A.W.F.  Hamer*, J. Bradbury, D.  Green, D.M.Toia, D.L. Hare.

Department of Cardiology, Austin & Repatriation Medical Centre, Heidelberg, Victoria.

Background:  Whether chronic psychological factors contribute to neurocardiogenic syncope (NCS) is unclear.  Methods:  70 consecutive patients (pts) aged 53.0 ± 2.1 years (female 39; male 31) with NCS confirmed by tilt table testing (TTT) underwent demographic assessment and psychological testing, hypothesising that NCS pts would have personalities characterised by anxiety, irrespective of acute anxiety, and more depressed mood than comparable groups.  At least 3 months after TTT, current state & chronic (trait) anxiety were separately measured using the Spielberger State/Trait Anxiety Inventory.  Depressed mood was assessed by the Cardiac Depression Scale. Symptom duration and frequency, interference with life style and response to treatment were assessed using Likert Scales.  Results:  (mean ± SD, Pearson Correlation with 2-tailed significance) 84% of pts were highly educated, "white collar" occupational class. Acute (State) anxiety (44.0 ± 9.3) was comparable to general medical/surgical (GMS) patients (42.4 ± 13.8), but well below anxious psychiatric pts (49.0 ± 11.6).  However chronic (trait) anxiety (49.0 ± 8.4) was much higher than GMS pts (41.9 ± 12.7) and similar to anxious psychiatric pts (48.1 ± 10.7.  Depression scores (85.0 ± 23.4) were much higher than post myocardial infarction. coronary surgery pts (66.2 ± 19.9, even exceeding chronic heart failure pts (80.5 ± 22.4).  In males (only) trait anxiety was associated with symptom interference (r² = 0.50, p=0.004) and frequency (r² = 0.53, p=0.002); good response to treatment was negatively associated with depression (r² = 0.066, p=0.008).  Conclusion:  Regardless of gender, chronic anxiety and depression are characteristic in pts with NCS.  In males however, these psychological factors also contribute to interference of lifestyle by symptoms and poor response to treatment.

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