Adjustment Disorder Presenting as Syncope in a Patient With Wolf-Parkinson White Syndrome

Adjustment disorder encompasses maladaptive emotional, behavioral, and physiologic symptomatology that is related to an identifiable psychosocial stressor. Adjustment disorder manifesting as syncope in a patient with Wolf-Parkinson White (WPW) Syndrome is uncommon and has not previously been documented in medical literature. In this case, we discuss a 24-year-old male with a history of WPW who presented with unexplained, episodic syncope in the setting of acute life stressors. A patient with no prior neurologic or psychiatric history was referred to the hospital for more than 15 unexplained syncopal episodes in the preceding week. The patient was confirmed to have WPW based on EKG interpretation, but cardiac work-up, including telemetry, troponins, and orthostatic vital signs, were within normal limits. Additionally, WPW was ruled out as the cause of syncope since there were no cardiac electrophysiologic changes during the syncopal episodes. While in the hospital, the patient had episodic syncopal episodes every three to four hours, with no identified triggers or patterns. A thorough seizure work-up consisting of EEG and neurological consultation was normal. After discussion with psychiatric services, the patient was diagnosed with adjustment disorder in the setting of significant psychosocial stressors following a recent legal arrest. The patient was discharged with escitalopram and was instructed to follow up closely with cardiology for cardiac event monitoring. This case report illustrates the importance of considering psychosocial factors when creating a differential diagnosis for syncope.