Cyclic vomiting syndrome in a 27-year-old male: A case repor
A 27-year-old average body built normotensive, non-diabetic, non-asthmatic policeman visited the psychiatry out-patient department (OPD) with complaints of post-meal chest tightness followed by vomiting for the last 3 years. He develops chest tightness for about 10–15 minutes after every meal, becomes restless in the pre-emetic phase, and then he vomits. Initially, the episode of vomiting was used to occur once or twice a month and gradually he vomits on daily basis after every meal.

The vomiting is non projectile, non-bilious with less mucous content and the vomitus contains undigested food particles. There is no history of hematemesis, no malena. His food habit is normal and culturally appropriate. He is non-alcoholic, non-smoker, and non-drug abuser. However, he gives a history of taking cannabis for a single episode that gave him an unpleasant experience. However, his sleep is disturbed and inadequate due to the frequently altered day-night shift duty of his job.

He has consulted with numerous consultants and undergone all the most possible routine and special investigations that revealed nothing contributory to the disease. He was hospitalized for diagnosis and further management. Doctors considered migraine, temporal lobe epilepsy, and brain pathology as differential diagnoses. During his hospital stay, we explored his all domains of life, performed all routine and necessary specialized investigations such as computed tomography (CT) of the abdomen, and magnetic resonance imaging (MRI) of the brain. Again his all investigation reports were normal. During the hospital stay repeated mental state examination (MSE) revealed no diagnosable disorder, however, he was found anxious.

Subsequently, a medical board was arranged consisted of a psychiatrist (first author), gastroenterologist, neurologist, neurosurgeon, internal medicine specialist, and endocrinologist to diagnose the case. He was assigned the diagnosis of CVS and prescribed carbamazepine 600 mg daily in divided dose, escitalopram oxalate 10 mg in the morning, and propranolol 20 mg three times daily on basis of the medical board comments. He was suggested taking frequent small meals while avoiding larger ones and regular physical exercise. He was suggested and trained in breath-holding relaxation exercises. As the patient developed chest tightness and vomiting after taking the meal, he was provided unstructured inter-personal psychotherapy to distract his mind from the domino.

During his 1-week hospital stay, he had no episodes of vomiting and discharged to home for further follow-up. A 6-month follow-up revealed that the patient was completely fine and leading a normal healthy life. During this period, the patient has been taking the suggested medications, maintaining sleep hygiene, doing physical, and breath-holding relaxation exercises. However, inter-personal psychotherapy was stopped.

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