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The prevalence of psychiatric disease in emergency department patients with unexplained syncope

Abstract

Current data suggest that up to 60 % of patients presenting to the emergency department with syncope leave the hospital without a defined etiology. Prior studies suggest a prevalence of psychiatric disease as high as 26 % in patients with syncope of unknown etiology. The objective of this study was to determine whether psychiatric disease is associated with an increased incidence of syncope of unknown etiology. Prospective, observational, cohort study of consecutive ED patients >18 presenting with syncope was conducted from 6/03 to 7/06. Patients were queried in the ED and charts reviewed for a history of psychiatric disease and use of psychiatric medication. Data were analyzed using SAS v9.2 with Fisher’s exact tests. We enrolled 518 patients who presented to the ED after syncope, 161 (31 %) did not have an identifiable etiology for their syncopal event; 166 patients (32 %) had a history of or current psychiatric disease. Among men with psychiatric disease, 37 % had an unknown etiology of their syncopal event, compared to 23 % of men without psychiatric disease (p = 0.04). However, among women with syncope of unknown etiology, there was no significant difference between those with and without psychiatric disease (34.4 vs. 32.7 %) with p = 0.77. Our results suggest that men with psychiatric disease have an increased incidence of syncope of unknown etiology. Given this relationship, clinicians might consider screening for psychiatric disorders in syncopal patients when no clear etiology can be identified.

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References

  1. Lamb LE, Green HC, Combs JJ, Cheeseman SA, Hammond J (1960) Incidence of loss of consciousness in 1980 air force personnel. Aeromed Acta 31:973–988

    CAS  Google Scholar 

  2. Murdoch BD (1980) Loss of consciousness in healthy South African men: incidence, causes and relationship to EEG abnormality. S Afr Med J 57:771–774

    PubMed  CAS  Google Scholar 

  3. Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W (2003) Prevalence and triggers of syncope in medical students. Am J Cardiol 91:1006–1008

    PubMed  Article  Google Scholar 

  4. Williams RL, Allen PD (1962) Loss of consciousness. Incidence, causes and electroencephalographic findings. Aeromed Acta 33:545–551

    CAS  Google Scholar 

  5. Savage DD, Corwin L, McGee DL, Kannel WB, Wolf PA (1985) Epidemiologic features of isolated syncope: the Framingham study. Stroke 16:626–629

    PubMed  Article  CAS  Google Scholar 

  6. Ganzeboom KS, Mairuhu G, Reitsma JB, Linzer M, Wieling W, van Dijk N (2006) Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35–60 years. J Cardiovasc Electrophysiol 17:1172–1176

    PubMed  Article  Google Scholar 

  7. Sarasin FP, Louis-Simonet M et al (2001) Prospective evaluation of patients with syncope: a population-based study. Am J Med 111:177–184

    PubMed  Article  CAS  Google Scholar 

  8. Farwell DJ, Sulke AN (2004) Does the use of a syncope diagnostic protocol improve the investigation and management of syncope? Heart 90:52–58

    PubMed  Article  CAS  Google Scholar 

  9. Linzer M, Varia I, Pontinen M, Divine GW, Grubb BP, Estes NA (1992) Medically unexplained syncope: relation to psychiatric illness. Am J Med 92:18S–25S

    PubMed  Article  CAS  Google Scholar 

  10. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  11. Ventura R, Maas R, Rüppel R, Stuhr U, Schuchert A, Meinertz T, Nienaber CA (2001) Psychiatric conditions in patients with recurrent unexplained syncope. Europace 3:311–316

    PubMed  Article  CAS  Google Scholar 

  12. Kapoor WN (1995) Work up and management of patients with syncope. Med Clin North Am 79:1153–1170

    PubMed  CAS  Google Scholar 

  13. Olshansky B, Grubb B (Eds) (2005) Syncope: mechanisms and management, 2nd edn. Wiley-Blackwell, Malden, pp 214–217

  14. Kapoor WN, Fortunato M, Hanusa BH et al (1995) Psychiatric illnesses in patients with syncope. Am J Med 99:505–512

    PubMed  Article  CAS  Google Scholar 

  15. Kapoor WN (1983) A prospective evaluation and follow-up of patients with syncope. N Engl J Med 309:197–204

    PubMed  Article  CAS  Google Scholar 

  16. Lipsitz LA (1983) Syncope in the elderly. Ann Intern Med 99:92–105

    PubMed  Article  CAS  Google Scholar 

  17. Linzer MF, Felder A, Hackel A et al (1990) Psychiatric syncope: a new look at an old disease. Psychomatics 31:181–188

    Article  CAS  Google Scholar 

  18. McGrady A, Kern-Buell C, Bush E, Khuder S, Grubb BP (2001) Psychological and physiological factors associated with tilt table testing for neutrally mediated syncopal syndromes. Pacing Clin Electrophysiol 24:296–301

    PubMed  Article  CAS  Google Scholar 

  19. Barrett-Connor E, Palinkas LA (1994) Low blood pressure and depression in older men: a population based study. BMJ 308:446–449

    PubMed  Article  CAS  Google Scholar 

  20. Grossman SA, Shapiro NI, Lee LL et al (2005) Women and syncope: impact of gender on the frequency and etiology of elderly patients presenting to the Emergency Department with Syncope. J Gerontol A Biol Sci Med Sci 60:1202–1205

    PubMed  Article  Google Scholar 

  21. Anson O, Carmel S, Levin M (1991) Gender differences in the utilization of emergency room services. Women Health 17:89–103

    Google Scholar 

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Correspondence to Shamai Aron Grossman.

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Wiener, Z., Shapiro, N.I., Chiu, D.TW. et al. The prevalence of psychiatric disease in emergency department patients with unexplained syncope. Intern Emerg Med 8, 427–430 (2013). https://doi.org/10.1007/s11739-013-0946-6

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  • DOI: https://doi.org/10.1007/s11739-013-0946-6

Keywords

  • Psychiatric
  • Syncope
  • Unexplained emergency