Psychogenic Pseudosyncope: Real or Imaginary? Results from a Case-Control Study in (ME/CFS) Patients, 2022, Visser

Abstract
Background and objectives: Orthostatic intolerance (OI) is a clinical condition in which symptoms worsen upon assuming and maintaining upright posture and are ameliorated by recumbency. OI has a high prevalence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Exact numbers on syncopal spells especially if they are on a weekly or even daily basis are not described. Although not a frequent phenomenon, this symptomatology is of very high burden to the patient if present. To explore whether patients with very frequent (pre)syncope spells diagnosed elsewhere with conversion or psychogenic pseudosyncope (PPS) might have another explanation of their fainting spells than behavioral psychiatric disorders, we performed a case–control study comparing ME/CFS patients with and without PPS spells.

Methods and results: We performed a case–control study in 30 ME/CFS patients diagnosed elsewhere with PPS and compared them with 30 control ME/CFS patients without syncopal spells. Cases were gender, age and ME/CFS disease duration matched. Each underwent a tilt test with extracranial Doppler measurements for cerebral blood flow (CBF). ME/CFS cases with PPS had a significant larger CBF reduction at end tilt than controls: 39 (6)% vs. 25 (4)%; (p < 0.0001). Cases had more severe disease compared with controls (chi-square p < 0.01 and had a p = 0.01) for more postural orthostatic tachycardia syndrome in cases compared with controls. PETCO2 end-tilt differed also, but the magnitude of difference was smaller than compared with the CBF reduction: there were no differences in heart rate and blood pressure at either end-tilt testing period. Compared with the test with the stockings off, the mean percentage reduction in cardiac output during the test with compression stockings on was lower, 25 (5) mmHg versus 29 (4) mmHg (p < 0.005).

Conclusions: This study demonstrates that in ME/CFS patients suspected of having PPS, or conversion, CBF measurements end-tilt show a large decline compared with a control group of ME/CFS patients.

Therefore, hypoperfusion offers an explanation of the orthostatic intolerance and syncopal spells in these patients, where it is clear that origin might not be behavioral or psychogenic, but have a clear somatic pathophysiologic background.

https://www.mdpi.com/1648-9144/58/1/98

 

Thank you to these researchers for this study.

However, I couldn't find the case definition they used.

It makes me wonder which definition they used, as they found 30 pwME who do not have syncopal spells.

It is frustrating that there seem to not have been enough studies to convince a notable number of researchers that hypoperfusion is common for pwME. I'm wondering when science will acknowledge this as fact and move on.

 

I still have to read this but well done by these researchers. I'm proud to be a Dutchman!

 

It's so weird that we have to waste resources on Russel's teapot research. I guess this has to be done because some people are obsessed with pushing this nonsense, but there is no need to disprove every single teapot orbiting out there, or even a single one. There has never been any evidence for "psychogenic" anything, a default ideological explanation should not have to be disproved.

Because this won't make a damn bit of difference. BPS ideologues always cherry-pick everything and no one cares that they do that explicitly. "No other explanation" accepts the premise that conversion disorder is a valid explanation when it explicitly uses absence of evidence while pointing at our own "all tests are normal" as evidence where they aren't.

We are literally stuck in doublethink, where "all tests are normal" but the people pushing conversion disorder use the many tests that aren't, eating their cake and having it because chronic medicine is a dysfunctional political disaster.

 

It says that psychogenic pseudosyncope is defined as not being caused by reduced cerebral blood flow. By demonstrating a greater reduction cerebral blood flow in participants who were diagnosed with psychogenic pseudosyncope the authors show that these diagnoses are questionable.

They also say that these diagnoses were given without measuring cerebral blood flow.

 

From the paper, "The diagnosis of ME/CFS was made according to the ME/CFS criteria of the International Consensus Criteria (ICC)"

 

Hi @Andy
Thanks very much.


Interesting the researchers found such a number of pwME who don't have syncopal spells as they term it. My understanding is a very significant number of us have this.

Nonetheless, it will be good to see this study replicated.

 

This follows the fallacious thinking that if tests for other disorders and diseases are negative there is nothing to be found. They deliberately ignore the way more than 2500 abnormalities found in ME. (I stopped counting in about 2015 and a lot more have been discovered since.)