Has Psychiatric Treatment Any Role in the Management of Vasovagal Syncope

Patients with recurrent vasovagal syncope frequently display mild to moderate psychiatric disorders, and the presence of psychiatric illness seem to predict the risk of recurrence. Thus, in our opinion, psychiatric evaluation should be included in the clinical management of patients with severe vasovagal syncope, because it may be valuable in identifying which subjects are at high risk of recurrence and really need long-term treatment. Psychiatric and psychological interventions seem to represent a promising treatment, at least in patients with refractory vasovagal syncope and in those with blood/injury phobia. However, before becoming a first-line therapy for most vasovagal fainters, the positive effects of psychiatric treatment need to be verified in larger, randomised and placebo-controlled trials.