Chapter 100- Delusional, Obsessive-Compulsive And Factitious Skin diseases Flashcards
Primary skin diseases that can be exacerbated or precipitated by psychosocial stress
Psychophysiologic skin disorders
Underlying psychiatric component that causes self-induced physical findings on the skin
Primary psychiatric skin disorders
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
Delusions of parasitosis/infestation
Variant of delusions of parasitosis characterized by fixed belief that there are fibers or solid material extruding from the skin
Morgellons disease
Specimes brought in various containers are referred to as
Matchbox sign, Ziploc sign, specimen sign
Biopsy is likely to be diagnostic for delusions of parasitosis.
True or False
False, nondiagnostic
Patients with shorter duration of active delusion have an increased probability of achieving remission following treatment.
True or False
True
Most studied pharmacologic agent for the treatment of delusions of parasitosis.
Pimozide (Orap)
Adverse effects of Pimozide (Orap)
Extrapyramidal symptoms (Akathisia) Pseudoparkinsonism symptoms QT prolongation
Treatment for extrapyramidal symptoms of Pimozide
Diphenhydramine (Benadryl)
Benztropine (Congentin)
Most studied atypical antipsychotic agent for delusions of parasitosis
Risperidone (Risperdal)
Adverse effects of Risperidone
Galactorrhea
Adverse effects of Olanzapine
Weight gain
Adverse effects of Aripiprazole
Akathisia or agitation
Somatoform disorder characterized by preoccupation with an imagined defect with excess time spent attempting to conceal or fix the defect
Body dysmorphic disorder
Treatment of choice for body dysmorphic disorder
High dose SSRIs
Cognitive behavioral therapy
BDD can appear as early as __, M __F
16 years old,
Commonly involved focus of BDD
Face
Hair pulling disorder results in patchy, scarring alopecia.
True or False
False, nonscarring
The most important treatment for hair pulling disorder is
Habit reversal training
Most common sites for hair pulling disorder
Scalp, eyebrows, eyelashes
Disorder where patient eats the hair root (___) or whole hair is eaten (___) and may develop GI hairballs (___)
Trichorhizophagia
Trichophagia
Trichobezoars
Most common comorbidity (40%) in hair pulling disorder
Depression
Dermoscopy signs of hair pulling disorder
V sign
Flame hairs
Hair powder
Coiled hair
2 or more hairs emerge from 1 follicular unit and are broken at the same length
V sign
Semitransparent, wavy, cone-shaped hair residues
Flame hairs
Sprinkled hair residue
Hair powder
Histologically, hair pulling disorder presents as (5)
Increased no. of catagen hairs Traumatized hair bulbs Empty follicles Follicular keratin debris Melanin pigment casts
4 key aspects of habit reversal therapy
- Awareness
- Competing response training
- Social support or contingency managment
- Stimulus control
Most studied medication for hair pulling which reduces the frequency of hair pulling urges
Clomipramine
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
Neurotic/ Psychogenic excoriations
Age of onset of neurotic excoriations
15 to 45 years old
Characteristic areas of sparing in unreachable areas of interscapular area may be present in neurotic excoriations
Classic butterfly sign
Psychiatric comorbidities observed with neurotic excoriations
Mood and anxiety disorders
Useful for neurotic excoriations for its dual antipruritic and antianxiety effects
Doxepin
ADE for doxepin
Cardiac arrhythmia
Nail biting (___) and nail picking (___)
Onychophagia
Onychotillomania
Psychodermatologic skin disorder characterized by self influcted injury to skin, hair, or nails using sharp instruments is called
Dermatitis artefacta/ factitial dermatitis
Comorbidities of dermatitis artefacta
Generalized anxiety
Major depression
Borderline personality disorder
Conscious motivation of secondary gain
Malingering
Dopaminergic dysfunction contributes to self injurious behavior hence antipsychotic meds such as (2) shows benefit in dermatitis artefacta
Pimozide
Risperidone
For patients with dermatitis artefacta and depression, ___ may be beneficial
High dose SSRIs
Patients with more severe presentations or comorbid borderline personality disorder could benefit from __
Psychotherapy
