Psychiatry + psychology of skin disease Flashcards
Psychological consequences of skin disease
decreased self esteem/self confidence
affected relationships
reduced employment opportunities
increased anxiety and depression
What psychological interventions are available for patients with negative mental health as a result of a skin disease (eg. acne)?
psychological interventions = CBT, self-help material, group therapy
medication = antidepressants
List some skin manifestations of psychiatric illness/psychological distress
deliberate self harm
dermatitis artefacta
parasitosis
dysmorphophobia
trichotillomania
excessive handwashing, neurotic excoriations
signs of alcohol/substance misuse
sun sensitivity
nicotine stained fingers
What are 5 causes of artefactual lesions?
malingering (conscious intent for specific gain)
hypochondriasis (response to delusional beliefs)
obsessive compulsive disorder (eg. relief of anxiety from repetitive scratching)
dermatitis artefacta
dermatitis artefacta by proxy (lesions on another to satisfy psychological need of perpetrator)
What is dermatitis artefacta?
patients consciously create lesions in skin, hair, nail, or mucosae to satisfy a psychological need, attract attention, or evade responsibility
complicity strenuously denied
What is the clinical picture of dermatitis artefacta?
dramatic lesions, calm manner
thick patient notes (presents frequently)
not characteristic of known dermatoses
in reach of patient’s hands
lesions appear fully formed all at same stage of development
Why do patients engage in dermatitis artefacta?
physical expression of emotional problems
inability to feel cared for unless something being ‘done’ (eg. ointment, investigations etc.)
learn that behaviour is rewarding
goal = to satisfy (unconscious) emotional need to be nurtured
What is parasitosis?
delusion that their body is infested with some type of organism
symptom, not a disease
related to monodelusional hypochondrial psychosis, somatic hallucinations and Ekbom syndrome
What is dysmorphophobia?
primary complaint of external physical defect thought to be noticeable to other people
objectively, appearance lies within normal limits
What is trichotillomania?
patient pulls out their own hair
a symptom
hair roots undergo pathological change called trichomalacia
List some psychiatric drugs that can cause skin conditions
lithium
anticonvulsants
chlorpromazine
lamotrigine
What skin condition can chlorpromazine cause?
photosensitivity
What skin condition can lamotrigine cause?
Stevens-Johnson syndrome
What effect can lithium have on the skin?
exacerbate psoriasis
