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

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. Thank you.

The differential diagnosis is

1. Vasculitis.

2. Seizure disorder.

The probable diagnosis

Major depressive disorder.

Tablet Fluvoxamine 50 mg at night.

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

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. Thank you.

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Saraswat Kumarshri Shriniwas

Experience: 19 + Yrs

Psychiatry

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