Intractable hiccups (Singultus) of psychogenic origin- a case report.

Abstract

Hiccups are repeated involuntary, intermittent spasmodic contractions of the diaphragm and inspiratory intercostal muscles which results in sudden inspiration, followed by a sudden closure of the glottis. It is naturally benign, self-limited but maybe most of the time organic in nature and in some cases, chronic, debilitating, and psychogenic. Here, we report a case of a 16-year-old female student who developed hiccups of a psychogenic origin started by stress, which last up to 48 hours sometimes for a month and is successfully treated by antipsychotics haloperidol and psychological interventions. Physicians always face a diagnostic challenge, especially when no identifiable organic cause is elicited. However, such cases are invariably referred for psychiatric evaluation and treatment.

Psychogenic hiccups in an older adult: A case report and literature review

“…Furthermore, a combination of psychological and pharmacological intervention has been reported to have strong effects in causing hiccups to subside in all cases reported in both adults and children. 3 , 4 , 5 , 6 In combination with psychoeducation, a low dose of benzodiazepines has been used to manage intractable hiccups in a 14-year-old boy 8 and in a 20-year-old woman 4 who was administered an antipsychotic agent. The hiccups were entirely resolved in both patients, and no further hiccups were reported in the follow-up period.…”

“…4 , 8 Psychological intervention was not an option in our case because of the patient's age and level of education, which would have affected adherence to such an intervention. The use of antipsychotics such as haloperidol 6 has also been reported to ameliorate psychogenic hiccups. However, chlorpromazine did not show an effect when used with an antidepressant in the same patient.…”

“… Episode 3: Patient was on medications for 8 weeks then gradually tapered off over the next 4 weeks; no further episodes reported in follow up Vaidya 9 Sertraline in the treatment of hiccups 42-year-old divorced African American man Intractable hiccups after a Mallory Weiss lesion of esophagus History of depressive episodes and anxiety symptoms on and off for 15 years; diagnosed with adjustment disorder; history of alcohol abuse but quit 3 years prior 3 years Started on sertraline 50 mg OD and gradually increased to 150 mg OD Reported improvement in depressive symptoms and decrease in hiccups; after gradual increase in sertraline to 150 mg OD for 2 weeks; brief hiccup episodes lasted 1–2 h and were usually associated with meals In 6 month follow up, reported improvement of depressive symptoms and relief of hiccups; after sertraline dose reduction, hiccups returned Nishi and Rajput 5 Intractable hiccups (singultus) in case of anxiety neurosis 40-year-old woman 3–4 episodes per day Anxiety, neurosis; on anti-anxiety and anti-depressants + frequent panic attacks More than 2 months Metoclopramide for 15 days TID + counseling + cognitive behavioral therapy + lifestyle modifications Decrease in intensity of hiccups Siddiqui et al. 6 Intractable hiccups (singultus) of psychogenic origin 16-year-old girl, student in grade 11, socially active Hiccup-like breaths; rate 4–6 times per minutes with regular intervals Initially persistent; lasted for up to 48 h, then slowly became intractable, lasting for more than 1 month Initially escitalopram 10 mg OD, chlorpromazine 50 mg HS for 2 weeks No relief reported with escitalopram and chlorpromazine Subsequently haloperidol 1.5 mg OD, then slowly increased to 1.5 mg BID along with escitalopram 10 mg OD and supportive therapy, such as reassurance, support, psychoeducation, counseling, and relaxation therapy Decreased frequency of hiccups after 1 week; completely subsided after 2 weeks; haloperidol was tapered down and stopped; escitalopram was continued and then stopped after 6 months; psychiatric symptoms and hiccups resolved …”

“…All patients were investigated thoroughly from a medical perspective, and organic causes were excluded. Four of seven cases 3 , 4 , 5 , 6 were treated with a combination of pharmacological and psychological management. Pharmacological treatments included benzodiazepines, antipsychotics, antidepressants, and dopamine antagonists.…”