1. *Dissociat
ive
experienc
e
*Trauma
*Anxiety
*Abuse
*Bereave
ment
*Stress
Depressio
n
Anger
Somatisat
ion
Individual
[diagnosed with PS]
?
Psychological factors associated with psychogenic syncope
and psychogenic nonepileptic seizures – a systematic literature review.
Hansen, Bente. S., Frizelle, D., Morley*, C., Department of Psychological Health and Well Being, University of Hull, United Kingdom, *Department of
Cardiology, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom.
Background
Within cardiology, psychogenic syncope (PS) is classed as a non-
traumatic loss of consciousness, and diagnosed as ‘psychogenic’
without a drop in blood pressure, although loss of postural tone, rapid
onset, and complete recovery occurs similar to cardiac related syncope
(European Society of Cardiology Guidelines, [ESC], 2009).
Psychogenic syncope (PS), psychogenic non-epileptic seizures (PNES)
and non-epileptic attack disorder (NEAD) are a group of conditions that
are medically unexplained that have in common a temporary loss of
consciousness. The majority of patients are diagnosed through the
epilepsy route in neurology. Studies have widely acknowledged
psychological distress, depression, and trauma in this patient group.
No research to date has explored the psychological factors across the
unexplained syncope presentations.
Research Question: What are the psychological factors associated
with psychogenic syncope or psychogenic nonepileptic seizures?
The aim of this study was to identify psychological factors and
their impact on people.
Methodology
A systematic review of four databases (PsycINFO, Medline, CINAHL,
Web of Science), in July 2014, identified 11 studies. A narrative
synthesis of data was employed due to diversity of the studies.
Criteria included peer reviewed journals, published between 1989-
2014, age 18+, quantitative and qualitative studies, exclusions were
for example, pharmacological studies, studies without a definition of
psychogenic syncope or a clear medical reason for syncope
presentation. Psychogenic syncope (PS), psychogenic non-epileptic
seizures (PNES) and non-epileptic attack disorder (NEAD), non
epileptic seizures (NES), pseudo-seizures (PS) were included terms.
Abstracts and full texts were assessed, and hand searches were
performed of bibliographies in included studies.
Quality measures employed STROBE (Vandenbrocke et al. 2007),
and inter-rater reliability assessment of the review, which was blindly
rated by an independent assessor.
Results
No literature was identified for PS via cardiology specialisation. There was a sparsity of information on the impact on people’s
lives, environmentally, or socially. However, there appears to be apparent consistency of factors across the PNES, NEAD, PS
(pseudo-seizures) and NES neurology diagnoses. So people who refer through cardiology may experience similar psychological
symptoms to the people who are treated via neurology. It is indicated that less investigated psychological factors such as anger,
bereavement and psychosocial factors may play a key role in patient experience. The findings concur with literature and
importantly suggest that the unexplained syncopal spectrum appears to be homogenous.
Psychological factors ‘verses’ individual experience
Uncertainty
Battlefield
Identity
Disconnected
Figure 1. An illustration highlighting an abstract nature to the concept of psychological factors identified within literature and
the lived experience of people with psychogenic syncope (identified in BS Hansen, 2015)
Conclusions
The clinical relevance of this study is that individuals may have similar healthcare needs across the PS diagnoses spectrum. Clearly,
there is a need for research within the cardiology specialisation in order to ascertain the possible homogeneity of patient’s needs
compared with patients from neurology specialisations. The impact of psychogenic syncope as an experience, coping strategies, and
adjustment, needs further investigation in order to move towards a better understanding and a more holistic healthcare approach.
‘Dissociative syncope’ may be useful as a new diagnostic term to replace the numerous terms that appear to have factors or
‘symptoms’ in common across neurology, and as indicated in cardiology (Hansen, 2015).
References: European Society of Cardiology (2009). The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology. Guidelines for the diagnosis and management of Syncope (2009). European Heart Journal, 30: 2631-2671;
Hansen, B. S., What are the experiences of people diagnosed with psychogenic syncope? (In preparation); Vandenbroucke, J. P., et al., (2007). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for
reporting observational studies. Preventive Medicine: An International Journal Devoted to Practice and Theory, 45, 247-251. Corresponding author: hansenpsychoglogy@gmail.com
PS
Dissociative
experience
 Dissociative experience
 Trauma
 Anxiety
 Abuse
 Bereavement vs
 Stress
 Depression
 Anger
 Somatisation
The individual
[diagnosed with
psychogenic syncope]
?
Discovery of our humanity will occur through mutual openness,
curiosity, intuition and affinity. Then and only then may we
understand ourselves as we really are’ (BSHansen, 2015)