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Psychogenic pseudosyncope: diagnosis and management.

Vidya Raj1, Ama A Rowe1, Sheryl B Fleisch1

  • 1Department of Psychiatry, Vanderbilt University, Nashville, TN, USA.

Autonomic Neuroscience : Basic & Clinical
|June 3, 2014
PubMed
Summary

Psychogenic pseudosyncope (PPS) mimics fainting but involves no true loss of consciousness, often linked to conversion disorder. Accurate diagnosis through history and tests like HUTT is crucial for appropriate patient management.

Keywords:
Conversion disorderDiagnosisManagementPsychogenic pseudosyncopeSyncope

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Area of Science:

  • Neurology
  • Psychiatry
  • Psychosomatic Medicine

Background:

  • Psychogenic pseudosyncope (PPS) presents as transient loss of consciousness (TLOC) without actual unconsciousness.
  • It is often categorized as conversion disorder, reflecting physical symptoms of psychological stress.
  • PPS is likely underdiagnosed within the unexplained syncope population.

Purpose of the Study:

  • To enhance understanding of PPS epidemiology and diagnosis.
  • To improve recognition and management of this under-investigated disorder.
  • To explore diagnostic methods and treatment considerations for PPS.

Main Methods:

  • Focused patient history taking.
  • Diagnostic investigations including head-up tilt testing (HUTT).
  • Electroencephalogram (EEG), potentially with video, and transcranial Doppler (TCD) in select centers.

Main Results:

  • PPS patients are typically young females experiencing recurrent episodes.
  • Prodromal symptoms like light-headedness, shortness of breath, and tingling are common.
  • Conversion disorder is linked to chronic symptoms, functional impairment, and reduced quality of life.

Conclusions:

  • Accurate diagnosis of PPS is achievable through targeted history and specific investigations.
  • Improved recognition is vital for effective patient management.
  • Psychotherapy is supported by conversion disorder research, with psychotropic medications considered for comorbid psychiatric conditions.