Psychological and physiological factors associated with tilt table testingfor neurally mediated syncopal syndromes

This study investigated psychological and physiological factors in two grou ps of patients who had tilt table testing for autonomic dysfunction. The fi rst group of 61 patients completed assessments of depression, anxiety, and symptom effects on lifestyle. The 25 patients identified as tilt positive w ere younger (30.5 years) and had higher mean depression scores (7.6) compar ed to the tilt-negative response group (n = 36); the latter averaged 40 yea rs of age and had mean depression scores of 4.6. These differences were sta tistically significant. Women testing tilt positive were significantly more depressed than tilt-negative women (P = 0.02). More severe depressive symp toms were associated with lower blood pressure (BP) (P < 0.05), A second gr oup of 52 patients was monitored during tilt for BP, heart rate (HR), skin temperature (TEMP), skin conductance level (SCL), and forehead muscle tensi on (EMG). Twenty-seven tested positive and 23 were negative. There were sta tistically significant group differences in systolic BP and diastolic BP (P < 0.05), There was a significant interaction between tilt status (positive or negative) and time (P = 0.03) in HR. TEMP increased 2 degrees over time in both groups (P < 0.05), The decrease in SCL from 13.7 to 10.4 <mu>Omega in the tilt-positive response group compared to the slight increase in the tilt-negative group was significantly different (P < 0.05). Identification of psychological factors correlated with BP and physiological changes that accompany decreases in BP in tilt-positive response patients could guide m anagement of patients with autonomic dysfunction.