Psychogenic Reactions Research Articles

Surveillance of adverse events following varicella vaccine immunization in Jiangsu province, China from 2017 to 2023

To assess the safety of varicella vaccine (VarV) by conducting post-marketing surveillance on adverse events following immunization (AEFI) in Jiangsu Province, China.MethodsWe utilized the AEFI Information System of mainland China to monitor and categorize adverse reactions associated with VarV.ResultsThe incidence rate of AEFI was significantly higher after the first dose (48.79/100,000 doses) compared to the second dose (45.18/100,000 doses) (χ2 = 4.63, P = 0.031). Regional variations in AEFI incidence were observed within Jiangsu Province. Common reactions comprised 90.96% of AEFIs, while rare reactions and coincidental events accounted for 6.59% and 0.51%, respectively. Notably, there were no adverse events linked to vaccine quality, program errors, psychogenic reactions, or fatalities. Over 96% of AEFIs occurred within three days of VarV administration, with redness at the injection site (2.6 cm to 5 cm in diameter) being the most frequently observed symptom.ConclusionVarV demonstrates a commendable safety profile. Although there was a slight increase in AEFI incidence between 2022 and 2023, common vaccine reactions were predominantly observed, and the rates of rare reactions remained very low.

Problems of diagnostics of oral lichen planus

Lichen planus is a disease most commonly found in both dermatological and dental practice. The etiology of this dermatosis is not fully understood. As a rule, with lichen planus, the organs of the gastrointestinal tract, cardiovascular, nervous, endocrine and other systems are affected. The disease can develop against the background of strong psychoemotional stress. Differential diagnosis of lichen planus is performed with leukoplakia, autoimmune pemphigus, candidiasis and lupus erythematosus.
 The authors present their own clinical observation of a patient with a lichen planus of the oral mucosa, in whom a diagnostic error led to the series of unsuccessful hospitalizations, examinations, surgical interventions against the background of a gradual aggravation of the mental state.
 The interest of this clinical observation is that in the case of diagnosis of lichen planus of the oral mucosa, a complete examination of the skin and all mucous membranes is necessary in order to identify the elements characteristic of this disease. Of particular importance is a biopsy with histological and immunohistochemical examination before the start of therapy. With a prolonged course of the disease, the ineffectiveness of invasive therapies requires timely administration of systemic glucocorticoids to achieve remission. Prolonged and persistent course of lichen planus of the oral mucosa can lead not only to the transformation of the process, but also to the development of psychogenic reactions.
 The article shows the importance of a tandem between a dermatovenerologist, a dentist and a psychiatrist forthe effective care of patients with lesions of the oral mucosa with lichen planus.

Лечение невротических, связанных со стрессом и соматоформных расстройств в условиях санатория

Study Objective: To assess the possibilities of sanatorium-and-spa treatment in patients with neurotic, stress-associated and somatoform disorders taking into account the modern idea of their pathogenesis. Main part. According to various sources, at least 30% of patients who come to outpatient clinics have neurotic and/or somatoform disorders. Given the complex pathogenesis of these conditions, the rate of exacerbations and relapses, such patients should undergo a long-term comprehensive therapy aimed at elimination of etiological and pathogenic factors, together with the development of adequate adaptive reactions, including psychogenic reactions, increased physical and mental performance, and healthy lifestyle habits. The potential to reach the goal increases considerably with the use of sanatorium-and-spa treatment, the main methods of which include climatotherapy, hydrobalneotherapy, reflexotherapy, physical factors, biofeedback techniques, mental therapy, and exercise therapy. Conclusion. The efficiency of the comprehensive treatment of neurotic, stress-related and somatoform disorders using natural and artificial therapeutic factors is 60%. The knowledge of non-drug treatments of such conditions is essential not only for medical staff in sanatoria and spas, but also for outpatient medical professionals, since they are the primary referring individuals. Keywords: neurotic disorders, sanatorium-and-spa treatment, balneotherapy, physical activity.

