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Tijdschrift voor Psychiatrie 60 (2018) 5, 297 - 305

New research

Long-term follow-up of psychogenic pseudosyncope

D.P. Saal, M.J. Overdijk, R.D. Thijs, I. M. van Vliet, J.G. van Dijk

background Patients with psychogenic pseudosyncope (pps) are frequently seen by neurologists and psychiatrists. As of yet, there has been no follow-up study of patients with pps after communicating the diagnosis.
aim To determine the outcome of patients with psychogenic pseudosyncope (pps) after communicatingthe diagnosis.
method A retrospective cohort study of patients with pps referred to a tertiary referral center for syncope from 2007 to 2015. We reviewed patient records, studying attack frequency, factors possibly affecting attack frequency, health care use and quality of life using questionnaires. We explored influences on absence of attack and attack frequency in the six months before follow-up for age, sex, level of education, duration until a diagnosis was made, probability of diagnosis, additional syncope and acceptance of diagnosis.
results 47 out 57 pps cases could be traced, of these 35 (74%) participated. Twelve (34%) were attack free for at least six months. The median time from diagnosis to follow-up was 50 months (range 6-103 months). Communication and explanation of 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 afterwards (median one attack, range 0-16). In the six months before follow-up the number of admissions decreased from 19/35 to 0/35 (p = 0.002). Furthermore, the demand for somatic health care shifted to psychiatric care (p < 0.0001). Quality of life at follow-up (Short Form Health Survey 36; sf-36) showed lower scores for seven of the eight domains compared to matched Dutch control values. The quality of life was not significantly influenced by absence of attack.
conclusion After communicating the diagnosis of pps, attack frequency decreased and health care use shifted toward mental care. Low quality of life underlines the fact that pps is a serious condition. Improvement of quality of life probably requires both a longer treatment and longer follow-up.

keywords conversion, psychogenic non-epileptic seizures, psychogenic pseudosyncope