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Somatic symptom disorder comorbidity in chronic cough: prevalence, clinical features, and neuroimaging
Tongyangzi Zhang1, Heng Wu2, Haodong Bai1
1Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065, China.
Background:
This study was aimed at exploring the prevalence of somatic symptom disorder (SSD) in patients with chronic cough and comparing SSD comorbid (SSD+) and non-comorbid (SSD-) groups, including sociodemographic, clinical, psychological, and neuroimaging characteristics.
Methods:
A total of 463 patients with chronic cough were enrolled. The structured clinical interview from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was used for SSD diagnosis. Clinical features, cough-related assessment and psychological assessment were used to compare the SSD+ and SSD- groups, while functional magnetic resonance imaging (fMRI) was performed in 24 patients (12 SSD+ and 12 SSD-) for neuroimaging comparisons.
Results:
SSD was diagnosed in 13.8% (64/463) of all enrolled patients. The prevalence of SSD was greater in patients with refractory chronic cough (27.7%) than those with non-refractory chronic cough (7.8%). The SSD+ group had higher levels of capsaicin cough sensitivity (P = 0.016), anxiety (P < 0.001), and depression (P < 0.001), and lower cough-related quality of life scores (P < 0.001), than the SSD- group. Binary logistic stepwise regression indicated that higher anxiety level, female sex, lower cough-related quality of life, and more doctor visits were predictors of SSD diagnosis. Notably, SSD- patients demonstrated enhanced regional neural activity synchronization in the right cerebellum and mid-cingulate cortex, whereas SSD+ patients exhibited diminished spontaneous neural activity in the lingual gyrus (voxel P < 0.001, cluster P < 0.05, FWE corrected).
Conclusion:
SSD was identified in 13.8% of chronic cough patients and in approximately 28% of those with refractory chronic cough. Comprehensive evaluation of psychological in chronic cough patients is essential for early identification and management of SSD comorbidity. Interdisciplinary collaboration, including psychosomatic medicine, may enhance diagnostic accuracy and treatment outcomes in this population.
Trial Registration:
This study was registered in the Chinese Clinical Trials Register ( http://www.chictr.org.cn/ ) (ChiCTR2400079808). Registration date: January 12, 2024.
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