Anxiety and Choreiform Disorder in a Patient Incidentally Diagnosed with Brugada Syndrome – a Case Report

Authors: Dr. Christopher Rolé, Dr. Gabriel J. Ellul & Dr. Joseph Cassar

Aims and Hypothesis: To highlight the importance of organic investigations including cardiac monitoring when dealing with patients presenting with treatment refractory anxiety.

Background: Brugada Syndrome is a rare autosomal dominant disorder which can remain asymptomatic for many years, but can be a cause of sudden cardiac death. Since this condition is rare, research into the association of Brugada syndrome and anxiety can proof challenging. We are presenting a case of a 68-year-old gentleman with a history of chronic anxiety who was incidentally diagnosed with Brugada syndrome, the latter condition being itself a contraindication to a vast number of psychiatric drugs, including commonly-prescribed antidepressants.

Methods: Our index case was referred by his psychiatrist for admission at the psychiatric unit of Mater Dei Hospital in view of disabling anxiety and tremor. Despite neurological and biochemical investigations being within normal limits, he was incidentally diagnosed with Brugada syndrome.

Results: The patient’s presentation of tremor and palpitations pose questions on whether symptoms were actually due to the Brugada syndrome itself or due to comorbid anxiety. Yet, given the fact that the patient responded to an increase in venlafaxine dose, it is more likely that symptoms were due to comorbid anxiety. Following formal diagnosis and management of Brugada syndrome, the patient objectively displayed a marked improvement in choreiform movements, with the patient reporting to be free of symptoms for the past few months.

Conclusions: When diagnosing and treating psychiatric conditions, including anxiety, it is important that clinicians and psychiatrists consider the use of biochemical investigations as well as other tests such as routine ECG. Despite being rare, a number of conditions can prove devastating unless identified. In certain conditions, psychiatric treatment may be the cause itself of further morbidity. To our knowledge there is no literature that contraindicates the use of venlafaxine in patients with Brugada syndrome and can therefore be a drug of choice in such cases.

No financial interests declared