Syncope: fainting and psychiatric problems were common in young patients.

Clinical bottom line (level 2b)

  1. Young patients with syncope were more likely to have a psychiatric problem or faint. They were more likely to complain of confusion, light-headedness, feeling of faintness or weakness.
  2. Elderly patients with syncope were more likely to have orthostatic hypotension.
Koenig et al: Journal of Internal Medicine 1992; 232: 169-176
Expires October 2004

The study

Prospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: syncope clinic, USA

197 patients (aged mean 53 years, 64% female) unexplained syncope. All patients answered a questionnaire, had a history and physical, orthostatic blood pressure measurements + Holter monitoring, loop ECG, exercise test. unexplained syncope. Three groups were compared:
  • young (aged 16-39; mean 29; 75% female)
  • middle-aged (40-65; mean 55; 36% female)
  • elderly (> 65; mean 75; 28% female)




Outcomes studied:

The evidence


  • diagnosis (%):
    • psychiatric: young 39%; middle-aged 20%; elderly 3.6%; p-value <0.001
    • unknown: young 33%; middle-aged 29%; elderly 44%; p=0.22
    • vasovagal: young 12%; middle-aged 10%; elderly 0%; p=0.04
    • neurological: young 6%; middle-aged 10%; elderly 7%; p=0.63
    • cardiac: young 2.9%; middle-aged 12%; elderly 16%; p=0.04
    • orthostatic: young 1.5%; middle-aged 3%; elderly 12.7%; p=0.01
    • situational: young 3%; middle-aged 9%; elderly 7%; p=0.33
    • medication: young 0%; middle-aged 3%; elderly 3.6%; p=0.31
  • Psychiatric diagnosis if evidence of depression, panic disorder, conversion disorder based on DSM-III criteria.
  • symptoms (%):
    • confusion: young 68%; middle-aged 42%; elderly 24%; p <0.001
    • dizziness: young 63%; middle-aged 49%; elderly 52%; p=0.18
    • pale: young 62%; middle-aged 56%; elderly 47%; p=0.32
    • light-headed: young 61%; middle-aged 42%; elderly 20%; p <0.001
    • aware about to faint: young 59%; middle-aged 37%; elderly 38%; p=0.01
    • weak: young 56%; middle-aged 43%; elderly 30%; p=0.01

Comments

  1. Psychiatric and drug use diagnoses were not assessed using fully standardised methods and may introduce bias.

Citation

  1. Koenig D, Linzer M, Pontinen M, et al: Syncope in young adults: evidence for a combined medical and psychiatric approach. Journal of Internal Medicine 1992; 232: 169-176
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer: Steve Kisely

Clinical Question.
Patient unexplained syncope
Intervention or Exposure age
Outcome psychiatric problems