Managing psychogenic pseudosyncope: facts and experiences
Open accessAbstract
Psychogenic pseudosyncope (PPS) is a common cause of apparent transient loss of consciousness (TLOC) with a dramatic impact on the quality of life. This review aims to give an overview of the definition, incidence, etiology, diagnosis, treatment, and prognosis of PPS based on a combination of literature data and personal experience. The limited literature on the subject suggests that PPS is relatively common but insufficiently recognized. PPS is probably similar to psychogenic nonepiteptic seizures (PNES), in which a long delay to diagnosis worsens the prognosis. A detailed history is of paramount importance for the diagnosis. The key feature in the history of patients with PPS is the occurrence of frequent, long attacks of apparent TLOC with closed eyes. The diagnosis is certain when a typical event is recorded during a tilt-table test with simultaneous blood pressure (BP), heart rate and video-electroencephalographic recordings. Home video and BP recording during an attack can be very useful. The diagnosis should be communicated to the patient in a way that is clear, understandable and does not cause offense. Although treatment options have not been investigated formally, the literature on PNES suggests that cognitive behavioral therapy is beneficial.
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The diagnosis of PPS rests on positive clues taken from the patient's history and from documenting normal EEG results, HR, or BP during an attack.
“The diagnosis of PPS rests on positive clues taken from the patient's history and from documenting normal EEG results, HR, or BP during an attack.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
The History taking and Conclusions sections support using characteristic history and measurements during an attack to diagnose PPS. But Additional tests specifies that the gold standards for distinguishing PPS from syncope are blood pressure not low enough to cause unconsciousness and a normal EEG during the attack; it does not say that a normal HR, BP, or EEG result alone is sufficient. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInjury does not exclude PNES or PPS.
“Injury does not exclude PNES or PPS.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
In “Diagnosing PPS: History taking” (page not provided), the paper says PPS can cause physical trauma and that the presence of trauma is not diagnostically reliable. This supports the claim for PPS, but the passage does not make the same point about injury in PNES. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is usually no recognisable trigger, and no sweating, pallor, or nausea beforehand in PPS.
“There is usually no recognisable trigger, and no sweating, pallor, or nausea beforehand.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
In “Diagnosing PPS: History taking” (page unavailable), the paper says patients with PPS often report no prodromal features and that extreme pallor is not described. It does not specifically establish that sweating or nausea are absent beforehand, or that attacks usually have no recognisable trigger. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn most cases, the duration of PPS is as short as in syncope, but a much longer duration is a useful diagnostic finding: patients may lie immobile on the floor for 15-30 min.
“In most cases, the duration of PPS is as short as in syncope, but a much longer duration is a useful diagnostic finding: patients may lie immobile on the floor for 15-30 min.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
The History taking section says that longer apparent loss of consciousness helps distinguish PPS from vasovagal syncope, and describes immobile attacks lasting 30 minutes or longer. It does not support the claim that PPS is as short as syncope in most cases; it describes PPS attacks as typically longer. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHBPM can be used to clarify that BP is not low during episodes of PPS.
“Finally, HBPM can be used to clarify that BP is not low during episodes of PPS. 154”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
The attack frequency in PPS is high, with several attacks occurring over a week or in a day.
“The attack frequency is high, with several attacks occurring over a week or in a day.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
The eyes are usually open in epileptic seizures and syncope but are usually closed in psychogenic TLOC.
“The eyes are usually open in epileptic seizures and syncope but are usually closed in psychogenic TLOC.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
PPS is probably insufficiently recognized.
“PPS is probably insufficiently recognized.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [154]
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- Authors
- Tannemaat, M. R., Thijs, R. D., & Van Dijk, J. G.
- Affiliations
- Leiden University Medical Center (NL)
- Venue
- Cardiology Journal
- Publisher
- VM Media Group sp. z o.o
- Published
- 2014-12-18
- Volume
- 21
- Issue
- 6
- Pages
- 658-664
- ISSN
- 1897-5593 (ISSN-L)
- 1898-018X
- OpenAlex
- W2320457362
- Cited by
- 32
- References
- 43
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 2 · 2015: 1
- FWCI
- 0.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cardiology Journal (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- transient loss of consciousness, psychogenic non-epileptic seizures, tilt table test, video electroencephalography, cognitive behavioral therapy, diagnosis, prognosis, patient communication, quality of life
- MeSH terms
- Diagnosis, Differential, Humans, Quality of Life, Unconsciousness, Disease Management, Dystonic Disorders
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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