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Francis O. Walker, MD; Anthony G. Alessi, MD; Kathleen B. Digre, MD; William T. McLean, MD

Arch Neurol. 1989;46(2):196-200.

Abstract
• Five patients developed recurrent episodes of psychogenic respiratory difficulty that were superimposed on psychogenic neurologic symptoms. Misdiagnosis resulted in long hospital stays, code blue alerts, intubation, mechanical ventilation, and, in one case, tracheostomy. Patients "learned" psychogenic respiratory distress because their breathing symptoms evoked distinct evidence of anxiety in physicians and staff. In these patients, gain was not incidental but exerted primary control over symptom selection. The behavioral mechanisms involved in the pathogenesis of psychogenic respiratory distress have significant implications for its diagnosis, treatment, and prevention.

Author Affiliations
From the Department of Neurology, Wake Forest University Bowman Gray School of Medicine, Winston-Salem, NC (Drs Walker and McLean); the Department of Neurology, University of Utah, Salt Lake City (Dr Digre); and the Department of Neurology, University of Michigan, Ann Arbor (Dr Alessi).

Footnotes
Accepted for publication Sept 15, 1988.

Read in part before the 37th annual meeting of the American Academy of Neurology, Dallas, May 2, 1985.

Reprint requests to Department of Neurology, Wake Forest University Bowman Gray School of Medicine, 300 S Hawthorne Rd, Winston-Salem, NC 27103 (Dr Walker).

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ABSTRACT