Indicators of severity and accentuated personality traits in men with various forms of eczema

Annotation. The purpose of this work is to determine the features of indicators of severity and features of accentuated personality traits in men with various forms of eczema. On the basis of the Military Medical Clinical Center of the Central Region and the Department of Dermatology and Venereal Diseases with a postgraduate course in National Pirogov Memorial Medical University, Vinnytsya, a survey of men of the first adult age (22-35 years) with true (n=34, including 16 with mild and 18 with severe course) and microbial (n=38, including 28 with mild and 10 with severe course) eczema was conducted. The diagnosis of eczema was performed according to the nomenclature of ICD-10. All men with the help of personality questionnaires were assessed by the severity and features of accentuated personality traits by Shmishek. Statistical data processing was performed in the license package “Statistica 5.5” using non-parametric methods of evaluation of the obtained results. The control group of subjects revealed the following percentage distribution of types of accentuation: hyperthymic – in 37.80 %; stuck – in 1.22 %; emotional – in 1.22 %; pedantic – in 3.66 %; anxious – in 1.22 %; cyclothymic – in 10.98 %; demonstrative – in 3.66 %; excitable – in 7.32 %; dysthymic – in 0 %; exalted type – in 14.63 %. In patients with true eczema of mild course: hyperthymic – in 43.75 %; stuck – in 0 %; emotional – in 0 %; meticulous – in 0 %; anxious – in 0 %; cyclothymic – in 0 %; demonstrative – in 6.25 %; excitable – in 0 %; dysthymic – in 6.25 %; exalted type – 6.25 %. In patients with true eczema of severe course: hyperthymic – in 83.33 %; stuck – in 0 %; emotional – in 0 %; meticulous – 5.56 %; anxious – in 0 %; cyclothymic – in 0 %; demonstrative – in 5.56 %; excitable – in 0 %; dysthymic – in 0 %; exalted type – in 11.11 %. In patients with mild microbial eczema: hyperthymic – in 53.57 %; stuck – in 0 %; emotional – in 0 %; meticulous – in 7.14 %; anxious – in 0 %; cyclothymic – in 3.57 %; demonstrative – in 0 %; excitable – in 7.14 %; dysthymic – in 0 %; exalted type – in 7.14 %. In patients with severe microbial eczema: hyperthymic – in 40.00 %; stuck – in 0 %; emotional – in 0 %; meticulous – 10.00 %; anxious – in 0 %; cyclothymic – in 0 %; demonstrative – in 0 %; excitable – in 0 %; dysthymic – in 0 %; exalted type – 10.00 %. Thus, the active use in everyday practice of interviewing and psychological testing of character accentuation are the most important components of adequate assessment of psycho-emotional status of patients with various forms and severity of eczema, which opens prospects for psychoprophylaxis and finding the right ways of correction. Thus, in patients with different forms and severity of eczema, the predominance of accentuation of the nature of the hyperthymic type was established. This allows us to consider this type of accentuation as one of the important criteria for assessing the patient's motivation to see a dermatologist and adherence to treatment, to identify weaknesses in his character, to predict factors that can cause decompensation or psychogenic reactions accompanied by maladaptation.

К ВОПРОСУ О ФАРМАКОЛОГИЧЕСКОЙ ЗАЩИТЕ ПРИ ОБЛУЧЕНИИ В НЕПОРАЖАЮЩИХ ДОЗАХ: ВОЗМОЖНО, НЕОБХОДИМО? СООБЩЕНИЕ 1. ОБЩИЙ ОБЗОР МЕДИКО-ТАКТИЧЕСКИХ И ФЕНОМЕНОЛОГИЧЕСКИХ АСПЕКТОВ

Purpose: Review of modern concepts of the biological effect of ionizing radiation in medium doses on a living organism and the consequences of radiation in order to assess the need for the use of drugs suitable for the purpose of modifying the effects; stimulation of discussion on the issue under consideration. Results: The conditions of origin and the list of possible radiation effects from irradiation at medium doses of the 0.1–1 Gy range were assessed, the scale and phenomenology of the consequences were assessed as a subject of modification by antiradiation agents. Conclusions: Pharmacological support (use of PLC) under conditions of short-term and prolonged irradiation with a low dose rate and in the dose range of 0.2–1 Gy seems to be necessary due to the reality of deterministic effects when the dose limits are exceeded (partly at the premorbid or preclinical level, with pronounced psychogenic reactions – components of the final state), as well as with the possibility of stochastic effects in excess of spontaneous ones, although, according to approximate estimates, with an insignificant frequency.

