Evaluation of psychological fear in children undergoing head-up tilt test
CHU Wei-Hong, WU Li-Jia, WANG Cheng, LIN Ping, LI Fang, ZHU Li-Ping, RAN Jing, ZOU Run-Mei, LIU De-Yu
Department of Pediatric Cardiovascular Diseases, Children's Medical Center, Second Xiangya Hospital of Central South University & Institute of Pediatrics of Central South University, Changsha 410011, China
Abstract Objective To investigate the effects of different tilt angles of head-up tilt test (HUTT) and different responses to HUTT on the psychological fear in children undergoing the test. Methods HUTT was performed on children with unexplained syncope or pre-syncope (107 cases: 52 males and 55 females), aged 5.5-17.8 years (mean 12.0±2.8 years). All subjects were randomly assigned to undergo HUTT at an angle of 60°, 70° or 80°; the negative cases underwent sublingual nitroglycerin-provocation HUTT at the same tilt angle. The Wong-Baker Faces Pain Rating Scale was used for self-assessment of psychological fear in subjects during HUTT at the end point of the test. Results The positive rate, hemodynamic changes and distribution of response types showed no significant differences between children at tilt angles of 60°, 70° and 80° (P>0.05). The greater the tilt angle, the higher the degree of psychological fear in children undergoing the test, but there were no significant differences between them (P>0.05). The degree of psychological fear in children who showed a positive response to HUTT (n=76) was significantly higher than that in children who showed a negative response (n=31) (P<0.01). Conclusions HUTT can cause psychological fear in children undergoing the test, and the degree of psychological fear increases in children tested at tilt angles from 60° to 80°, but the differences have no statistical significance. A positive response to HUTT can significantly increase the psychological fear in children.
Linzer M, Gold DT, Pontinen M, et al. Recurrent syncope as a chronic disease:Preliminary validation of a disease-specific measure of functional impairment[J]. J Gen Int Med, 1994, 9(4): 181-186.
[2]
Cohen TJ, Thayapran N, Ibrahim B, et al. An association between anxiety and neurocardiogenic syncope during head-up tilt table testing[J]. Pacing Clin Electrophysiol, 2000, 23(5): 837-841.
[3]
D'Antono B, Dupuis G, St-Jean K, et al. Prospective evaluation of psychological distress and psychiatric morbidity in recurrent vasovagal and unexplained syncope[J]. J Psychosom Res, 2009, 67(3): 213-222.
[4]
Giada F, Silvestri I, Rossillo A, et al. Psychiatric profile, quality of life and risk of syncopal recurrence in patients with tilt-induced vasovagal syncope[J]. Europace, 2005, 7(5): 465-471.
[5]
Lee SH, Park SJ, Byeon K, et al. Prevalence and clinical factors of anxiety and depression in neutrally mediated and unexplained syncope[J]. Yonsei Med J, 2013, 54(3): 583-589.
Lin J, Wang Y, Ochs T, et al. Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance[J]. Cardiol Young, 2013: 1-5.
Kataoka H. A case of orthostatic tachycardia syndrome presenting with Panic attack during tilt table testing[J]. Cardiology, 2011, 120(2): 91-94.
[10]
Rapee RM, Sanderson WC, McCauley PA, et al. Differences in reported symptom profile between panic disorder and other DSMⅢ-R anxiety disorders[J]. Behav Res Ther, 1992, 30(1): 45-52.
[11]
Sledge WH. Antecedent psychological factors in the onset of vasovagal syncope[J]. Psychosom Med, 1978, 40(7): 568-579.
[12]
McGrady A, Kern-Buell C, Bush E, et al. Psychological and physiological factors associated with tilt table testing for neurally mediated syncopal syndromes[J]. Pacing Clin Electrophysiol, 2001, 24(3): 296-301.
[13]
Novak V, Spies JM, Novak P, et al. Hypocapnia and cerebral hypoperfusion in orthostatic intolerance[J]. Stroke, 1998, 29(9): 1876-1881.
[14]
Linzer M, Pontinen M, Gold DT, et al. Impairment of physical and psychosocial function in recurrent syncope[J]. J Clin Epidemiol, 1991, 44(10): 1037-1043.
[15]
Linzer M, Gold DT, Pontinen M, et al. Recurrent syncope as a chronic disease: preliminary validation of a disease-specific measure of functional impairment[J]. J Gen Int Med, 1994, 9(4): 181-186.
[16]
Ventura R, Maas R, Ruppel R, et al. Psychiatric conditions in patients with recurrent unexplained syncope[J]. Europace, 2001, 3(4): 311-316.
