AIMS: The relationship between syncope and psychiatric disorders is little investigated. This study evaluated the prevalence of psychiatric diseases and prognostic outcome in patients with recurrent unexplained syncope. METHODS AND RESULTS: After an inconclusive standard diagnostic work-up for syncope, including head-up tilt testing, a psychiatric evaluation was offered to 50 consecutive patients with recurrent syncope. The evaluation was accepted by 26 patients (77% females, 36 +/- 16 years) and refused by 24 (63% females, 50 +/- 19 years). A psychiatric disorder was diagnosed in 21 (81%) patients: 12 had depression, four panic attacks, two general anxiety, and three a somatization disorder. Only five patients showed normal psychosocial function. Of the patients with psychiatric disorders four accepted psychiatric care, such as psychotherapy and/or pharmacotherapy; 17 patients refused treatment. During 6 months of follow-up no patient under psychiatric care had syncope, while all patients without psycho- or pharmacotherapy had recurrent syncopal events. In these patients the median of syncopal episodes was three in a 6 months interval before and after clinical assessment. Patients who refused both psychiatric evaluation and therapy continued to experience syncope as before. CONCLUSIONS: In patients with recurrent unexplained syncope psychiatric alteration is common. However, patients seldom accepted a psychiatric evaluation and treatment.
