Psychiatric disorders in patients with psychogenic cough

Objective: Psychogenic and habit cough are the common terms to refer to a chronic dry cough without evidence of organic base that does not respond to antitussive pharmacotherapy. It has been reported that children with psychogenic cough may have an underlying psychiatric disorder, most commonly conversion disorder (21.9%), followed by mixed anxiety and depressive disorder (12.2%). We aim to investigate underlying psychiatric disorders in patients with psychogenic cough.

Methods: Thirty-eight patients with psychogenic cough (23 males, 15 females, minimum age6, maximum age15, mean age: 9.4±2.9 years) were included in the study. To exclude other medical etiologies, physical examination, blood tests with complete blood count, erythrocyte sedimentation rate, blood chemistry, liver function tests, throat swab culture, pulmonary function tests, allergic profile, and chest X-ray were performed. Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL) was administered to assess psychiatric comorbidities.

Results: The most common psychiatric disorder was tic disorder with a frequency of 23.7%, followed by conversion disorder with the frequency of 21.1%. Other common diagnoses were as follows: separation anxiety disorder (13.2%), anxiety disorder not otherwise specified (13.2%), generalized anxiety disorder (10.5%).

Conclusion: Psychogenic cough was the second-most common cause of chronic cough in children aged 6 to 16 years, which may be due to a high frequency of tic disorders in childhood. Tic disorders were the most common diagnosis in our group, followed by conversion disorder and separation anxiety disorder. Some studies also report psychiatric comorbidities in patients with psychogenic cough. Bhatia et al. reported a 62% rate of psychiatric comorbidity; the most common diagnoses were conversion disorder (22%), mixed anxiety and depressive disorder (12%), and generalized anxiety disorder (10%). Anbar and Hall reported that conversion disorder was diagnosed in 11% and anxiety disorder in 2 % of patients with psychogenic cough. Consistent with these findings, conversion disorder was the second-most common diagnosis in our sample. As a result, differential diagnosis between psychogenic and organic etiology of cough is very important in order to provide psychiatric help and avoid unnecessary medical procedures. Therefore, psychiatric evaluation should be performed for children with chronic cough.