Psychogenic (habitual) coughing

Most often, psychogenic cough is described in patients of childhood and adolescence. Despite the limited number of publications on this problem, in adults, with the exception of a 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 quite common. As a rule, it can also be one of the clinical manifestations of hyperventilation syndrome.

Psychogenic (habitual) cough is loud, dry, barking, often reminiscent of the cry of wild geese or the sound of a car siren. Due to 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 prescription of hormonal drugs, is ineffective. In some cases, the absence of changes in the lungs during a thorough clinical and paraclinical examination, the absence of a bronchospastic reaction to a test with methacholine, histamine, etc. force doctors to diagnose such patients with psychogenic asthma. It is necessary to take into account that many years of erroneous treatment of respiratory disorders, the prescription of hormones and other active drugs, bronchoscopic studies and various types of inhalations can lead to iatrogenic consequences on the part of the respiratory organs, seriously complicating clinical diagnostics.

The complexity of diagnosing a cough of psychogenic origin is associated with the need to establish a psychogenic disease, which often causes difficulties, especially in cases where the patient does not have any pathological disorders, and the understanding of his illness, as well as the concept of the treating doctors and family environment, are oriented towards a somatogenic basis.

A thorough clinical analysis usually allows us to identify hidden signs of conversion (hysterical) disorders in patients at the time of examination or in the past: transient somatosensory disorders, ataxic disorders, loss of voice, the presence of signs of “beautiful indifference”.

The pathogenesis and some mechanisms of symptom formation of psychogenic cough have not been studied in detail to date. In general terms, it should be emphasized that the mechanisms of the conversion series can play a major role in the development of the disease, given that the cough phenomenon itself can be included in the repertoire of expressive means of non-verbal communication.

Treatment of psychogenic cough in adult patients involves psychotherapy: individual, behavioral, family, etc. In this case, the orientation of patients to a psychosocial understanding of the basis of their disease is of key importance, since the psychogenic interpretation of cough radically changes the principles of therapy. In the complex of therapeutic measures, relaxation techniques, speech therapy , and mastering slow breathing techniques play a major role. Psychotropic drugs are indicated. The arsenal of therapeutic effects in childhood and adolescence describes such techniques for treating psychogenic (habitual) cough as tightly wrapping sheets around the chest for 1-2 days, distraction therapy - electrical (shock) shocks to the forearm area, slow breathing through growth using a button between the lips, the appointment of tranquilizers, etc.

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