Telling Fainting Patients It's All in Their Heads

Like psychogenic nonepileptic seizures (PNES), psychogenic pseudosyncope (PPS) can be diagnosed through history and testing (e.g., confirmatory response on a tilt table test) but results in significant disability. Dutch investigators followed 35 patients (69% female; median age, 36) who had received this diagnosis at a tertiary syncope center, where they were initially seen by a neurologist with experience in PPS. At diagnosis, patients were informed that PPS attacks occur involuntarily and indicate an “underlying psychological problem.” If the problem persisted beyond 2 weeks, they were instructed to seek mental health treatment.

Among patients with PPS diagnoses, 57% also had true syncope. During the month before diagnosis, median attack f…