Medically unexplained syncope: Relationship to psychiatric illness

Linzer, Mark; Varia, Indira; Pontinen, Michele; Divine, George; Grubb, Blair P.; Estes, N.A. Mark

doi:10.1016/0002-9343(92)90132-u

Cited by 79 publications

(56 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Psychogenic events are amenable to suggestion and can be induced by tilt-table testing. 9,[11][12][13] A clinical suspicion of PPS is a recognized indication for tilt-table testing by the European Society of Cardiology. 3 Herein, we present the semiology of PPS based on the analysis of consecutive episodes of tilt-evoked proven psychogenic apparent TLOC documented with video, EEG, ECG, and blood pressure (BP) measurements.…”

mentioning

confidence: 99%

The semiology of tilt-induced psychogenic pseudosyncope

Tannemaat

Niekerk²,

Reijntjes³

et al. 2013

Neurology

View full text Add to dashboard Cite

Objectives: To provide a detailed semiology to aid the clinical recognition of psychogenic pseudosyncope (PPS), which concerns episodes of apparent transient loss of consciousness (TLOC) that mimic syncope. Methods:We analyzed all consecutive tilt-table tests from 2006 to 2012 showing proven PPS, i.e., apparent TLOC had occurred without EEG changes or a decrease in heart rate (HR) or blood pressure (BP). We analyzed baseline characteristics, video data, EEG, ECG, and continuous BP measurements on a 1-second time scale. Data were compared with those of 69 cases of tilt-induced vasovagal syncope (VVS).Results: Of 800 tilt-table tests, 43 (5.4%) resulted in PPS. The majority (74%) were women. The median duration of apparent TLOC was longer in PPS (44 seconds) than in VVS (20 seconds, p , 0.05). During the event, the eyes were closed in 97% in PPS but in only 7% in VVS (p , 0.0001). A sudden head drop or moving down the tilt table was more common in PPS than in VVS (p , 0.01), but jerking movements occurred more frequently in VVS (p , 0.0001). In PPS, both HR and BP increased before and during apparent TLOC (p , 0.0001).Conclusions: PPS is clinically distinct from VVS and can be diagnosed accurately with tilt-table testing and simultaneous EEG monitoring. Compared with VVS, eye closure during the event, long periods of apparent TLOC, and high HR and BP are highly specific for PPS. Improved understanding of the semiology of PPS as a clinical entity is vital to ensure accurate diagnosis. Neurology â 2013;81:752-758 GLOSSARY BP 5 blood pressure; DBP 5 diastolic blood pressure; HR 5 heart rate; PNES 5 psychogenic nonepileptic seizure; PPS 5 psychogenic pseudosyncope; SBP 5 systolic blood pressure; sMAP 5 smoothed mean arterial pressure; TLOC 5 transient loss of consciousness; VVS 5 vasovagal syncope.Transient loss of consciousness (TLOC) is the reason for approximately 3% of all emergency department visits. 1 The most common major causes of apparent TLOC are syncope, epileptic seizures, and psychogenic events. [2][3][4] The pathophysiology of psychogenic and somatic apparent TLOC is different, but they can be difficult to distinguish clinically.Psychogenic apparent TLOC bears various labels. When episodes involve pronounced movements, they resemble epilepsy and are frequently labeled psychogenic nonepileptic seizures (PNES). 5 Episodes without pronounced movements resemble syncope and are generally labeled psychogenic pseudosyncope (PPS). 3 PNES and PPS are probably manifestations of the same underlying psychiatric disorder, but their different presentation has important consequences for diagnosis. PNES is relatively well known, with a reported prevalence of up to 30% in patients in epilepsy clinics. 5 In contrast, PPS is rarely mentioned in the literature on syncope, and the reported prevalence of PPS in those analyzed for presumed syncope is lower, ranging from 0% to 8%. [6][7][8]

show abstract

mentioning

confidence: 99%

The semiology of tilt-induced psychogenic pseudosyncope

Tannemaat

Niekerk²,

Reijntjes³

et al. 2013

Neurology

View full text Add to dashboard Cite

show abstract

“…Besides, mental stress and particular emotional states facilitate or trigger syncopal episodes in patients with VVS [3, 15]. The prevalence of anxiety and mood disorders in patients with VVS may be as high as 26% [4, 35]. Despite these observations, it is not clear whether psychiatric disorders are consequent to recurrent syncope, or whether they predispose to syncopal episodes.…”

Section: Discussionmentioning

confidence: 97%

“…A high prevalence of ‘minor psychiatric disorders’ (MPDs) has been reported among patients with vasovagal syndrome [4]. Although there are indications that central serotonergic activity participates in the pathogenesis of both psychiatric disorders and VVS [5,6,7,8], it is still unclear whether VVS causes psychiatric morbidity or the psychiatric substrate predisposes to syncopal events.…”

Section: Introductionmentioning

confidence: 99%

Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Leftheriotis

Michopoulos²,

Flevari³

et al. 2008

Psychother Psychosom

View full text Add to dashboard Cite

Background: A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasovagal syncope (VVS). However, the relationship between the psychiatric substrate and syncope remains unclear. Methods: In order to test the hypothesis that MPDs may predispose to VVS, we assessed the prevalence of syncope, the response to head-up tilt test (HUTT) and the efficacy of psychiatric drug treatment in reducing syncopal episodes, in patients with recently diagnosed MPDs. The response to HUTT was compared with that in an equal number of matched (a) patients with VVS and (b) healthy controls. Results: A high rate of patients with MPDs (58%) had a positive HUTT. Additionally, 45% had a history of syncope; among them, the rate of positive HUTT was identical to that in the VVS group (83%). Following psychiatric drug treatment, the number of patients with syncope decreased in the MPD group (6/67 from 30/67, p < 0.01). Psychiatric symptoms and quality of life were also improved. The number of syncopal spells decreased equally in the MPD and VVS groups (0.6 ± 0.5 from 2.5 ± 1.4, p < 0.01, and 0.7 ± 0.5 from 2.7 ± 1.3, p < 0.01, respectively). Conclusion: A high proportion of patients with MPDs experience syncope, associated with a high rate of positive HUTT, comparable to that observed in VVS. Psychiatric treatment results in the improvement of syncopal and psychiatric symptoms. These findings suggest involvement of co-occurring MPDs in the pathogenesis of VVS. Therefore, the diagnosis and treatment of MPDs, when present, may be crucial for the effective therapy of vasovagal syndrome.

show abstract

“…C) Psychiatric disorders may cause syncope. In the past, psychiatric causes of syncope have been felt to be uncommon, occurring only in 1-7 % of patients with syncope [18,19]. This could have been the consequence of the approach to these subjects.…”

Section: Introductionmentioning

confidence: 98%