100 - Delusional, Obsessive-Compulsive, and Factitious Skin Diseases

Question 1

It is estimated that approximately _____ of patients seeking treatment of skin complaints have associated psychological stress or psychiatric disease

Answer 1

One-third

Question 2

Primary skin diseases that can be precipitated or exacerbated by psychosocial stress

Answer 2

Psychophysiologic skin disorders

Question 3

Skin diseases are also known to lead to and/or exacerbate psychiatric disorders such as anxiety and depression

Answer 3

Secondary psychiatric disorders

Question 4

Underlying psychiatric component that causes self-induced physical findings on the skin

Answer 4

Primary psychiatric disorders

Question 5

Conditions in which the patient has various abnormal sensation so n the skin, such as itching, burning, stinging, biting, and crawling, in the absence of any diagnosable dermatologic, neurologic, medical, or psychiatric diagnosis

Answer 5

Cutaneous sensory disorders

Question 6

Psychophysiologic skin disorders

Answer 6

Psoriasis
Atopic dermatitis
Acne vulgaris
Seborrheic dermatitis
Hyperhidrosis
Lichen simplex chronicus

Question 7

Primary psychiatric skin disorders

Answer 7

Delusional disorders
Obsessive-compulsive and related disorders
Factitious disorders

Question 8

Secondary psychiatric disorders

Answer 8

Anxiety
Depression
Social phobia

Question 9

Cutaneous sensory disorders

Answer 9

Cutaneous dysesthesia
“Central” pruritus
Formication

Question 10

Characterized by the presence of usually one fixed, false belief
By definition, lack insight

Answer 10

Delusional skin disorders

Question 11

False, fixed belief that one is infested with living organisms or inanimate materials in the absence of objective proof

Answer 11

Delusions of parasitosis

Question 12

Variant of delusions of parasitosis

Fixed belief that there are fibers or solid material extruding from the skin

Answer 12

Morgellons disease

Question 13

Specimens are brought in various containers, such as in an empty matchbox or Ziploc bags, which is referred to as the

Answer 13

Matchbox sign
Ziploc sign
Specimen sign

Question 14

In some patients, there is no ideation of infestation, in which case the patient has a diagnosis simply of

Answer 14

“Formication”

Question 15

Y/N: Patients with a shorter duration of active delusion have an increased probability of achieving remission following treatment

Answer 15

Yes

Question 16

Most studied pharmacologic agent for the treatment of delusions of parasitosis

Answer 16

Antipsychotic agent pimozide

Question 17

Notable adverse effects of pimozide

Answer 17

Extrapyramidal symptoms such as akathisia (restlessness) and pseudoparkinsonian symptoms
QT prolongation

Question 18

Most studied atypical antipsychotic agent for delusions of parasitosis

Answer 18

Risperidone

Question 19

Risperidone is (more/less) likely to induce extrapyramidal symptoms than pimozide

Answer 19

Less

Question 20

Side effects of risperidone

Answer 20

Galactorrhea

Question 21

Adverse effect of olanzapine

Answer 21

Significant weight loss

Question 22

Adverse effect of aripiprazole

Answer 22

Akathisia or agitation

Question 23

Preoccupation with body odor that is not perceived by others

Answer 23

Delusion of bromosis

Question 24

Intrusive thoughts or urges that are experienced as unwanted

Answer 24

Obsession

Question 25

Repetitive behaviors or rituals to help alleviate the otherwise intolerable anxiety

Answer 25

Compulsion

Question 26

Somatoform disorder characterized by preoccupation with a nonexistent or minor physical flaw

Answer 26

Body dysmorphic disorder

Question 27

Two efficacious treatments in body dysmorphic disorder

Answer 27

High-dose selective serotonin reuptake inhibitors | Cognitive behavioral therapy

Question 28

Formerly known as trichotillomania

Answer 28

Hair pulling disorder

Question 29

Patient eats the hair root

Answer 29

Trichorhizophagia

Question 30

Whole hair is eaten

Answer 30

Trichophagia

Question 31

GI hairballs

Answer 31

Trichobezoars

Question 32

Most common comorbidity observed in approximately 40% of patients with hair pulling disorder

Answer 32

Depressive disorder

Question 33

Dermoscopy findings in hair pulling disorder

Answer 33

``` Irregular broken hairs V-sign Flame hairs Hair powder Coiled hairs ```

Question 34

2 or more hairs emerging from 1 follicular unit are broken at the same length

Answer 34

V-sign

Question 35

Semitransparent, wavy, cone-shaped hair residues

Answer 35

Flame hairs

Question 36

Sprinkled hair residue

Answer 36

Hair powder

Question 37

Hair pulling disorder presents histologically as

Answer 37

``` Increased number of catagen hairs Traumatized hair bulbs in the absence of perifollicular inflammation (trichomalacia) Empty follicles Follicular keratin debris Melanin pigment casts ```

Question 38

Most effective treatment for hair pulling disorder

Answer 38

Behavioral therapy, specifically habit reversal therapy

Question 39

4 key aspects of habit reversal training

Answer 39

1. Awareness 2. Competing response training 3. Social support or contingency management 4. Stimulus control

Question 40

Most studied medication for hair pulling disorder

Answer 40

TCA clomipramine

Question 41

Self-induced cutaneous lesions resulting from the uncontrollable impulse to excessively pick, rub, or scratch normal skin or skin with minor surface irregularities

Answer 41

Neurotic excoriation

Question 42

Characteristic areas of sparing in the unreachable areas of the interscapular area

Answer 42

"Butterfly sign"

Question 43

Y/N: Patients with neurotic excoriations frequently acknowledge that they are self-inducing the lesions and have more insight as compared to those with delusional disorders

Answer 43

Yes

Question 44

Useful for neurotic excoriations because of its dual antipruritic and antianxiety effects Particularly useful if the underlying psychopathology is major depression

Answer 44

TCA doxepin

Question 45

With higher doses of doxepin, there is increasing risk of

Answer 45

Cardiac arrhythmia