The most common complications of local anesthesia in pregnant women in dental practice

The article presents the results of a sociological study to identify the variability and frequency of complications caused by the use of local anesthetic drugs in pregnant women at the stomatological appointment. The study was conducted using a Google Forms application based on dental education sites on social media. 155 dentists of various specialties took part in the survey. According to the data obtained, among the doctors participating in the study, 70.3% faced complications of local anesthesia in pregnant women. The most common complications are from the nervous (n=54) and cardiovascular (n=19) systems. Some of them can be attributed to the manifestations of the psychogenic reaction of patients to the introduction of local anesthetic drugs, and not to the immediate undesirable effects of anesthetics. Taking into account the results obtained and the data of literature sources, recommendations are given to prevent the development of complications in pregnant patients from the introduction of local anesthetics. Recommendations can be useful for dentists and dental students.

BRONCHIAL ASTHMA WITH VOCAL CORD DYSFUNCTION DIFFERENTIATED FROM SEVERE ASTHMA BY BRONCHOSCOPY

Although an important cause of vocal cord dysfunction (VCD) is psychogenic reaction, VCD may be associated with severe asthma and must be distinguished from the disease. A 30-years-old woman was admitted to our hospital with dyspnea despite treatment for asthma. Inspiratory stridor and expiratory wheezes were noted, and neck and chest computed tomography showed normal airways and lungs. Fractional exhaled nitric oxide levels were also normal. Pulmonary function test with a flow-volume loop curve showed normal expiratory loop with flattening of the inspiratory loop after methacholine inhalation. During the attack, bronchoscopy revealed the vocal cord closing with stridor during the inspiratory phase. Therefore, the patient was diagnosed with VCD. The dyspnea improved with respiratory rehabilitation and pursed-lip breathing. VCD should be considered in the differential diagnosis of intractable severe asthma. In this case, bronchoscopy and bronchial inhalation challenge with methacholine helped in the diagnosis.

Doctrine of dynamics of psychopathies: phases and psychogenic reactions (from K. Jaspers to P.B. Gannushkin)

The influence of description of the forms of course of mental pathology and systematization of abnormal mental reactions in General Psychopathology of K. Jaspers(1913) on the subsequent development of the concepts of psychopathies dynamics and psychopathic reactions in the works of E. Kretschmer (1918), E. Bleuler (1920), K. Schneider (1927) and especially P.B. Gannushkin (1933) is analyzed. In the notion of personality development K. Jaspers included three components: constitutional growth, forming due to the interactions with the environment (including habits and exercises), mental reactions. The P.B. Gannushkin's description of the dynamics of psychopathies reflects the three-component structure of personality development suggested by K. Jaspers. The distinguished by K. Jaspers three principles of differentiation of mental reactions: according to occasion (including as the reactions to single acute trauma as to repeating chronic mental traumas), according to psychopathological structure, and according to the ground (psychopathic and schizophrenic), found its development in P.B. Gannushkin's clinical descriptions of situational and constitutional reactions and of boundaries between the pathopsychological structure of reactions and different constitutional ground.

Safety evaluation of mass inoculation of 23 valent pneumococcal polysaccharide vaccine among elderly people aged 60 and above in Shanghai from 2013 to 2017

Objective: To evaluate the safety of 23 Valent Pneumococcal Polysaccharide Vaccine (PPV23) among eldly people aged 60 and above in Shanghai. Methods: A total of 1 310 660 monitoring data of adverse events following immunization (AEFI) of PPV23 among people aged 60 and above were collected through the National AEFI Surveillance System from September 14, 2013 to December 31, 2017 in Shanghai. And the descriptive epidemiological methods were used for analysis. Results: 433 cases of AEFI were reported from September 14, 2013 to December 31, 2017, with the incidence rate of AEFI was 33.04/100 000 doses. The general reactions were reported as 392 cases (90.53%), with 17 cases of abnormal reactions (3.93%), 23 cases of coincidences (5.31%) and 1 case of psychogenic reactions (0.23%). The reported incidence rates of general reactions and abnormal reactions of free PPV23 inoculation among elderly people in urban areas were 41.31 per 100 000 doses and 1.91/100 000 doses, respectively, which were higher than those in suburban areas (24.18/100 000 doses, 1.32/100 000 doses) and exurban areas (27.84/100 000 doses, 0.59/100 000 doses). The reported incidence rate of general reaction in females (35.38/100 000 doses) was higher than that in males (24.06/100 000 doses), and the reported incidence rate of abnormal reaction in males (1.58/100 000 doses) was higher than that in females (1.03/100 000 doses). The reported incidence rates of general and abnormal reactions were the highest in 60-64 years old group (62.65/100 000 doses and 4.87/100 000 doses, respectively). In addition, all patients with general reactions or abnormal reactions were better or cured. Conclusion: PPV23 vaccination is safe among people aged 60 and above in Shanghai.

