100 - Delusional, Obsessive-Compulsive, and Factitious Skin Diseases Flashcards
It is estimated that approximately _____ of patients seeking treatment of skin complaints have associated psychological stress or psychiatric disease
One-third
Primary skin diseases that can be precipitated or exacerbated by psychosocial stress
Psychophysiologic skin disorders
Skin diseases are also known to lead to and/or exacerbate psychiatric disorders such as anxiety and depression
Secondary psychiatric disorders
Underlying psychiatric component that causes self-induced physical findings on the skin
Primary psychiatric disorders
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
Cutaneous sensory disorders
Psychophysiologic skin disorders
Psoriasis Atopic dermatitis Acne vulgaris Seborrheic dermatitis Hyperhidrosis Lichen simplex chronicus
Primary psychiatric skin disorders
Delusional disorders
Obsessive-compulsive and related disorders
Factitious disorders
Secondary psychiatric disorders
Anxiety
Depression
Social phobia
Cutaneous sensory disorders
Cutaneous dysesthesia
“Central” pruritus
Formication
Characterized by the presence of usually one fixed, false belief
By definition, lack insight
Delusional skin disorders
False, fixed belief that one is infested with living organisms or inanimate materials in the absence of objective proof
Delusions of parasitosis
Variant of delusions of parasitosis
Fixed belief that there are fibers or solid material extruding from the skin
Morgellons disease
Specimens are brought in various containers, such as in an empty matchbox or Ziploc bags, which is referred to as the
Matchbox sign
Ziploc sign
Specimen sign
In some patients, there is no ideation of infestation, in which case the patient has a diagnosis simply of
“Formication”
Y/N: Patients with a shorter duration of active delusion have an increased probability of achieving remission following treatment
Yes
Most studied pharmacologic agent for the treatment of delusions of parasitosis
Antipsychotic agent pimozide
Notable adverse effects of pimozide
Extrapyramidal symptoms such as akathisia (restlessness) and pseudoparkinsonian symptoms
QT prolongation
Most studied atypical antipsychotic agent for delusions of parasitosis
Risperidone
Risperidone is (more/less) likely to induce extrapyramidal symptoms than pimozide
Less
Side effects of risperidone
Galactorrhea
Adverse effect of olanzapine
Significant weight loss
Adverse effect of aripiprazole
Akathisia or agitation
Preoccupation with body odor that is not perceived by others
Delusion of bromosis
Intrusive thoughts or urges that are experienced as unwanted
Obsession
Repetitive behaviors or rituals to help alleviate the otherwise intolerable anxiety
Compulsion
Somatoform disorder characterized by preoccupation with a nonexistent or minor physical flaw
Body dysmorphic disorder
Two efficacious treatments in body dysmorphic disorder
High-dose selective serotonin reuptake inhibitors
Cognitive behavioral therapy
Formerly known as trichotillomania
Hair pulling disorder
Patient eats the hair root
Trichorhizophagia
Whole hair is eaten
Trichophagia
GI hairballs
Trichobezoars
Most common comorbidity observed in approximately 40% of patients with hair pulling disorder
Depressive disorder
Dermoscopy findings in hair pulling disorder
Irregular broken hairs V-sign Flame hairs Hair powder Coiled hairs
2 or more hairs emerging from 1 follicular unit are broken at the same length
V-sign
Semitransparent, wavy, cone-shaped hair residues
Flame hairs
Sprinkled hair residue
Hair powder
Hair pulling disorder presents histologically as
Increased number of catagen hairs Traumatized hair bulbs in the absence of perifollicular inflammation (trichomalacia) Empty follicles Follicular keratin debris Melanin pigment casts
Most effective treatment for hair pulling disorder
Behavioral therapy, specifically habit reversal therapy
4 key aspects of habit reversal training
- Awareness
- Competing response training
- Social support or contingency management
- Stimulus control
Most studied medication for hair pulling disorder
TCA clomipramine
Self-induced cutaneous lesions resulting from the uncontrollable impulse to excessively pick, rub, or scratch normal skin or skin with minor surface irregularities
Neurotic excoriation
Characteristic areas of sparing in the unreachable areas of the interscapular area
“Butterfly sign”
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
Yes
Useful for neurotic excoriations because of its dual antipruritic and antianxiety effects
Particularly useful if the underlying psychopathology is major depression
TCA doxepin
With higher doses of doxepin, there is increasing risk of
Cardiac arrhythmia
