Rostrum: How to diagnose psychogenic and functional breathing disorders in children and adolescents

Abstract

Psychogenic and functional breathing disorders are common and affect mostly children and adolescents, resulting in considerable morbidity and contributing significantly to patient and physician cost and frustration. The most common non-organic clinical entities are psychogenic cough, throat clearing tic, sighing dyspnoea, hyperventilation syndrome, and vocal cord dysfunction. Combinations of organic respiratory diseases and psychogenic aspects can coincide. The mainstay of the diagnosis of psychogenic and functional breathing disorders is full and meticulously taken history. A list of possible questions is presented. Furthermore, the value of a thorough physical examination is often underestimated. If a diagnosis cannot be made clear enough by history taking and examination alone, some baseline instrumental diagnostics are meaningful. An interview with an experienced clinical psychologist and a visit at the physiotherapist may add further information in some cases. Criteria, which differentiate psychogenic or functional breathing symptoms from organic ones, include no nocturnal symptoms, mostly no typical trigger factors, symptoms may occur suddenly and even at rest, speaking is possible without problems and there are normal diagnostic results during episodes of symptoms. Intensive efforts should be made to diagnose psychogenic and functional symptoms, because this will reduce or eliminate harm, prevent stigmatization and fixation of symptoms and disease, allow an untroubled life (including sports), and prevent patients from undergoing unnecessary and potentially harmful therapies.