18 - 100 - DELUSIONAL, OBSESSIVE-COMPULSIVE AND FACTITIOUS SKIN DISEASES

Question 1

What is the treatment of choice for delusion of parasitosis?

a. Psychotherapy

b. TCA (eg. Clomipramine)

c. Pimozide followed by atypical antipsychotics (eg. Risperidone, aripiprazole, olanzapine)

d. High-dose SSRI and cognitive behavioral therapy, alone or in combination

Answer 1

C

Page 1693. (At-a-glance). Treatment of choice for delusions of parasitosis is pimozide, followed by atypical antipsychotics.

Question 2

Which of the following is NOT a histologic finding in hair pulling disorders?

a. Decreased number of catagen hairs

b. Traumatized hair bulbs in the absence of perifollicular inflammation (trichomalacia),

c. Empty follicles

d. Follicular keratin debris

e. Melanin pigment casts

Answer 2

A

Page 1699. Hair pulling disorder presents histologically as an increased number of catagen hairs, traumatized hair bulbs in the absence of perifollicular inflammation (trichomalacia), empty follicles, follicular keratin debris, and melanin pigment casts.

Question 3

Which medication is useful for neurotic excoriations because of its dual antipruritic and antianxiety effects?

a. Fluoxetine

b. Risperidone

c. Doxepin

d. Sertraline

Answer 3

C

Page 1701. The TCA doxepin is useful for neurotic excoriations because of its dual antipruritic and antianxiety effects. High-dose doxepin is particularly useful if the underlying psychopathology is major depression.

Question 4

True about body dysmorphic disorder except?

a. Characterized by preoccupation with a nonexistent or minor physical flaw.

b. Patients can have comorbid anxiety, depression, and OCD

c. The face is commonly involved.

d. Sertraline and risperidone, alone and in combination, are 2 efficacious treatments in BDD

Answer 4

D

Page 1699. High-dose selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy, alone and in combination, are 2 efficacious treatments in BDD.

Question 5

True regarding risperidone in the treatment of delusion of parasitosis except?

a. Risperidone is both the most-studied atypical antipsychotic agent for delusions of parasitosis and efficacious.

b. Risperidone is more likely to induce extrapyramidal symptoms than pimozide.

c. Associated with other side effects, such as galactorrhea.

d. None of the above

Answer 5

B

Page 1696. Risperidone is more likely to induce extrapyramidal symptoms than pimozide.

Question 6

T/F Delusional patients lack insight.

Answer 6

TRUE

Question 7

PSYCHOPHYSIOLOGIC SKIN DISORDERS

Answer 7

Question 8

PRIMARY PSYCHIATRIC SKIN DISORDERS

Answer 8

Question 9

SECONDARY PSYCHIATRIC SKIN DISORDERS

Answer 9

Question 10

CUTANEOUS SENSORY DISORDERS

Answer 10

Question 11

type of monosymptomatic hypochondriacal psychosis characterized by a false, fixed belief that one is infested with living organisms or inanimate materials in the absence of objective proof.

Answer 11

Delusions of parasitosis, also known as delusions of infestation

Question 12

variant of delusions of parasitosis characterized by a fixed belief that there are fibers or solid material extruding from the skin

Answer 12

Morgellons disease

Question 13

The 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, or specimen sign.

WHAT CONDITION IN THIS SEEN?

Answer 13

delusions of parasitosis and Morgellons disease

Question 14

Answer 14

Delusions of parasitosis, Morgellons disease

Question 15

Answer 15

Body dysmorphic disorder

Question 16

Answer 16

Trichotillomania

Question 17

Answer 17

Neurotic excoriations

Question 18

Answer 18

Dermatitis Artefacta

Question 19

characterized by preoccupation with an imagined defect with excessive time spent attempting to conceal or fix the defect.

Answer 19

Body dysmorphic disorder (BDD)

Question 20

Treatment of choice for BDD

Answer 20

high-dose selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT)

Question 21

repetitive action of pulling out hair, resulting in significant hair loss, which appears as nonscarring, patchy alopecia.

Answer 21

Hair pulling disorder

Question 22

The most effective treatment for hair pulling disorder

Answer 22

habit-reversal training (HRT)

Question 23

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

Answer 23

Neurotic excoriations or psychogenic excoriations

Question 24

patients eat the hair root

Answer 24

trichorhizophagia

Question 25

whole hair is eaten

Answer 25

trichophagia

Question 26

GI hairballs

Answer 26

trichobezoars

Question 27

Dermoscopic findings of hair pulling disorder

Answer 27

• irregularly broken hairs,
• V-sign (2 or more hairs emerging from 1 follicular unit are broken at the same length)
• flame hairs (semitransparent, wavy
• cone-shaped hair residues),
• hair powder (sprinkled hair residue)
• coiled hairs

Question 28

histological findings of hair pulling disorder

Answer 28

• increased number of catagen hairs,
• traumatized hair bulbs in the absence of perifollicular inflammation (trichomalacia),
• empty follicles,
• follicular keratin debris,
• melanin pigment casts.

Question 29

4 key aspects of habit reversal therapy

Answer 29

1. awareness (increase awareness of hair-pulling behavior),
2. competing response training (perform a specific action when there is an urge to pull hair),
3. social support or contingency management (a person who reinforces the former), and
4. stimulus control (minimize the influence of environmental factors on pulling behavior).

Question 30

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

Answer 30

Neurotic excoriations, also called psychogenic excoriations

Question 31

The classic “butterfly sign,” in which there are characteristic areas of sparing in the unreachable areas of the interscapular area, may be present.

What condition can this be seen?

Answer 31

Neurotic excoriations, also called psychogenic excoriations

Question 32

T/F Patients with neurotic excoriations frequently acknowledge that they are self-inducing the lesions and have more insight compared to those with delusional disorders.

Answer 32

True

Question 33

useful for neurotic excoriations because of its dual antipruritic and antianxiety effects

Answer 33

doxepin

Question 34

characterized by repetitive, damaging, and seemingly nonfunctional habits, such as hair pulling, skin picking, and nail biting, which cause significant distress and functional impairment.

Answer 34

Body-focused repetitive behavior disorders

Question 35

A psychodermatologic skin disorder characterized by self-inflicted injury to the skin, hair, or nails

Answer 35

dermatitis artefacta

Question 36

involves the conscious motivation of secondary gain, such as obtaining disability or insurance benefits

Answer 36

Malingering

Question 37

T/F If malingering is suspected, the case is no longer considered psychiatric in nature; rather, it is considered a criminal act that may require legal actions.

Answer 37

True