Long-term follow-up of psychogenic pseudosyncope

Abstract

Objective: To determine the outcome of patients with psychogenic pseudosyncope (PPS) after communication of the diagnosis.

Methods: This was a retrospective cohort study of patients with PPS referred in 2007 to 2015 to a tertiary referral center for syncope. We reviewed patient records and studied attack frequency, factors affecting attack frequency, health care use, and quality of life using a questionnaire. We explored influences on attack freedom and attack frequency in the 6 months before follow-up for age, sex, education level, duration until diagnosis, probability of diagnosis, additional syncope, and acceptance of diagnosis.

Results: Forty-seven of 57 patients with PPS could be traced, of whom 35 (74%) participated. Twelve (34%) were attack-free for at least 6 months. The median time from diagnosis to follow-up was 50 months (range 6-103 months). Communicating and explaining the diagnosis resulted in immediate reduction of attack frequency (p = 0.007) from the month before diagnosis (median one attack, range 0-156) to the month after (median one attack, range 0-16). In the 6 months before follow-up, the number of admissions decreased from 19 of 35 to 0 of 35 (p = 0.002). The use of somatic and mental health care shifted toward the latter (p < 0.0001). Quality of life at follow-up (Short Form Health Survey 36) showed lower scores for 7 of 8 domains compared to matched Dutch control values; quality of life was not influenced by attack freedom.

Conclusions: After communication of the diagnosis in PPS, attack frequency decreased and health care use shifted toward mental care. Low quality of life underlines that PPS is a serious condition.

Figure 1. Flowchart explaining the number of subjects

PPS = psychogenic pseudosyncope.

Figure 2. Attack freedom and quality of life

The 8 domains of the Short Form Health Survey 36 (SF-36) are shown for those who were and who were not attack-free. The horizontal dotted lines above the bars indicate normal values per domain corrected for age and sex. Vertical bars indicate mean values for those who were not attack-free (n = 23) and those who were attack-free (n = 12). Vertical lines show standard errors. Horizontal bold lines indicate the mean value per domain for the entire psychogenic pseudosyncope (PPS) group (n = 35). BP = body pain; GH = general health; MH = mental health (emotional wellbeing); PF = physical functioning; RE = role emotional; RP = role physical; SF = social functioning; VT = vitality (energy).