Psychological correlates of unexplained syncope: preliminary findings.

Background and Aims. 5-37% of the cases of syncope remain unexplained after a thorough medical evaluation. A psychogenic etiology is seldom investigated and a well-defined relationship between syncope and psychological distress has not yet been established. We aimed to assess psychological profile in patients with medically unexplained syncope. Methods. A consecutive series of 63 patients (mean age=47.9±17.8 years) with syncope of unknown origin underwent to head-up tilt test: 40 subjects presented vasovagal syncope-VVS, 23 unexplained syncope-US. The sample was evaluated by both observer-rated (DSM and DCPR) and self-rated (Symptom Questionnaire-SQ, Psychosocial Index-PSI, Illness Attitude Scale-IAS and Fear Questionnaire-FQ) methods. Differences on diagnoses and questionnaires’ mean scores between VVS and US subjects were analyzed using χ2-test and analysis of variance. Results. Of the 63 patients, 60 had at least one DSM or DCPR diagnosis, such as specific phobia (47.6%), illness denial (22.2%) and demoralization (19%). We found no statistical differences on diagnoses’ distribution between VVS and US patients. However, US group had significantly higher scores on SQ anxiety, depression and hostility (p<.01); worse outcomes on PSI stress (p<.01), well-being (p<.01) and psychological distress (p<.05); lower level of IAS health anxiety (p<.05), higher of nosophobia (p<.05). At the FQ, VVS were more blood (p=.007) and social phobic (p=.003), while US patients had more associated anxiety/depression (p=.039). Conclusion. Despite similar psychopathology, US patients reported higher psychological distress than VVS patients. These findings underline the need to include the evaluation of self-perceived distress in screening patients with US and consider it for effective treatment.