Psychogenic cough


Psychogenic cough

Description, Causes and Risk Factors:

Psychogenic cough is a term designated for cases of chronic cough where there is no apparent organic or physiologic etiology. Despite its being a relatively rare condition, there are data that indicate that psychogenic cough is an underdiagnosed condition, due mainly to health care professionals' unfamiliarity with the disorder.

Psychogenic cough is a barking or honking cough that is persistent and disruptive to normal activity. It may be a debilitating condition of long duration that can significantly interfere with work and social relationships. Although frequency of this condition is low, the condition is not rare. In contrast to cough that are variant of reactive airway disease, there is no objective laboratory evidence of disease. Patients with this condition do not show bronchial constriction on methacholine challenge test or other proactive tests for asthma.

Surprisingly, there are scant basic or clinical data reported on this condition in the adult population. Freud reported the condition in 1 patient and related it to repressed sexual fantasies of an oedipal nature, but there have been no reports in the last 50 years of psychogenic cough in the adult. Although the case reports in the pediatric/adolescent literature have not looked at the psychodynamics involved, they have identified characteristics that suggest conversation disorder.

The behavior of pediatric psychogenic cough patients demonstrates many features consistent with conversation disorder. Many of these children obtain secondary gain by avoiding school remaining at home with the family. About one fourth of the 53 children reported to have chronic cough initially had a respiratory illness such as bronchitis and then developed chronic psychogenic cough, thus providing themselves with a model for the symptoms.

Some children have responded to psychotherapy and minor tranquilizers which suggests associated psychopathology. The available literature contains less information about the presence or absence of somatization disorder, emotional stress before onset of symptoms, disturbed sexuality, or sibling position.

Symptoms:

Psychogenic cough is characterized by a small, harsh tinny type sound, and becomes persistent for weeks to months. The cough is hallmarks are severe frequency, often a cough every 2-3 seconds, and the lack of other symptoms such as fever. The diagnosis is made when the child falls asleep and the cough stops completely. Any other pathologic cough will not totally stop at night. The child can have trouble falling asleep but once asleep will not cough.

Diagnosis:

The diagnosis of psychogenic cough should be considered when:

    Other causes of chronic cough excluded (asthma, Gastroesophageal reflux, etc).

  • The cough is not responding to adequate conventional pharmacotherapy.

Tests:

    Blood tests.

  • Lung function test.

Imaging: Chest x-ray.

Treatment:

Firstly, it is important to recognize that despite the disruptive nature of the cough, and its harsh sound, habit cough is not a dangerous condition, and your child in fact is healthy. Sometimes the simple reassurance that the cough is not serious and will go away helps resolve the symptoms.

Coughing can irritate the airways and lead to more coughing, so it's important to try to break the cycle. The use of cough lollies or a sip of water can help suppress the urge to cough. It is important to give positive reinforcement in the form of praise and positive comments when there is any evidence that the cough is diminishing.

Psychogenic cough is generally a manifestation of a perceived stress or anxiety. Your child might be able to isolate this stress by identifying situations in which the cough gets worse. For example, bullying in the schoolyard and travelling to and from school is a common trigger of psychogenic cough.

If your child is not improving, your doctor may suggest referral to a child psychologist or similar health professional.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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