Psychiatric profile and attention deficits in postural tachycardia syndrome

Abstract

Objectives: Patients with postural tachycardia syndrome (POTS) often appear anxious and report inattention. Patients with POTS were formally assessed for psychiatric disorders and inattention and compared with patients with attention deficit hyperactivity disorder (ADHD) and control subjects.

Methods: Patients with POTS (n = 21), ADHD (n = 18) and normal control subjects (n = 20) were assessed for DSM-IV psychiatric disorders and completed a battery of questionnaires that assessed depression, anxiety and ADHD characteristics.

Results: Patients with POTS did not have an increased prevalence of major depression or anxiety disorders, including panic disorder, compared with the general population. Patients with POTS had mild depression. They scored as moderately anxious on the Beck Anxiety Inventory but did not exhibit a high level of anxiety sensitivity. Patients with POTS scored significantly higher on inattention and ADHD subscales than control subjects. These symptoms were not present during childhood.

Conclusions: Patients with POTS do not have an increased lifetime prevalence of psychiatric disorders. Although they may seem anxious, they do not have excess cognitive anxiety. They do experience significant inattention which may be an important source of disability.

Figure 1

The Beck Anxiety Inventory (BAI) scores (top panel) and the Anxiety Sensitivity Index (ASI) scores (bottom panel) are shown for the healthy control subjects (normals; solid black), patients with postural tachycardia syndrome (POTS; hashed lines), patients with attention deficit hyperactivity disorder (ADHD; open bar), and published population norms (dark gray). The overall P value is measured using an analysis of variance (ANOVA) for the 3 study groups (not including the published population norms) and paired P values were performed using a post-hoc Scheffe test. Data are presented as mean ± standard error. The differences between the 2 anxiety tools may reflect the inclusion of somatic anxiety symptoms in the BAI, whereas the ASI scores only for cognitive anxiety.

Figure 2

The ADHD Behavior Checklist for Adults Inattention scores are presented for the 3 groups (as outlined earlier) during their childhood (left) and during the last 6 months (right). The overall P value is measured using an analysis of variance (ANOVA) for the 3 groups and paired P values were performed using a post-hoc Scheffe test. Data are presented as mean ± standard error.