Table). Patients with vasovagal or US have similar incidence of depression, anxiety or phobia symptoms and higher incidence of somatization symptoms compared to control subjects. However, recurrent and more frequent attacks of syncope was predictive of more deteriorative psychological profile for all four domains. Our findings should prompt motivation to study the effectiveness of psychological intervention in patients with recurrent syncope