Psychogenic pseudosyncope (PPS) should be considered in the differential diagnosis
of syncope. It is defined as the appearance of transient loss of consciousness (TLOC)
in the absence of true TLOC. Psychiatrically it is characterized as a somatic symptom
disorder (formerly conversion disorder) and is clinically considered similar to psychogenic
non-epileptic seizures (PNES). Recent functional neuroimaging studies suggest that
these patients are not feigning their symptoms. Patients with PPS usually present
to their cardiologist, neurologist or primary care physician, who may feel uncomfortable
in presenting this diagnosis and managing the patient. The prevalence of PPS is estimated
between 0-8% in patients presenting for syncope evaluations, which is likely an underestimate
as the diagnosis is not actively investigated. Diagnostic clues include the young
female demographic, prolonged apparent TLOC compared with the typical duration of
less than one minute in syncope patients, increasing frequency of episodes, more pre-episode
symptoms such as light-headedness and tingling, and eye closure during episodes. Patients
with somatic symptom disorder are more likely to report a history of physical or sexual
abuse and present with comorbid depression and anxiety disorders. PPS can be accurately
diagnosed with a thorough history, and ancillary investigation with head-up tilt testing
(HUTT), electroencephalogram (EEG) or trans-cranial Doppler (TCD) in selected cases.
While patients can be reluctant to engage in psychiatric care, cognitive behavioral
therapy (CBT) is the evidenced-based treatment of choice. This clinically focused
session will cover the underpinnings, diagnosis and management of PPS.
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© 2015 Published by Elsevier Inc.