Chapter 100- Delusional, Obsessive-Compulsive And Factitious Skin diseases

Question 1

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

Answer 1

Psychophysiologic skin disorders

Question 2

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

Answer 2

Primary psychiatric skin disorders

Question 3

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

Answer 3

Delusions of parasitosis/infestation

Question 4

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

Answer 4

Morgellons disease

Question 5

Specimes brought in various containers are referred to as

Answer 5

Matchbox sign, Ziploc sign, specimen sign

Question 6

Biopsy is likely to be diagnostic for delusions of parasitosis.
True or False

Answer 6

False, nondiagnostic

Question 7

Patients with shorter duration of active delusion have an increased probability of achieving remission following treatment.
True or False

Answer 7

True

Question 8

Most studied pharmacologic agent for the treatment of delusions of parasitosis.

Answer 8

Pimozide (Orap)

Question 9

Adverse effects of Pimozide (Orap)

Answer 9

Extrapyramidal symptoms (Akathisia)
Pseudoparkinsonism symptoms
QT prolongation

Question 10

Treatment for extrapyramidal symptoms of Pimozide

Answer 10

Diphenhydramine (Benadryl)

Benztropine (Congentin)

Question 11

Most studied atypical antipsychotic agent for delusions of parasitosis

Answer 11

Risperidone (Risperdal)

Question 12

Adverse effects of Risperidone

Answer 12

Galactorrhea

Question 13

Adverse effects of Olanzapine

Answer 13

Weight gain

Question 14

Adverse effects of Aripiprazole

Answer 14

Akathisia or agitation

Question 15

Somatoform disorder characterized by preoccupation with an imagined defect with excess time spent attempting to conceal or fix the defect

Answer 15

Body dysmorphic disorder

Question 16

Treatment of choice for body dysmorphic disorder

Answer 16

High dose SSRIs

Cognitive behavioral therapy

Question 17

BDD can appear as early as __, M __F

Answer 17

16 years old,

Question 18

Commonly involved focus of BDD

Answer 18

Face

Question 19

Hair pulling disorder results in patchy, scarring alopecia.

True or False

Answer 19

False, nonscarring

Question 20

The most important treatment for hair pulling disorder is

Answer 20

Habit reversal training

Question 21

Most common sites for hair pulling disorder

Answer 21

Scalp, eyebrows, eyelashes

Question 22

Disorder where patient eats the hair root (___) or whole hair is eaten (___) and may develop GI hairballs (___)

Answer 22

Trichorhizophagia

Trichophagia

Trichobezoars

Question 23

Most common comorbidity (40%) in hair pulling disorder

Answer 23

Depression

Question 24

Dermoscopy signs of hair pulling disorder

Answer 24

V sign
Flame hairs
Hair powder
Coiled hair

Question 25

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

Answer 25

V sign

Question 26

Semitransparent, wavy, cone-shaped hair residues

Answer 26

Flame hairs

Question 27

Sprinkled hair residue

Answer 27

Hair powder

Question 28

Histologically, hair pulling disorder presents as (5)

Answer 28

``` Increased no. of catagen hairs Traumatized hair bulbs Empty follicles Follicular keratin debris Melanin pigment casts ```

Question 29

4 key aspects of habit reversal therapy

Answer 29

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

Question 30

Most studied medication for hair pulling which reduces the frequency of hair pulling urges

Answer 30

Clomipramine

Question 31

Disorder characterized by self induced cutaneous lesions resulting fron uncontrollable impulse to excessively pick, rub, or scratch normal skin or skin with minir surface irregularities

Answer 31

Neurotic/ Psychogenic excoriations

Question 32

Age of onset of neurotic excoriations

Answer 32

15 to 45 years old

Question 33

Characteristic areas of sparing in unreachable areas of interscapular area may be present in neurotic excoriations

Answer 33

Classic butterfly sign

Question 34

Psychiatric comorbidities observed with neurotic excoriations

Answer 34

Mood and anxiety disorders

Question 35

Useful for neurotic excoriations for its dual antipruritic and antianxiety effects

Answer 35

Doxepin

Question 36

ADE for doxepin

Answer 36

Cardiac arrhythmia

Question 37

Nail biting (___) and nail picking (___)

Answer 37

Onychophagia | Onychotillomania

Question 38

Psychodermatologic skin disorder characterized by self influcted injury to skin, hair, or nails using sharp instruments is called

Answer 38

Dermatitis artefacta/ factitial dermatitis

Question 39

Comorbidities of dermatitis artefacta

Answer 39

Generalized anxiety Major depression Borderline personality disorder

Question 40

Conscious motivation of secondary gain

Answer 40

Malingering

Question 41

Dopaminergic dysfunction contributes to self injurious behavior hence antipsychotic meds such as (2) shows benefit in dermatitis artefacta

Answer 41

Pimozide | Risperidone

Question 42

For patients with dermatitis artefacta and depression, ___ may be beneficial

Answer 42

High dose SSRIs

Question 43

Patients with more severe presentations or comorbid borderline personality disorder could benefit from __

Answer 43

Psychotherapy