CoChat
Sign Up
Cited by 125Cardiovascular Syncope and Autonomic DisordersLong-Term Effects of COVID-19Psychosomatic Disorders and Their Treatments

Cognitive and psychological issues in postural tachycardia syndrome

Open access
Raj, Vidya, Opie, Morwenna, Arnold, Amy C.·2018·Autonomic Neuroscience
DOI 10.1016/j.autneu.2018.03.004PMC PMC6160364
Open this paper in CoChat — free accountOpen PDF

Abstract

Postural tachycardia syndrome (POTS) is one of the most common forms of chronic orthostatic intolerance. In addition to orthostatic symptoms, many POTS patients report incapacitating cognitive dysfunction or "brain fog" even while lying down or seated. Consistent with these subjective reports, there is accruing objective evidence of specific cognitive difficulties in POTS, with studies showing mild to moderate cognitive impairment using standardized neuropsychological assessment batteries. The precise profile of cognitive dysfunction in POTS patients has been shown to vary among these studies potentially due to the neuropsychological tests used, postural position, comorbidities and length of illness, inclusion of adolescent versus adult patients, and sites of recruitment. The extent of the impact that this cognitive challenge has in patients justifies ongoing investigation and research into lifestyle and pharmacological treatments. Psychologically, patients face challenges congruent with many chronic illnesses, perhaps especially early in adjusting to the condition. POTS patients often exhibit mild to moderate depression symptoms as well as symptoms of anxiety disorders. Since even low levels of anxiety can exacerbate symptoms, and a high number of patients experience sub-clinical low mood and sleep disturbances, there is a likely role for psychotherapy in helping control adjustment-related issues, and possibly aberrant physiology, in POTS.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.autneu.2018.03.004

Cites

30 of 30 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • When anxiety questionnaires included autonomic items, POTS patients did not report symptoms of anxiety disorders more often than control groups, unlike when questionnaires excluded autonomic items.

    “previous studies have shown that although POTS patients scored high on a range of anxiety measures; when comparing anxiety questionnaire scores that included autonomic items (such as State-Trait Anxiety Inventory) with those that excluded autonomic items (such as ASI), POTS patients did not report symptoms of anxiety disorders more often than control groups (Raj et al., 2018”

    From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Raj et al., 2018

    Section 2.3 (Anxiety; page unavailable) reports the opposite questionnaire pattern: POTS patients scored as moderately anxious on the Beck Anxiety Inventory, which includes somatic and psychological symptoms, but did not have elevated anxiety on the Anxiety Sensitivity Index, weighted toward psychological symptoms. The section separately reports no increased prevalence of diagnosed anxiety disorders; that finding does not support the claimed reversal of questionnaire results. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • There is extensive evidence that CBT, ACT, and Autogenic Training improve sleep, pain, fatigue, headache, immune function, heart rate variability, and distress in other long-term conditions.

    “There is extensive evidence in support of CBT, Acceptance and Commitment Therapy (ACT) and Autogenic Training for improving sleep, pain, fatigue, headache, immune function, heart rate variability and distress in other long-term conditions”

    From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Raj et al., 2018

    Sections 5.4 and 5.5 report evidence for CBT in chronic conditions, including chronic pain, and describe benefits for psychological stress and functioning. They do not establish the claimed evidence for ACT or Autogenic Training, or for improvements across the full list of outcomes, including immune function and heart rate variability. Page numbers were not available in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 40

