Early outcomes in youth with psychogenic nonsyncopal collapse

Area of Science:

• Neurology
• Psychiatry
• Clinical Medicine

Background:

• Psychogenic nonsyncopal collapse (PNSC) is a diagnosis of exclusion often presenting with fainting.
• Early outcome measures and associated risks following PNSC diagnosis require further evaluation.

Purpose of the Study:

• To assess early outcomes and identify risk factors after diagnosing psychogenic nonsyncopal collapse (PNSC).

Main Methods:

• A prospective cohort study of 539 patients referred for tilt-table evaluation.
• 100 patients diagnosed with PNSC; outcome data collected a median of 572 days postdiagnosis.
• Anxiety and depressive symptom questionnaires administered prior to testing.

Main Results:

• 38% of patients experienced immediate PNSC resolution; 69% resolved within 12 months.
• Continued PNSC was associated with higher anxiety scores (p=0.047).
• Emergency visits for fainting decreased significantly post-diagnosis (78.6% to 20.2%, p=0.017); psychological management increased (26.2% to 76.2%, p<0.001).
• 9.5% hospitalized for suicidal ideation, associated with higher anxiety (p=0.007). 14.3% developed new conversion disorders.

Conclusions:

• PNSC diagnosis improves attack frequency but carries risks of self-harm and new conversion disorders.
• Higher anxiety scores are linked to poorer outcomes and suicidal ideation.
• Careful monitoring and psychological support are crucial for patients diagnosed with PNSC.