Some questions about the child`s experience of loss crisis (death of the parents – the mother) of primary school age

The article is related to the theoretical analysis of a child of primary school age who is experiencing a crisis of loss, namely the death of a loved one (one of the parents - the mother). The concepts of «grief», «loss crisis», «psychotrauma» and «post-traumatic stress disorder» were also analyzed. We also touched upon the issue of the type of loss crisis during the analysis. Primary school children have a specific emotional sphere for their development - we have considered this issue in more detail in a scientific article. The main reactions of the child to the loss of a loved one are also described. The death of a loved one has a certain individual imprint on the life of any person or child. Therefore, the impact of the death of a loved one on the present and future of the child was considered. Too often, relatives or guardians living with a child misbehave with a younger student, which also affects the child’s emotional state and has a significant impact on his or her personal development. In our work, this problem was also considered as the main cause of the development of a child of primary school age not only depression but also post-traumatic stress disorder, which is a serious intervention for the already vulnerable psyche of the child. Post-traumatic stress disorder (PTSD) in children of primary school age who survived the death of one of the parents – the mother – is considered. The article emphasizes that the emotional sphere in children and adolescents is particularly reactive, so mental trauma (loss crisis) affects them more than adults. However, it is necessary to take into account the smaller depth of feelings, the rapid change of mood in children, due to which psychogenic reactions in them are shorter. We also considered in the article the reasons for the development of post-traumatic stress disorder in children of primary school age. The scientific article considered post-traumatic stress disorder at the emotional, cognitive and behavioral levels in a child of primary school age who has lost a loved one. The article examines children of primary school age with post-traumatic stress disorder who have lost a loved one – the mother, the presence of a negative emotional state (malaise, low activity and poor depressed mood) and the results were confirmed by statistical processing.

Exploring criminal responsibility of PTSD patients; findings from a survey in Chinese Mainland courts

BackgroundThe Wenchuan Earthquake in Sichuan Province is China's deadliest natural disaster in a generation; after such disturbance, a kind of mental illness named post-traumatic stress disorder (PTSD, also called delayed psychogenic reaction) raises concern in Mainland China, but probably not rapidly sufficient. Different from that in the USA, earthquake is both the reason and focus of PTSD research in China. MethodsIn order to find out the relationship between the PTSD defense and criminal responsibility in Mainland China, the authors decided to use certain academic tools and analysis judicial decisions (816 cases). The authors identified key information from government official websites. ResultsData demonstrated that research regarding PTSD increases considerably after the Wenchuan earthquake in 2008. However, data also showed that Chinese courts are hesitant in accepting PTSD as a mental defense for criminals, despite relevant existing rules. Some legal ambiguities, such as lack of procedures or instructions for the connection between diagnosis and judgment, can be observed when courts encounter criminals with PTSD. ConclusionsPTSD patients occur in all races, classes, religions, and nationalities and some would unfortunately be criminals. This pattern reveals concern for the boundary between the reasonable use and abuse of PTSD in view of medico-legal expertise practice. Expert testimony or opinion cannot replace the judges’ decision. Chinese courts should learn from the American Bar Association and accept the three-part analysis for forensic consideration of PTSD. Further details regarding the regulations for resolving the criminal responsibility of PTSD patients should be obtained.

Evaluation of mental and social adaptation of patients with breast cancer.

