PSYCHIATRIC ILLNESS AND SYNCOPE - 20/09/12
Resumen |
Syncope is a common disorder accounting for up to 3% of emergency department visits and 6% of hospital admissions.4 Although studies have reported a high prevalence of psychiatric illness in patients with syncope,10, 11 fewer than 5% of patients have been assigned psychiatric diagnoses in cohort studies from the 1980s.4, 5, 9, 20, 27 This may be due to lack of standardized assessment for psychiatric illness in the earlier studies. Physicians did not recognize psychiatric illness in half of the patients in one study.10 Thus, there is a need to understand better the association of psychiatric illnesses and syncope. This article reviews the association of psychiatric illness and syncope and provides recommendations for incorporating psychiatric assessment in the evaluation of syncope.
In an evaluation of 414 patients with syncope using Diagnostic Interview Schedule (DIS), a structured interview administered to formulate DSM-III-R diagnosis, the authors found that the prevalence of psychiatric illnesses was highest in the syncope of unknown origin group and lowest in the cardiac syncope group (24.5% and 9.7%, P < .04). The most frequent diagnoses were major depressive disorder (MDD) in 9.9%, general anxiety disorder (GAD) in 7.3%, and alcohol dependence in 6.5% (Table 1).10
Linzer and colleagues14 had 72 patients with syncope evaluated by psychiatrists and found 17 (24%) in whom the cause of the syncope was attributed to a psychiatric disorder. Those patients were reported to have the diagnosis of panic disorder (PD) in 12.5%, MDD in 8.3%, MDD plus panic attacks in 2.8%, and conversion disorder in 2%.
Patients with syncope and psychiatric disorders were younger, had more prodromal symptoms, had a higher number of syncopal episodes in the last 6 to 12 months before evaluation,10, 14, 17 and had a larger number of other complaints.10 In the authors' study, when psychiatric disorders were subdivided into alcohol/substance abuse or psychiatric disorders, multivariate predictors for the former were male gender and age less than 65 years and for the latter having four or more episodes of syncope in the past year and prodromal symptoms before syncope.10
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| Address reprint requests to Wishwa N. Kapoor, MD, MPH, Montefiore University Hospital Suite W933, 200 Lothrop Street, University of Pittsburgh Medical Center, Pittsburgh, PA 15213–2582 |
Vol 15 - N° 2
P. 269-275 - mai 1997 Regresar al número
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- DYSAUTONOMIC AND REFLEX SYNCOPE SYNDROMES
- Blair P. Grubb, Daniel Kosinski
- SYNCOPE IN THE PEDIATRIC PATIENT
- Ronn E. Tanel, Edward P. Walsh
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