Psychogenic Sneezing

Abstract

Introduction Sneezing is considered to be physiological defense mechanisms against nasal mucosal irritation due to allergy, infection, or local pathology, unusual triggers of sneezing include light, full stomach, sexual ideation, or orgasm. Psychogenic sneezing is a relatively rare entity, first described by Shilkret1 in 1949. Since then it has been accepted clinically and commonly considered as a differential in chronic intractable cases of sneezing. It is more common in adolescents and females appear to be affected more than males2, the individuals do not sneeze while asleep and they sneeze with their eyes open3, generally, the sneezing is refractory to a wide variety of medications but responds well to psychological measures such as psychotherapy, biofeedback, and relaxation exercises4,5. The psychogenic sneezing consists of an aborted or pseudo sneeze and generally has little or no inspiratory phase, short nasal grunting, and little or no aerosolization of the nasal mucous secretions, one can often but not always elicit a significant psychiatric history, and finally, despite the continuous sneezing the physical examination and relevant investigations are normal.6,7 In addition to the psychogenic origin of sneezing it can originate due to allergic, infectious, or local nasal causes,8,9 CNS epilepsy, or vasomotor causes. We are reporting a case of a 9-year-old female who remitted with psychological and pharmacological interventions. Case Report A 9-year-old female was brought to the pediatric OPD by her mother with a chief complaint of transient episodes of sneezing usually 4-5 sneezes associated with throat itching and nose itching for 10 -15 days with no diurnal variation, no seasonal variation. Not accompanied by nasal discharge or cough. There was no dysphagia, vomiting, nausea, or associated throat pain. The sneezing was episodic but did not occur while talking or during sleep. There was no history of allergy, respiratory distress, or skin rashes. There was a history of a family stressor event after which the patient started these episodes of sneezing. Before being referred to the Psychiatry Department the patient was given a trial of antihistamines and steam inhalation sessions. A local examination of the sinuses was done which was normal. The patient complained of pain in both submandibular region which shifted to the submental region on examining the patient 15 minutes apart indicating psychogenic origin. Mental status examination revealed that the child had a sad mood and anxious affect and the symptoms aggravated when the child was afraid of separation from the mother. When the mother was asked to leave the child alone for some time the sneezing episodes would aggravate and then subsides by themselves. The patient was started on low-dose Benzodiazepines to which she responded well in controlling episodes of her sneezing. Discussion The local exam and investigations were normal. In this case, a psychogenic stressor was recognized and once the psychogenic nature of symptoms, their onset (due to underlying stress), and their perpetuation (due to secondary gain) was explained initially to the mother, there was an improvement followed by remission of sneezing. The role of low-dose benzodiazepines lies in reducing underlying anxiety and making the patient more amenable to psychotherapy. There is a role of supportive psychotherapy (i.e., explanation of nature of the illness, suggestion to overcome symptoms) and behavior therapy (reward when there is symptom reduction, aversion therapy, hypnosis, and relaxation)4,5 Commonly, the reported cases of intractable sneezing are psychogenic in nature, particularly in adolescent patients.2-5,7-10 Therefore when confronting such patients this is to be kept in mind, in order to avoid an unnecessary extensive medical evaluation and unneeded medications, parental anxiety, and effect on school performance.2,4,7,9 Finding the specific psychogenic triggering event and avoidance of secondary gain (or attention) can sometimes relieve the symptoms.5,10

Imprint

Aman Singh, Debalina Biswas, Tabish Brar, Amit Beniwal, Vivek Pathak, Brijesh Saran, A. K. Seth . Psychogenic Sneezing. Cardiometry; Issue 25; December 2022; p.1429-1430; DOI: 10.18137/cardiometry.2022.25.14291430; Available from: https://www.cardiometry.net/issues/no25-december-2022/psychogenic-sneezing