e23167 Background: In 2018, in the N.N. Petrov National Medical Research Center of Oncology, there was conducted a study of the effectiveness of a mental and social adaptation of patients to the disease and treatment in the framework of The International Classification of Functioning, Disability and Health (ICF). Methods: The patients with breast cancer (n = 28, mean age 31 ±7) were examined at the stages of diagnosis and admission to the hospital. The basis of the study is the «Narcissism Evaluation Test», EORTC QLQ-C30, as well as the following ICF domains: Body function - global psychosocial functions (b122), temperament and personality functions (b126), energy and drive functions (b130), sleep functions (b134), attention functions (b140), psychomotor functions (b147), emotional functions (b152), thought functions (b160), higher-level cognitive functions (b164). Activity and participation- doing housework (d640), family relationships (d760), intimate relationships (d770), acquiring, keeping and terminating a job (d845). Results: The increase in values (7.26–13.61; p < 0.05) on the “Depersonalization” scale indicates an attempt to dissociate from threatening processes in oneself by means of dissociation and splitting, to preserve the coherence of the personality structure. This tendency can be viewed as an attempt by the patient to deny that destabilization affects his personality and lifestyle, which leads to the experience of melancholia as an attempt at destruction of Self-Concept. Such reactions are classified by us within the framework of psychogenic, i.e. conditionally normal in the situation of cancer, however, it was shown that the pathology of “psychogeny” significantly reduces the quality of life and social adaptation. For example, in 11 patients, there is a decrease in the quality of life (62.85; p < 0.05), disturbed sleep, emotions, energy and drive functions (b134, b152, b130), and there are difficulties in the resumption of labor activities (d845). Conclusions: Experiencing the threat to the integrity of Self-Concept launches psychological defenses, as a result of which a rapid regression of Self-Concept occurs before the primary narcissism. Psychogenic reactions during pathologization contribute to the patient’s social and mental maladjustment.

MENTAL DISORDERS AND THEIR INFLUENCE ON THE COMMITMENT TO OBSERVATION IN THE INFECTIONIST IN HIVINFECTED PATIENTS WITH EARLY SYPHILIS

HIV and syphilis have similar epidemiological characteristics which causes a high level of combined infection. Both STDs affect the central nervous system early after infection. Mental disorders occur with a high incidence in HIV-infected patients and patients with syphilis, but data on the effect of combined HIV and syphilis infection on mental disorders are found only in single articles. Objectives. The goal is to study mental disorders and their effect on the commitment to observation in the infectionist in HIV-infected patients with early syphilis. Materials and methods. A comparative study of 148 patients (65 HIV-infected patients with syphilis, 50 patients with syphilis monoinfection, 33 HIV-infected patients, seronegative for syphilis) was carried out. We used clinical, psychopathological, follow-up, psychometric, laboratory and statistical methods of investigation. Results. It was found that mental disorders occur in the majority (83%) of HIV-infected patients with syphilis with the predominance of affective (54%) and addictive (48%) disorders. In HIV-infected patients with early neurosyphilis, psychogenic reactions developed statistically significantly more often than in HIV-infected patients with early syphilis. In contrast, there were no statistically significant differences in the incidence of addictive, affective, personality disorders and mental disorders due to organic brain damage in patients with early neurosyphilis and early syphilis in the case of co-infection with HIV infection. Mental disorders due to organic brain damage had a mixed genesis (including infectious) in all cases and were associated and caused by the already existing HIV infection. HIV-infected patients with syphilis, in general, were characterized by the low commitment to observation in the infectionist which were influenced by the following factors: social maladjustment, drug abuse and criminal activity. Discussion. The frequency of detected mental disorders in the examined HIV-infected patients with syphilis (83,1%) corresponded to the literature on the incidence of mental illness in HIVinfected patients inSt. Petersburg(85,6%), but was higher than the prevalence of mental disorders in patients with syphilis (68%). Given the established influence of neurosyphilis mono-infection on the development of mental disorders due to organic brain damage, it can be concluded that the disease with early neurosyphilis is important in the development of mental disorders of organic genesis. But the weight of this factor is insufficient in case of co-infection with HIV and early neurosyphilis and can only have additional significance in the development of mental disorders and the key factor is HIV-infection action. Mental disorders (addictive disorders and cognitive impairment) adversely affect the commitment to observation in the infectionist of HIV-infected patients with syphilis, therefore timely correction of mental disorders may be one of the factors improving compliance of patients. Conclusions. The study found a minor role of early neurosyphilis (as opposed to HIV infection) on the formation of mental disorders in the case of a combination of these infections. At the same time, it was found that addictive and cognitive symptomatic complexes have a negative impact on the probability of reference to an infectious disease specialist for initiating therapy in HIV-infected patients with syphilis.

