From the Guidelines
Psychogenic cough management requires a multidisciplinary approach focusing on behavioral therapy rather than medication, with the most recent and highest quality study suggesting non-pharmacological trials of hypnosis or suggestion therapy for children diagnosed with somatic cough disorder 1. Begin with a thorough medical evaluation to rule out organic causes, then implement suggestion therapy, which involves explaining the non-organic nature of the cough and suggesting it will resolve. Some key points to consider in managing psychogenic cough include:
- Speech therapy techniques are highly effective, including diaphragmatic breathing exercises, relaxation techniques, and cough suppression strategies like sipping water when feeling the urge to cough.
- Cognitive behavioral therapy addresses underlying psychological factors by identifying triggers and developing coping mechanisms.
- Hypnotherapy may help some patients by addressing subconscious patterns.
- In resistant cases, low-dose amitriptyline or gabapentin might be considered for their neuromodulatory effects, though evidence for pharmacotherapy is limited, as noted in earlier studies 1.
- Reassurance and education about the benign nature of the condition are crucial, as anxiety about the cough often perpetuates the cycle.
- Family involvement in therapy improves outcomes, particularly for pediatric patients, with common precipitating or perpetuating factors including school phobia and fear of rejection and need for attention 1. Most patients respond well to these non-pharmacological interventions within 2-4 weeks when consistently applied. It is essential to note that the term "psychogenic" has been replaced by "somatic cough disorder" to be consistent with the DSM-5 classification of diseases, as suggested by the American College of Chest Physicians 1. The current guidelines aim to assist clinicians in managing patients with suspected psychogenic, habit, or tic cough, emphasizing the importance of a thorough evaluation and non-pharmacological interventions 1.
From the Research
Psychogenic Cough Management
- Psychogenic cough is a type of cough without an obvious medical etiology, which is refractory to medical management and considered to have a psychiatric or psychological basis 2
- The term somatic cough syndrome was introduced by the American College of Chest Physicians in 2015 to replace the term psychogenic cough, in order to be consistent with the Diagnostic Statistical Manual of Mental Disorders, 5th edition (DSM-5) 2
- Several pharmacologic and nonpharmacologic therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology, including hypnosis, suggestion therapy, and counseling and reassurance 3
Treatment Options
- Hypnosis was effective in resolving cough in 78% of patients and improving it in another 5% 3
- Suggestion therapy resolved cough successfully in 96% of patients 3
- Counseling and reassurance were also used as interventions, although the effectiveness of these treatments is not as well established 3
- Gabapentin, pregabalin, and speech therapy may be considered for patients with refractory chronic cough 4
Psychological Factors
- Psychomorbidity can be present in chronic cough arising from a variety of etiologies and can impact on symptom perception and clinical management of the condition 2
- Psychological symptoms can also improve after effective treatment of the chronic cough 2
- Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have been used to treat anxiety and depression, which may be comorbid with psychogenic cough 5, 6
- The combination of CBT and SSRIs has been shown to be effective in treating youth with depression and anxiety, although the added value of CBT may occur late in treatment 6