PSYCHIATRIC ILLNESSES IN PATIENTS WITH SYNCOPE

PURPOSE: To determine the prevalence of psychiatric disorders among patients with syncope; the relationship between psychiatric disorders and the cause of syncope; and the outcome of syncope patients with psychiatric disorders. PATIENTS AND METHODS: In a prospective cohort study in a university-affiliate medical center, hospitalized and ambulatory patients with syncope underwent a standardized medical and psychiatric evaluation consisting of the Diagnostic Interview Schedule (DIS) sections for somatization, panic, generalized anxiety, major depression disorders, and drug and alcohol dependence and abuse disorders. RESULTS: Of 414 patients who completed the DIS, 82 (20%) met the criteria for at least one of the psychiatric disorders or alcohol/drug disorders. Patients with at least one of the four major psychiatric disorders (n = 58) were more likely to report greater than or equal to 4 syncopal events in the past year (odds ratio (OR) 2.5, P <0.04); and to have prodromal symptoms prior to syncopal events (OR 2.4, P <0.04) than were patients without psychiatric disorders. Syncope patients with only alcohol/ drug disorders (n = 24) were more likely to be male (OR 7.7, P <0.001) and younger than 65 years old (OR 4.5, P <0.001) than patients without alcohol/drug disorders. One-year recurrence rate for syncope in patients with any psychiatric diagnosis was 35%, compared to 15% in those without a psychiatric disorder (P <0.0001). Physicians were able to recognize potential psychiatric or alcohol/drug disorders in 70% of patients with more than one psychiatric disorder, but failed to note or treat 60% of the patients with only one of the assessed disorders. CONCLUSIONS: We recommend screening for psychiatric disorders in patients with unexplained syncope, especially in individuals with recurrent syncope and multiple physical symptoms, or for males who are under 65 years of age.