The Impact of Clinical Diagnosis and Plaintiff's Award Request on Mock Juror Damage Awards and Injury Perceptions

A total of 250 participants read a case summary and partial transcript including the expert testimony of a neuropsychologist who evaluated the plaintiff for a suspected mild traumatic brain injury (mTBI) in a personal injury trial. There were three diagnostic conditions (organic injury, psychogenic reaction, or malingering) to which participants were randomly assigned, along with two requested award amounts ($10,000 or $5 million). Both pre- and postdeliberation effects emerged for the diagnosis (largest awards for the organic mTBI condition) and for the award request (larger requests resulted in larger awards), with the effect size for award request being substantially larger than the clinical diagnosis. A significant interaction also emerged, whereby the effect of the clinical diagnosis was only present when the award request was large. Thus, factors that are potentially less relevant to pain and suffering (award request) may disproportionately impact mock juror decisions in personal injury trials relative to factors that should be more salient (the expert witness's diagnosis). However, the award request had no impact on mock juror perceptions of the injury's life impact, sympathy for the plaintiff, or perceived plaintiff credibility, but the diagnosis did influence these outcomes. Implications for civil litigation in mTBI trials are discussed.

A case of psychogenic reaction in pediatric patient with anaphylactic-like symptoms induced by ingestion of apple

A case of psychogenic reaction in pediatric patient with anaphylactic-like symptoms induced by ingestion of apple

Allergy to local anesthetics: Reality or myth?

The incidence of allergic reactions to local anesthetics is low. Most cases involve a psychogenic reaction rather than an allergic reaction. Additives and preservatives added to local anesthetics may cause allergic reactions. Vascular resorption of epinephrine-containing local anesthetics may produce cardiovascular signs similar to an allergic reaction. Diagnosis of allergy to local anesthetics must be established by skin testing and provocative challenge.

In Process Citation

Local anaesthetics are an integral part of most dental procedures and are therefore widely used and safely applied. Though rare, complications may occur and can be categorized as local or systemic. In the majority they are of minor nature but there is a potential for severe and possibly lethal side effects. Local complications are nerve damage (mainly the lingual and the inferior alveolar nerve), lesions of vascular structures, hematoma formation, temporary palsy of the facial nerve and post injection pain being the most common local complication. Examples for systemic complications are allergic reactions, cardiovascular complications, intoxication and psychogenic reactions.

Psychogenic Pseudosyncope and Conversion Reactions: Neuroimaging and Management

Psychogenic Pseudosyncope and Conversion Reactions: Neuroimaging and Management

Com­plications in dental local anaesthesia

Local anaesthetics are an integral part of most dental procedures and are therefore widely used and safely applied. Though rare, complications may occur and can be categorized as local or systemic. In the majority they are of minor nature but there is a potential for severe and possibly lethal side effects. Local complications are nerve damage (mainly the lingual and the inferior alveolar nerve), lesions of vascular structures, hematoma formation, temporary palsy of the facial nerve and post injection pain being the most common local complication. Examples for systemic complications are allergic reactions, cardiovascular complications, intoxication and psychogenic reactions.

Near-infrared Spectroscopy to Assess Cerebral Perfusion during Head-up Tilt-table Test in Patients with Syncope.

Neurocardiogenic syncope (NCS) is the most common cause of syncope in children and adolescents. Neurocardiogenic syncope occurs secondary to cerebral hypotension because of bradycardia, hypotension, or both. Head-up tilt-table test (HUTT) is the primary diagnostic test. Near-infrared spectroscopy (NIRS) is a noninvasive technology that directly monitors trends in regional tissue oxygen saturations over a specific body region. Placing an NIRS probe over the temporal region allows an indirect measurement of cerebral perfusion. Our hypothesis is that regional tissue oxygen saturation will decrease during an NCS episode and will remain stable in patients without syncope. The investigators conducted a retrospective review of all HUTT utilizing cephalic NIRS performed at our institution from August 2012 to January 2013. Tests were classified as positive, negative, or psychogenic reactions. Paired t-test was used to determine statistical significance of NIRS changes and one-way analysis of variance was used to analyze baseline characteristics among the three groups. Twelve patients were included in the study (female = 10). The average age was 14.4 years (range: 12-17). Five tests were positive for NCS, four were negative, and three demonstrated psychogenic reactions. Patients with a positive test had a sudden, significant decrease in regional tissue oxygen saturations (P = .009) by an average of 11.3 ± 5.2% compared with baseline. The decrease in regional tissue oxygen saturation preceded symptoms, hypotension, and bradycardia in all patients. Regional tissue oxygen saturation levels remained stable in patients with a negative test or psychogenic syncope. NIRS monitoring during HUTT produces a reliable, positive result that precedes clinical signs and symptoms. Further, it helps distinguish NCS from psychogenic syncope.