Psychiatric conditions in patients with recurrent unexplained syncope

Aims The relationship between syncope and psychiatric disorders is little i nvestigated. This study evaluated the prevalence of psychiatric diseases an d prognostic outcome in patients with recurrent unexplained syncope. Methods and Results After an inconclusive standard diagnostic work-up for s yncope, including head-up tilt testing, a psychiatric evaluation was offere d to 50 consecutive patients with recurrent syncope. The evaluation was acc epted by 26 patients (77% females, 36 +/- 16 years) and refused by 24 (63% females, 50 +/- 19 years). A psychiatric disorder was diagnosed in 21 (81%) patients: 12 had depression, four panic attacks. two general anxiety, and three a somatization disorder. Only five patients showed normal psychosocia l function. Or the patients with psychiatric disorders four accepted psychi atric care, such as psychotherapy and/or pharmacotherapy; 17 patients refus ed treatment. During 6 months of follow-up no patient under psychiatric car e had syncope, while all patients without psycho- or pharmacotherapy had re current syncopal events. In these patients the median of syncopal episodes was three in a 6 months interval before and after clinical assessment. Pati ents who refused both psychiatric evaluation and therapy continued to exper ience syncope as before. Conclusions In patients with recurrent unexplained syncope psychiatric alte ration is common. However, patients seldom accepted a psychiatric evaluatio n and treatment. (C) 2001 The European Society of Cardiology.