  1. [2]Singer W Sletten DM Opfer-Gehrking TL Brands CK Fischer PR Low PA Postural tachycardia in children and adolescents: What is abnormal? J Pediatr 2012 160 222 226 21996154 PMC3258321
  2. [8]Benrud-Larson LM Sandroni P Haythornthwaite JA Rummans TA Low PA Correlates of functional disability in patients with postural tachycardia syndrome: Preliminary cross-sectional findings Health Psychol 2003 22 643 648 14640863
  3. [9]McDonald C Koshi S Busner L Kavi L Newton JL Postural tachycardia syndrome is associated with significant symptoms and functional impairment predominantly affecting young women: A uk perspective BMJ Open 2014 4 e004127 PMC4067814 24934205
  4. [11]Shanks L Jason LA Evans M Brown A Cognitive impairments associated with cfs and pots Front Physiol 2013 4 113 23720636 PMC3655280
  5. [12]Ocon AJ Messer ZR Medow MS Stewart JM Increasing orthostatic stress impairs neurocognitive functioning in chronic fatigue syndrome with postural tachycardia syndrome Clin Sci (Lond) 2012 122 227 238 21919887 PMC3368269
  6. [13]Stewart JM Medow MS Messer ZR Baugham IL Terilli C Ocon AJ Postural neurocognitive and neuronal activated cerebral blood flow deficits in young chronic fatigue syndrome patients with postural tachycardia syndrome Am J Physiol Heart Circ Physiol 2012 302 H1185 1194 22180650 PMC3311460
  7. [14]Ross AJ Medow MS Rowe PC Stewart JM What is brain fog? An evaluation of the symptom in postural tachycardia syndrome Clin Auton Res 2013 23 305 311 23999934 PMC3896080
  8. [15]Masuki S Eisenach JH Johnson CP Dietz NM Benrud-Larson LM Schrage WG Curry TB Sandroni P Low PA Joyner MJ Excessive heart rate response to orthostatic stress in postural tachycardia syndrome is not caused by anxiety J Appl Physiol (1985) 2007 102 896 903 17110507
  9. [19]Umeda S Harrison NA Gray MA Mathias CJ Critchley HD Structural brain abnormalities in postural tachycardia syndrome: A vbm-dartel study Front Neurosci 2015 9 34 25852449 PMC4362313
  10. [20]Khurana RK Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome Clin Auton Res 2006 16 371 377 16915526
  11. [21]Bagai K Song Y Ling JF Malow B Black BK Biaggioni I Robertson D Raj SR Sleep disturbances and diminished quality of life in postural tachycardia syndrome J Clin Sleep Med 2011 7 204 210 21509337 PMC3077350
  12. [22]Lkhagvasuren B Oka T Kawai K Takii M Kanemitsu Y Tokunaga S Kubo C Prevalence of postural orthostatic tachycardia syndrome in patients with psychiatric disorders Psychother Psychosom 2011 80 308 309 21720193
  13. [23]Pederson CL Blettner Brook J Sleep disturbance linked to suicidal ideation in postural orthostatic tachycardia syndrome Nat Sci Sleep 2017 9 109 115 28442939 PMC5396946
  14. [25]Stewart JM Del Pozzi AT Pandey A Messer ZR Terilli C Medow MS Oscillatory cerebral blood flow is associated with impaired neurocognition and functional hyperemia in postural tachycardia syndrome during graded tilt Hypertension 2015 65 636 643 25510829 PMC4326551
  15. [26]Biederman J Spencer T Attention-deficit/hyperactivity disorder (adhd) as a noradrenergic disorder Biol Psychiatry 1999 46 1234 1242 10560028
  16. [28]Charney DS Woods SW Nagy LM Southwick SM Krystal JH Heninger GR Noradrenergic function in panic disorder J Clin Psychiatry 1990 51 Suppl A 5 11 2258377
  17. [30]Eccles JA Owens AP Mathias CJ Umeda S Critchley HD Neurovisceral phenotypes in the expression of psychiatric symptoms Front Neurosci 2015 9 4 25713509 PMC4322642
  18. [31]Rea NA Campbell CL Cortez MM Quantitative assessment of autonomic symptom burden in postural tachycardia syndrome (pots) J Neurol Sci 2017 377 35 41 28477704
  19. [32]Wise S Ross A Brown A Evans M Jason L An assessment of fatigue in patients with postural orthostatic tachycardia syndrome J Health Psychol 2017 22 733 742 26537521
  20. [34]Bagai K Wakwe CI Malow B Black BK Biaggioni I Paranjape SY Orozco C Raj SR Estimation of sleep disturbances using wrist actigraphy in patients with postural tachycardia syndrome Auton Neurosci 2013 177 260 265 23538032 PMC3700681
  21. [35]Mallien J Isenmann S Mrazek A Haensch CA Sleep disturbances and autonomic dysfunction in patients with postural orthostatic tachycardia syndrome Front Neurol 2014 5 118 25071706 PMC4083342
  22. [36]Xu X Huang H Sethi S Zuzuarregui JR Weinberg J Hohler AD A survey based study on sleep disturbance in postural tachycardia syndrome J Neurol Sci 2016 365 199 202 27206906
  23. [37]Pengo MF Higgins S Drakatos P Martin K Gall N Rossi GP Leschziner G Characterisation of sleep disturbances in postural orthostatic tachycardia syndrome: A polysomnography-based study Sleep Med 2015 16 1457 1461 26611942
