CVS

Q: A 22-year-old female is admitted to ICU with severe dehydration and hypotension, requiring IVF fluid resuscitation and low-dose pressors. The patient reports severe episodes of nausea and vomiting. All workup stayed negative. Patient reports similar episodes in the past. Mother reports that the patient prefers hot-water showers during such episodes or rapid drinking of fluids after such episodes. Patient was previously diagnosed with cyclic vomiting syndrome (CVS). CVS is considered a psychiatric disease.

A) True

B) False

Answer: B

CVS is common in children and adults. This is not a psychiatric disease, though many behavioral symptoms, as described in our patient above, may falsely lead people around to believe that it is a psychiatric disorder. Also, its association with migraine, menses and the use of cannabinoids make it a hard-to-diagnose disease. CVS is believed to have underlying mitochondrial and/or autonomic dysfunctions. Also, hyperactivity of the hypothalamic-pituitary-adrenal axis is suspected.

#GI

#psychiatry

References:

1. Li BU, Balint JP. Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder. Adv Pediatr 2000; 47:117.

2. Fleisher DR, Gornowicz B, Adams K, et al. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med 2005; 3:20.

3. Kovacic K, Li BUK. Cyclic vomiting syndrome: A narrative review and guide to management. Headache. 2021 Feb;61(2):231-243. doi: 10.1111/head.14073. Epub 2021 Feb 23. PMID: 33619730.

4. Bhandari S, Jha P, Thakur A, Kar A, Gerdes H, Venkatesan T. Cyclic vomiting syndrome: epidemiology, diagnosis, and treatment. Clin Auton Res. 2018 Apr;28(2):203-209. doi: 10.1007/s10286-018-0506-2. Epub 2018 Feb 13. PMID: 29442203.