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

Abstract

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.