Defining clinical details of psychogenic cough are yet to be solidified, but a sudden onset of a barking or honking cough that appears due to an unknown trigger and its absence during nighttime are proposed as clinical criteria [1]. It is described in individuals of all ages [2] [3] [4], but the pediatric population is most frequently diagnosed with this disorder [2], with some form of emotional stress or anxiety considered as the main cause. Other manifestations (for example fever or weakness) are never observed [5], but the cough may disrupt daily activities and can be severely debilitating for the patient, especially when the diagnosis is delayed because of other suspected etiology [3]. Most recent guidelines, however, dispute the abovementioned clinical manifestations as sufficient to make the diagnosis, as very little evidence exists to support such criteria [1]. In fact, the term psychogenic cough was proposed to be replaced with "somatic cough", given the fact that patients with a presumed diagnosis of a psychogenic cough fulfill the diagnostic criteria for a somatic symptom disorder, such as continuous presence of a symptom that consumes excessive time and energy and high levels of anxiety related to the present symptom [1] [6]. The diagnosis may be even further complicated when a concomitant presence or recent history of other respiratory disorders - asthma or respiratory tract infection, is noted [2] [3] [4].

• Cough

  CONCLUSIONS: Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at [ncbi.nlm.nih.gov]

  Psychogenic cough is most commonly encountered in children and adolescents. A persistent cough due to an unidentifiable cause is the most important symptom. [symptoma.com]

• Suggestibility

  With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. [ncbi.nlm.nih.gov]

  Hypnosis (three studies), suggestion therapy (four studies), and counseling and reassurance (seven studies) were the most commonly used interventions. [mayoclinic.pure.elsevier.com]

• La Belle Indifference

  Tic disorder patients are typically ashamed, anxious, and self-conscious about their tics whereas patients with psychogenic coughs show typical “la belle indifference.” [11] Patients with tic disorder also present with associated motor tics which are [ijpm.info]

• Vocal Tic

  The search terms used were "children" and "vocal tics" or "habit cough," or "psychogenic cough" or "chronic cough." [ncbi.nlm.nih.gov]

  Vocal tic was suspected by a liaison psychiatry service, and treatment with low-dose haloperidol was successful. This case suggests that more attention to tic syndromes is needed before qualifying persistent idiopathic cough as psychogenic. [cambridge.org]

  These coughs have been variously described as habit cough, psychogenic cough, or vocal tic. Referred to as Psychogenic Cough. Nonpharmacological Interventions for Refractory Freiberg, in the Austrian Empire. [fondbust.tk]

  When organic pathology is ruled out, confusion still remains between two entities: SSD and vocal tics (as found in Tourette's syndrome). [ijpm.info]

  Tics are sudden or brief movements ( motor tics ) or sounds ( vocal tics, also known as vocalizations or phonic tics). They are repetitive. [jefflazarusmd.com]

An extensive workup is necessary for patients with a chronic and unexplained cough [7]. The first step is a detailed patient history that can reveal possible triggers (allergens, tobacco, occupational exposure to irritants, or drugs) and assess the onset and progression of the cough [2]. If additional manifestations (fever, productive cough, weakness, nasal discharge, pain, epistaxis, etc) are noted, an infection of the upper respiratory tract, either bacterial or viral, is much more likely. Nevertheless, a thorough physical examination, with an emphasis on the respiratory system (lung auscultation and a proper throat exam, including indirect laryngoscopy), should follow [2], and if the etiology is still not disclosed, several other diagnostic procedures can be performed. Functional lung testing through spirometry, imaging studies (computed tomography) and allergen testing are recommended, but crucial part of workup if psychogenic cough is suspected is an interview with a clinical psychologist [1], which can provide more information about the emotional background of a patient [2] [7]. It is not uncommon for patients to stop coughing after guided counseling sessions [2] [7], further emphasizing the role of a clinical psychologist in evaluating chronic unexplained cough.

• Normal Chest X-Ray

  A normal chest x-ray does not exclude the presence of an inhaled foreign body. Management of acute cough in children The majority of children who present to general practice with acute cough will have a viral URTI. [bpac.org.nz]

1. Vertigan AE, Murad MH, Pringsheim T, et al. Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children: CHEST Guideline and Expert Panel Report. Chest. 2015;148(1):24-31.
2. Niggemann B. How to diagnose psychogenic and functional breathing disorders in children and adolescents. Pediatr Allergy Immunol. 2010;21(6):895-899.
3. McGarvey LP, Warke TJ, McNiff C, Heaney LG, MacMahon J. Psychogenic cough in a schoolboy: evaluation using an ambulatory cough recorder. Pediatr Pulmonol. 2003;36(1):73-75.
4. Oliveira R, Martins V, Moreira C. Psychogenic Cough: A Rare Cause of Chronic Cough. Arch Bronconeumol. 2015;51(11):604-605.
5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Arlington, VA: American Psychiatric Publishing; 2013.
7. Linz AJ, Daniels RW, Fallon LF Jr. Psychogenic cough in an asthmatic child: case report with unusual findings. J Asthma. 2007;44(1):13-18.