Outcomes of Adolescent Orthostatic Dysregulations in Psychosomatic Medicine

Aims: Orthostatic dysregulation (OD) such as postural orthostatic tachycardia syndrome (POTS) occurs in school-aged children and adolescents. Psychosomatic comorbidities such as migraine, gastrointestinal disorders, and chronic fatigue syndrome are common in patients with OD. OD has a negative impact on school life and QOL, but it remains to be investigated in this age group. To investigate the impact of clinical factors on outcomes of adolescent OD patients in psychosomatic medicine. Methods: A retrospective chart review was performed on adolescent OD patients aged 13-18 years from 2007 to 2016. OD was diagnosed by orthostatic intolerance and active standing tests. Comorbid conditions were diagnosed by certified psychosomatic medicine specialists. Ethical approval was obtained from the Research Ethics Committee of St. Luke's International Hospital. Results: Among 55 participants, 41 were female and mean age was 16.3 years (SD 1.4). Eighteen were transition from pediatricians, and others were adolescent-onset cases within 14.8 months (SD 15.1). Mean durations of illness and treatments were 22.4 (SD 20.1) and 15.2 (SD 18.4) months, respectively. POTS was the most common OD subtype (n=44, 80.0%). Major comorbid mental disorders were eating disorders (n=10, 18.2%), anxiety disorders (n=7, 12.7%) and depressive disorders (n=3, 5.5%). Thirty five participants had functional disorders (19 migraine. 21 functional gastrointestinal disorders, 6 chronic fatigue syndrome, 3 fibromyalgia). Thirty nine participants (70.9%) were clinically improved. Female gender, transition from pediatricians, and family psychoeducation were associated with better outcomes. However, duration of illness, family histories, comorbidities, and medications were not significantly related with clinical outcome. Conclusion: 70% of adolescent OD patients were improved in 2 years after psychosomatic interventions regardless of OD duration, transition, and comorbidities. Family interventions may be an useful treatment for adolescent OD.