If initial basic laboratory test results are normal, patients are stable and the circumstances of the outbreak suggest mass psychogenic illness as the etiology, further testing may not be indicated. Physicians are trained to search for an organic cause of disease, and it can be very difficult to resist pressure to perform increasingly obscure tests in search of an elusive diagnosis, particularly amid the substantial public concern frequently generated by such outbreaks. Females affected disproportionately more often than males. Adolescents and children affected. Patients with psychologic or physical stress affected.
Symptoms spread and resolve rapidly.
Symptoms may include hyperventilation or syncope. Symptoms associated with minimal physical or laboratory findings. Illness may recur with return to environment of initial outbreak. Illness may escalate with vigorous or prolonged emergency or media response. Promptly perform physical examination and basic laboratory testing sufficient to exclude serious acute illness.