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Article
July 25, 2018

Early outcomes in youth with psychogenic nonsyncopal collapse

August 28, 2018 issue
91 (9) e850-e858

Abstract

Objective

To evaluate several early outcome measures following diagnosis of psychogenic nonsyncopal collapse (PNSC).

Methods

Over a 34-month period, a prospective cohort study was conducted of patients referred for tilt-table evaluation of fainting and orthostatic intolerance. Clinical histories were obtained and anxiety and depressive symptom questionnaires were completed prior to testing. Among 539 patients referred, 100 (18.6%) were diagnosed with PNSC. Outcome data were collected by telephone or during routine follow-up a median of 572 days postdiagnosis.

Results

Eighty-four patients (84%) provided outcome data. Following communication of the diagnosis, 32 patients (38%) had immediate PNSC resolution. Attack resolution occurred in 44% by 1 month, 51% by 6 months, 52% by 12 months, 69% after 12 months, and 31% continued to have PNSC at the time of follow-up. Patients with continued PNSC had higher anxiety scores than patients with immediate resolution (p = 0.047). Following diagnosis, emergency department visits for fainting decreased from 78.6% to 20.2% (p = 0.017), and management by psychology or psychiatry increased from 26.2% to 76.2% (p < 0.001). During the follow-up period, 8 patients (9.5%) were hospitalized for suicidal ideation, a median of 253 (range 33–470) days postdiagnosis; 12 patients (14.3%) developed new (non-PNSC) conversion disorders, a median of 86 (range 9–504) days postdiagnosis. Suicidal ideation was associated with higher anxiety (p = 0.007) but not higher depression scores.

Conclusions

The diagnostic rate of PNSC parallels that of PNES among patients referred for tertiary care evaluations. The improvements in attack frequency following PNSC diagnosis must be tempered by the potential risks of self-harm and the development of new conversion disorders.

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Information & Authors

Information

Published In

Neurology®
Volume 91Number 9August 28, 2018
Pages: e850-e858
PubMed: 30045963

Publication History

Received: January 23, 2018
Accepted: May 25, 2018
Published online: July 25, 2018
Published in print: August 28, 2018

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Geoffrey L. Heyer, MD
From the Division of Pediatric Neurology (G.L.H., L.M.P.), Nationwide Children's Hospital; and Departments of Pediatrics (G.L.H., L.M.P., T.A.C.) and Neuroscience (B.N.K.), The Ohio State University, Columbus.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
(1) Pediatric Stroke and Cerebrovascular Disorders, Demos Medical Publishing, 2012
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Lisa M. Pabst, MD
From the Division of Pediatric Neurology (G.L.H., L.M.P.), Nationwide Children's Hospital; and Departments of Pediatrics (G.L.H., L.M.P., T.A.C.) and Neuroscience (B.N.K.), The Ohio State University, Columbus.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Brady N. Kaucic
From the Division of Pediatric Neurology (G.L.H., L.M.P.), Nationwide Children's Hospital; and Departments of Pediatrics (G.L.H., L.M.P., T.A.C.) and Neuroscience (B.N.K.), The Ohio State University, Columbus.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Tionna A. Coley, RN
From the Division of Pediatric Neurology (G.L.H., L.M.P.), Nationwide Children's Hospital; and Departments of Pediatrics (G.L.H., L.M.P., T.A.C.) and Neuroscience (B.N.K.), The Ohio State University, Columbus.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Heyer [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Geoffrey Heyer conceived of the study, recruited patients, collected/interpreted data, conducted statistical analysis, wrote the first manuscript draft, and approved the final manuscript draft. Lisa Pabst collected/interpreted data, revised the initial manuscript, and approved the final manuscript. Brady Kaucic collected/interpreted data, revised the initial manuscript, and approved the final manuscript. Tionna Coley collected/interpreted data, revised the initial manuscript, and approved the final manuscript.

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Cited By
  1. Syncope and Unresponsiveness in an Adolescent With Comorbid Cardiac Disease: An Illustrative Case Report and Literature Review of Functional Neurologic Symptom Disorder, Journal of the Academy of Consultation-Liaison Psychiatry, 64, 4, (392-402), (2023).https://doi.org/10.1016/j.jaclp.2023.03.006
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  2. Differential Diagnosis Between Psychogenic Pseudosyncope and Vasovagal Syncope in Children: A Quantitative Scoring Model Based on Clinical Manifestations, Frontiers in Cardiovascular Medicine, 9, (2022).https://doi.org/10.3389/fcvm.2022.839183
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  3. The Fainting Assessment Inventory, Journal of Nervous & Mental Disease, 207, 4, (255-263), (2019).https://doi.org/10.1097/NMD.0000000000000952
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  4. Atypical Prodromal Symptoms Help to Distinguish Patients With Psychogenic Nonsyncopal Collapse Among Youth Referred for Fainting, Pediatric Neurology, 95, (67-72), (2019).https://doi.org/10.1016/j.pediatrneurol.2019.02.006
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