  24. [38]Bagai K Peltier AC Malow BA Diedrich A Shibao CA Black BK Paranjape SY Orozco C Biaggioni I Robertson D Raj SR Objective sleep assessments in patients with postural tachycardia syndrome using overnight polysomnograms J Clin Sleep Med 2016 12 727 733 26951415 PMC4865560
  25. [39]Miglis MG Muppidi S Feakins C Fong L Prieto T Jaradeh S Sleep disorders in patients with postural tachycardia syndrome Clin Auton Res 2016 26 67 73 26695400
  26. [40]Moriarty O McGuire BE Finn DP The effect of pain on cognitive function: A review of clinical and preclinical research Prog Neurobiol 2011 93 385 404 21216272
  27. [43]Baeza-Velasco C Bourdon C Polanco-Carrasco R de Jouvencel M Gely-Nargeot MC Gompel A Hamonet C Cognitive impairment in women with joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type Rheumatol Int 2017 37 937 939 28180909
  28. [48]Stewart JM Update on the theory and management of orthostatic intolerance and related syndromes in adolescents and children Expert Rev Cardiovasc Ther 2012 10 1387 1399 23244360 PMC3896077
  29. [49]Biringer ERA Lund A A review of modern antidepressants effects on neurocognitive function Curr Psychiatry Rev 2009 5 1 11
  30. [51]Turner DC Clark L Dowson J Robbins TW Sahakian BJ Modafinil improves cognition and response inhibition in adult attention-deficit/hyperactivity disorder Biol Psychiatry 2004 55 1031 1040 15121488
  31. [52]Kpaeyeh J Mar PL Jr Raj V Black BK Arnold AC Biaggioni I Shibao CA Paranjape SY Dupont WD Robertson D Raj SR Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome: A randomized, placebo-controlled trial J Clin Psychopharmacol 2014 34 738 741 25222185 PMC4239166
  32. [53]Smith SM Sonego S Ketcheson L Larson JL A review of the effectiveness of psychological interventions used for anxiety and depression in chronic obstructive pulmonary disease BMJ Open Respir Res 2014 1 e000042 PMC4242084 25478188
  33. [58]Vujanovic AA Zvolensky MJ Bernstein A Feldner MT McLeish AC A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance Behav Res Ther 2007 45 1393 1400 16949030
  34. [60]Roerink ME Lenders JW Schmits IC Pistorius AM Smit JW Knoop H van der Meer JW Postural orthostatic tachycardia is not a useful diagnostic marker for chronic fatigue syndrome J Intern Med 2017 281 179 188 27696568
  35. [63]Kovacs AH Saidi AS Kuhl EA Sears SF Silversides C Harrison JL Ong L Colman J Oechslin E Nolan RP Depression and anxiety in adult congenital heart disease: Predictors and prevalence Int J Cardiol 2009 137 158 164 18707776
  36. [64]Ralston TE Kanzler KE Symptom discrimination and habituation: A case study of behavioral treatment for postural orthostatic tachycardia syndrome (pots) Behav Med 2016 42 57 62 25337949
  37. [66]Knight KM McGowan L Dickens C Bundy C A systematic review of motivational interviewing in physical health care settings Br J Health Psychol 2006 11 319 332 16643702
  38. [67]Alperstein D Sharpe L The efficacy of motivational interviewing in adults with chronic pain: A meta-analysis and systematic review J Pain 2016 17 393 403 26639413
  39. [68]Ma C Zhou Y Zhou W Huang C Evaluation of the effect of motivational interviewing counselling on hypertension care Patient Educ Couns 2014 95 231 237 24530144
  40. [69]Masterson Creber R Patey M Lee CS Kuan A Jurgens C Riegel B Motivational interviewing to improve self-care for patients with chronic heart failure: Miti-hf randomized controlled trial Patient Educ Couns 2016 99 256 264 26358533 PMC4733398

Cited by

Sorted by citations

Authors
Raj, V., Opie, M., & Arnold, A. C.
Affiliations
  • University of Calgary (CA)
  • King's College Hospital NHS Foundation Trust (GB)
  • Pennsylvania State University (US)
Corresponding author
Arnold, Amy C.
ORCID
Arnold, Amy C.
Venue
Autonomic Neuroscience
Publisher
Elsevier BV
Published
2018-12
Volume
215
Pages
46-55
ISSN
1566-0702 (ISSN-L)
DOI
10.1016/j.autneu.2018.03.004
PMC
PMC6160364
OpenAlex
W2795076896
Cited by
125
References
30
Citations by year
2026: 17 · 2025: 21 · 2024: 16 · 2023: 15 · 2022: 20 · 2021: 16 · 2020: 15 · 2019: 2 · 2018: 3
FWCI
2.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Autonomic Neuroscience (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (HL122507)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
postural orthostatic tachycardia syndrome, cognitive impairment, brain fog, orthostatic intolerance, depression, anxiety disorders, sleep disorders, psychotherapy, neuropsychological assessment, adaptation to chronic illness
MeSH terms
Anxiety, Depression, Humans, Postural Orthostatic Tachycardia Syndrome, Cognitive Dysfunction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review