Psychogenic (habitual) cough
Last reviewed: 23.04.2024
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Most often cough of psychogenic nature is described in patients of childhood and adolescence. Despite the limited number of publications on this issue, in adults, except for the description of one case in the works of S. Freud, there is only one article [Gay M. Et al., 1987], which describes 4 clinical observations. In clinical practice, psychogenic cough is common. As a rule, it can also be one of the clinical manifestations of hyperventilation syndrome.
A psychogenic (habitual) cough - loud, dry, barking, often recalls the cry of wild geese or the sound of an automotive siren. In connection with its resistance to treatment and its duration (months, years), patients often lose their ability to work and social activity. As a rule, sleep is not disturbed. Such patients are usually diagnosed with chronic bronchitis with an asthmatic component, but the therapy, including the administration of hormonal drugs, is ineffective. In some cases, the absence of changes in the lungs with a careful clinical and paraclinical study, the lack of bronchospastic reaction to the test with methacholine, histamine, etc. Force the doctors to diagnose such patients as psychogenic asthma. It should be borne in mind that many years of mistaken treatment of respiratory disorders, the appointment of hormones and other active drugs, bronchoscopy and various inhalations can lead to iatrogenic effects on the part of the respiratory organs, seriously complicating clinical diagnosis.
The complexity of diagnosis of a psychogenic cough is related to the need to establish a psychogenic illness, which often causes difficulties, especially when the patient has no pathological disorders, and the understanding of his illness, as well as the concept of treating doctors and family environment, are oriented to the somatogenic basis.
Careful clinical analysis usually allows you to identify hidden signs of conversion (hysterical) disorders at the time of examination or in the past in patients: transient somatosensory disorders, atactic disorders, disappearance of the voice, signs of "perfect indifference".
Pathogenesis and some mechanisms of symptom formation of psychogenic cough have not been studied in detail until now. In general terms, it should be emphasized that the mechanisms of the conversion series can play a big role in the development of the disease, considering that the cough phenomenon itself can enter into the repertoire of expressive means of non-verbal communication.
Treatment of psychogenic cough in adult patients consists in the conduct of psychotherapy: individual, behavioral, family, etc. At the same time, patients' orientation to a psychosocial understanding of the basics of their illness is of key importance, since the psychogenic treatment of a cough changes the principles of therapy fundamentally. In the complex of therapeutic measures, relaxation techniques, speech therapy , mastery of slow breathing techniques play an important role . Psychotropic agents are shown. In the arsenal of therapeutic effects in childhood and adolescence, such methods of treating psychogenic (habitual) cough as dense tight wrapping of the sheets around the chest for 1-2 days, distracting therapy - electric (shock) blows to the forearm area, slow breathing through growth with the use of a button between the lips, the appointment of tranquilizers, etc.
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