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Q. Whom should I consult for my long-term cough?

Answered by
Dr. Kumarshri Shriniwas Saraswat
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 31, 2016 and last reviewed on: Jul 25, 2020

Hi doctor,

I am a college student. Since last years, I feel cough all the time. Before two years, I had cold and fever and since that time I am having cough. I have consulted an ENT specialist regarding this, but nothing happened. I have attached the prescription as well. Earlier, I was able to visualize things very well, but now I am unable to do the same. It is very hard to do the problems now, which I was able to do effortlessly earlier. Whenever I think deep, the cough started coming in my throat. Also, it increases while studying and my eyes starts tearing. I have also consulted with eye specialist regarding this and he advised me power glasses. The thing that happened a minute ago seems like long time ago and my brain sometime suffers to think deep. I am too sensitive. But, I am happy and not depressed. I do yoga and enjoying life. But, some doctors say that I am taking too much stress. Please help.

Dr. Kumarshri Shriniwas Saraswat

Psychiatry Psychologist/ Counsellor Psychotherapy Sexology Sleep Medicine
#

Hello,

Welcome to icliniq.com.

I have gone through your query in detail, the reports (attachment removed to protect patient identity) and have the following observations:

  • Chronic cough not responding to medicines, difficulty thinking (cognitive impairment), memory problems, periods of delirium or confusion that could also be seen in some seizure disorders, difficulty in visualization and excess lacrimation in eyes.
  • These are all neurological symptoms which will require consultation with a neurologist and relevant investigations like brain imaging, EEG, etc., to diagnose the condition.
  • Also, there are lack of energy and laziness. These symptoms are commonly seen in depression. Besides, OCD (obsessive-compulsive disorder) and anxiety are frequent co-morbidities to depression.
  • I see that you also have taken opinion for acne, alopecia and some nutritional issues recently.
  • Involvement of many organs simultaneously (brain, lungs, skin, hair, eyes and gastrointestinal system) could also be suggestive of vasculitis. Ask your doctor about it.
  • If you can consult a rheumatologist online or in person for the same, then it will be even better than consulting a neurologist, in view of all your symptoms.
  • Your ENT examination and prescription papers (attachment removed to protect patient identity) do not show any positive finding. The ENT surgeon has also started you on Censpram (Escitalopram), which is an antidepressant medicine. However, the dose of 5 mg is inadequate for this kind of depression.
  • There is a type of OCD in which you get a recurrent feeling of something stuck in your throat and feel little relieved after coughing. Do let me know if this is similar to what you are experiencing?
  • It would be nice if you can get an MRI scan along with MRI angiography of the brain.
  • I would suggest Fluvoxamine at a dose of 50 mg at night time and follow up after seven days. It is an antidepressant, which has anti-OCD action as well. Consult your specialist doctor, discuss with him or her and take the medicine with consent.

Differential diagnosis:

1. Vasculitis.
2. Seizure disorder.

Probable diagnosis:

Major depressive disorder.

Treatment plan:

Tablet Fluvoxamine 50 mg at night.

Regarding follow up:

Revert back with the reports to a psychiatrist online.---> https://www.icliniq.com/ask-a-doctor-online/psychiatrist


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Thank you doctor,

I just sent the same query to a neurologist and he said that I should consult a psychiatrist as it looks like OCD.

Dr. Kumarshri Shriniwas Saraswat

Psychiatry Psychologist/ Counsellor Psychotherapy Sexology Sleep Medicine
#

Hello,

Welcome back to icliniq.com.

  • OCD has one thought or image or impulse coming repeatedly in mind and some senseless activity done multiple times.
  • You have more than a few complaints and there are symptoms like difficulty visualization, memory problems, difficulty in thinking and confusion.
  • I think visiting a rheumatologist would be more productive, because vasculitis could give rise to different types of neurological symptoms, which do not fit into one neurological condition.

For further doubts consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist


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