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Pots syndrome: the importance of organic screening in anxiety patients. Case report

Published online by Cambridge University Press:  01 September 2022

P. Del Sol Calderón*
Affiliation:
Hospital Universitario Puerta de Hierro, Psiquiatría Infanto-juvenil, Madrid, Spain
L. Mallol Castaño
Affiliation:
Hospital Universitario Puerta de Hierro, Psiquiatría Infanto-juvenil, Madrid, Spain
R. Paricio Del Castillo
Affiliation:
Hospital Universitario Puerta de Hierro, Psiquiatría Infanto-juvenil, Madrid, Spain
A. Izquierdo De La Puente
Affiliation:
HOSPITAL UNIVERSITARIO PUERTA DE HIERRO MAJADAHONDA, Psychiatry, MADRID, Spain
M. Garcia Moreno
Affiliation:
HOSPITAL UNIVERSITARIO PUERTA DE HIERRO MAJADAHONDA, Psychiatry, MADRID, Spain
*
*Corresponding author.

Abstract

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Introduction

16-year-old female who starts psychiatric follow-up due to episodes of anxiety crises with dizziness and tremors.

Objectives

To expose a case in which it is essential to rule out organic pathology in cases where there is anxiety and physical symptoms.

Methods

Case report and literature review

Results

The patient explains that she was in a situation of conflict with her ex-partner, commenting that he did not accept the breakup. Sertraline was prescribed in ascending doses up to 100 mg per day with complete remission of anxiety. 8 months later, she went to the emergency room for loss of consciousness and tremor of the lower limbs. She was diagnosed with conversive disorder and was prescribed lorazepam up to 3 mg per day. Since then, there has been a worsening in the frequency of syncope occurring up to 10 times a day, limiting her academic and social life. She was evaluated by a cardiologist who diagnosed Pots Syndrome (postural orthostatic tachycardia syndrome) and started treatment with ivabradine and mineralocorticoids. With this treatment, the episodes were drastically reduced and spaced out to 1-2 per week. The dose of lorazepam is decreased until its withdrawal without worsening of the anxious symptomatology.

Conclusions

This disorder consists of an involvement of the autonomic nervous system in which there is a sudden drop in blood pressure together with an abrupt increase in heart rate. Its treatment is based on increasing blood volume with drugs such as corticosteroids as well as postural measures with adequate water intake.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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