ArticleBrain : a journal of neurology2022
Fear conditioning as a pathogenic mechanism in the postural tachycardia syndrome.
Article in Brain : a journal of neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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16 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Mapping cerebral blood flow in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and orthostatic intolerance: insights from a systematic review.Journal of translational medicine · 2025Pooled it
- Cognitive behavioral therapy, exercise training, and cognitive remediation for patients with post-COVID-19 condition: protocol of an open-label randomized controlled trial.BMC psychology · 2025Trial
- Catecholamine metabolism revisited: from neurochemistry to integrative physiology and pathophysiology.Physiological reviews · 2026Review
- Feasibility and Preliminary Outcomes of a Brain/Body Intervention for Postural Tachycardia Syndrome (POTS): Pilot Trial of POts Reprocessing Therapy (PORT).Research square · 2026Article
- An alternative "Port"? Rationale and development process for POts Reprocessing Therapy (PORT), a brain-body therapy for postural tachycardic syndrome (POTS).Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- The body and the brain keep the score: a data-driven conceptual model linking trauma and postural tachycardia syndrome.Frontiers in psychology · 2026Review
- A systematic review of functional neurological disorder in transgender people.International journal of transgender health · 2026Review
- Visual symptoms in postural tachycardia syndrome: An investigation of position-dependent visual exploration.European journal of neurology · 2025Article
- Pathophysiology of functional neurological disorder for the general neurologist.BMJ neurology open · 2025Review
- Post-COVID dysautonomias: what we know and (mainly) what we don't know.Nature reviews. Neurology · 2024Review
- Linking the Extended Autonomic System with the Homeostat Theory: New Perspectives about Dysautonomias.Journal of personalized medicine · 2024Article
- [Myalgic encephalomyelitis/chronic fatigue syndrome: an overview of current evidence].Der Nervenarzt · 2023Review
- Assessment and Therapeutic Modulation of Heart Rate Variability: Potential Implications in Patients with COVID-19.Journal of cardiovascular development and disease · 2023Review
- Review
- Post-COVID-19 Syndrome is Rarely Associated with Damage of the Nervous System: Findings from a Prospective Observational Cohort Study in 171 Patients.Neurology and therapy · 2022Article
- Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder.Harvard review of psychiatryArticle
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Abstract
Despite its increasing recognition and extensive research, there is no unifying hypothesis on the pathophysiology of the postural tachycardia syndrome. In this cross-sectional study, we examined the role of fear conditioning and its association with tachycardia and cerebral hypoperfusion on standing in 28 patients with postural tachycardia syndrome (31 ± 12 years old, 25 females) and 21 matched controls. We found that patients had higher somatic vigilance (P = 0.0167) and more anxiety (P < 0.0001). They also had a more pronounced anticipatory tachycardia right before assuming the upright position in a tilt-table test (P = 0.015), a physiological indicator of fear conditioning to orthostasis. While standing, patients had faster heart rate (P < 0.001), higher plasma catecholamine levels (P = 0.020), lower end-tidal CO2 (P = 0.005) and reduced middle cerebral artery blood flow velocity (P = 0.002). Multi-linear logistic regression modelling showed that both epinephrine secretion and excessive somatic vigilance predicted the magnitude of the tachycardia and the hyperventilation. These findings suggest that the postural tachycardia syndrome is a functional disorder in which standing may acquire a frightful quality, so that even when experienced alone it may elicit a fearful conditioned response. Heightened somatic anxiety is associated with and may predispose to a fear-conditioned hyperadrenergic state when standing. Our results have therapeutic implications.
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