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Affections such as psychogenic (functional) pseudosyncope and cataplexy are characterized by transient attacks without impairment of consciousness, but with loss of postural control and unresponsiveness. Therefore, these disorders should be differentiated from syncope and should not be ignored by the cardiologist, who is usually a reference point for patients with syncope or suspected syncope. Clinical findings that suggest psychogenic pseudosyncope include frequent attacks always in the presence of audience, a fall to the ground that may develop slowly enough to allow the patient to stagger and break the fall before hitting the floor, prolonged attacks (>10 min), many psychosomatic symptoms as the clinical context. In most cases, the differential diagnosis should be made with neurally mediated syncope; to this end, tilt test appears to be very useful. Cataplexy is a relevant symptom of narcolepsy; the differential diagnosis between cataplexy and syncope should be made only when symptoms of narcolepsy are mild. Clinical findings that suggest cataplexy include an emotional trigger - above all if the emotion is positive -, an "unreal" fall similar to that observed in patients with psychogenic pseudosyncope, repeated attacks in a daytime, symptoms of narcolepsy as the clinical context. Since cataleptic attacks are triggered by emotion, in most cases the differential diagnosis should be made with vasovagal syncope; a positive emotion as a trigger suggests a cataleptic attack.

At present, syncope is still a matter of great concern and anxiety for both parents and children. Neurocardiogenic syncope is the most common type of syncope in children with an incidence of 70%. It usually has a benign etiology, with rapid loss of consciousness and spontaneous resolution. In case of neurocardiogenic syncope, it is important to assess the emotional and/or adaptive capacity of the patient. From a psychological point of view, the presence of a traumatic area of development has been reported in pediatric patients with syncope. This area is characterized by symptoms of anxiety and/or depression, self-withdrawal, somatic complaints and dissociation. Neurocardiogenic syncope in pediatric age can be the expression of a psychosomatic disorder underlying psychopathological vulnerability.

Background: Based on the relevant literature, the aim of this study was to analyze the psychosocial characteristics of patients with vasovagal syncope and to evaluate these factors as possible etiopathological components., Methods: The study sample consisted of 60 subjects divided as follows: the syncope group (n = 30) and the control group (n = 30, without prominent diseases). The two groups were matched with regard to age, sex, education and civil status. Each participant filled in the Twenty-Item Toronto Alexithymia Scale, acceptance of emotions scale, profile of mood state, attachment style questionnaire, and childhood traumatic events scale., Results: The syncope group showed a higher number of somatic diseases (p < 0.0002) and a higher drug use (p < 0.0001) than the control group. Moreover, the syncope group showed higher scores at the childhood traumatic events scale (p < 0.04) and more difficulties in emotion regulation (p < 0.02). The syncope group also showed higher scores at the need for approval scale (p < 0.0006) and lower scores at the confidence scale (p < 0.02) of the attachment style questionnaire, which reflect an insecure style of relationship with others., Conclusions: A high number of traumatic events in infancy and adolescence, difficulties in the expression of emotions and an insecure style of relationship seem to characterize subjects with vasovagal syncope. These data show that syncope could be at least partiality due to a relational and emotional imbalance that finds expression through the body in the presence of insufficient mental processing. Treatment of this syndrome should therefore take these aspects into consideration.