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Psychogenic Cough

Psychogenic cough is most commonly encountered in children and adolescents. A persistent cough due to an unidentifiable cause is the most important symptom. A detailed patient history and thorough physical examination are most important parts of the diagnostic workup, which must exclude organic causes prior to making the diagnosis.


Presentation

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].

Pathologist
  • Inhalt 17 Chronic Cough in Children 313 Gastrointestinal and Extraesophageal Manifestations 331 19 Juvenile Onset Recurrent Respiratory Papillomatosis 345 20 Primary Ciliary Dyskinesia 353 The SpeechLanguage Pathologists Perspective 377 22 Aspiration[books.google.de]
  • Finally, it is becoming recognized that voice therapy (under guidance from a qualified speech language pathologist or SLP) is beneficial for patients with neurogenic chronic cough.[fauquierent.net]
Cough
  • […] than habit cough or psychogenic cough.[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]
  • Many diseases can cause cough, and several studies have shown asthma among the most common etiologies associated with chronic cough in adult nonsmokers, as well as children.[ncbi.nlm.nih.gov]
  • Objective cough monitoring may therefore improve the evaluation and management of chronic cough.[ncbi.nlm.nih.gov]
  • It is important to include psychogenic cough in the differential diagnosis of persistent or recurrent chronic cough and asthma that is difficult to control and communicate that diagnostic criteria are based on indicative symptoms (cough access only when[ncbi.nlm.nih.gov]
Distractibility
  • When she got distracted and talked, the access decreased, starting again when the word "cough" or similar terms were mentioned in front of her.[ncbi.nlm.nih.gov]
  • One case is unique in the sense that the cough responded to a distracter in the form of a throat lozenge, and this patient consumed or 20 lozenges/day for approximately 13 years.[ncbi.nlm.nih.gov]
  • When she got distracted and talked, the access decreased, starting again when the word “ cough ” or similar terms were mentioned in front of her.[journals.lww.com]
  • Also, the cough may not occur when the child is distracted. Habit cough is not associated with shortness of breath or wheeze. If these symptoms develop, it is likely the cough is related to an underlying disease.[mydr.com.au]
  • Habit cough is completely absent during sleep and usually during distraction, such as when the child is undergoing lung-function testing. Comorbid symptoms are rare and physical examination is entirely normal.[clinicaladvisor.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]
Speech Disorders
  • Clinical forms and templates are included for use in assessing and treating various speech disorders.[books.google.de]

Workup

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]

Treatment

  • She continued treatment with oral codeine for 3 days, showing no relapse.[ncbi.nlm.nih.gov]
  • The treatment of persistent psychogenic cough, a potentially debilitating condition among pediatric patients, can pose diagnostic and treatment dilemmas.[ncbi.nlm.nih.gov]
  • CONCLUSION: Further studies are warranted to study the treatment and outcome of this important psychiatric disorder.[ncbi.nlm.nih.gov]
  • Our success suggests a possible future use of this treatment protocol for cases of psychogenic cough.[ncbi.nlm.nih.gov]
  • OBJECTIVES: To review the literature on habit, tic, and psychogenic cough, and to make evidence-based recommendations regarding diagnosis and treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Monday, 01 June 2009 Anxiety is a significant problem for many patients with respiratory disease and can have a very negative impact on the disease course and prognosis.[bjpcn-respiratory.com]

Etiology

  • Other manifestations (for example fever or weakness) are never observed, 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.[symptoma.com]
  • Many diseases can cause cough, and several studies have shown asthma among the most common etiologies associated with chronic cough in adult nonsmokers, as well as children.[ncbi.nlm.nih.gov]
  • Extensive diagnostic work-up failed to find an organic etiology. Numerous medical and surgical treatments had failed. The patient was treated with a combination of biofeedback-assisted relaxation training, psychotherapy, and physical therapy.[ncbi.nlm.nih.gov]
  • The appropriate use of psychologic consultation, testing, and success with supportive reinforcement therapy confirmed a psychogenic etiology. Extended medical follow-up of the patient concerning cough reoccurrence remains uneventful.[ncbi.nlm.nih.gov]
  • BACKGROUND: Several pharmacologic and nonpharmacologic therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology.[ncbi.nlm.nih.gov]

Epidemiology

  • Studies suggest that in 90% of children with acute upper respiratory tract infections, the cough has settled within 25 days. [ 5 ] Epidemiology Surveys show that parent-reported cough (as an isolated symptom) is common. [ 1 ] Prevalence of chronic cough[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Huxham Jennifer McGinley 347 36 1 Frontal Gait Apraxia: Pathophysiological Mechanisms and Rehabilitation, Robert Iansek Noor H. Ismail Margaret Bruce 363 37 1 Gait Dysfunction in Huntington's Disease: Parkinsonism and a Disorder of Timing.[laurel.lso.missouri.edu]
  • In these cases the cough is frequently dry, but because excess mucus production is part of the pathophysiology of asthma, the cough can become “wet.” All patients with asthma should have a written asthma-management plan in place ( Table 2 ).[clinicaladvisor.com]

Prevention

  • Covering the full spectrum of health conditions seen in the primary care of children, Pediatric Primary Care, 5th Edition emphasizes both prevention and management from the unique perspective of the Nurse Practitioner.[books.google.de]
  • In contrast with cough of organic etiology, there is no clinical or laboratory evidence of disease. 1,2 Efforts to make an early diagnosis will reduce morbidity, prevent fixation of symptoms and avoid unnecessary procedures and therapies. 2 We report[archbronconeumol.org]
  • How to Stop the Anxiety Cough Generally, the best way to stop symptoms of anxiety is to prevent anxiety itself. With coughing though, it's not quite that simple.[calmclinic.com]
  • General Although cough is burdensome, the function of cough serves as a vital defensive mechanism for lung health Cough prevents pulmonary aspiration, promotes ciliary activity and clears airway debris.[kidshealthwa.com]
  • National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart, Lung and Blood Institute. Published August 28, 2007. .[consultant360.com]

References

Article

  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.

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Last updated: 2019-07-11 21:34