Psychocutaneous disorders Flashcards
Epidemiology of delusions of parasitosis?
Average onset 50-60 y/o, in younger patients they tend to be lower socioeconomic status w/ hx of substance abuse (more likely an etiology of this condition in this age group) -Older patients tend to be a higher socioeconomic status
Key component of delusions of parasitosis?
Fixed false belief that they are infested w/ parasites in absence of clinical findings; may describe sensations of biting, crawling, or stinging; “matchbox sign” (patient brings in bits of skin and other materials he/she believes are parasites)
No amount of evidence will convince the pt’s that they don’t have it by definition, these discussions are usually futile
What is it called when the delusion (like delusions of parasitosis) is shared between two people?
folie a deux
Treatment for delusions of parasitosis?
antipsychotic such as pimozide is classic treatment of choice (be aware of QT prolongation on EKG, extrapyramidal side effects, and drug-drug interactions); -newer atypical antipsychotics (more recent 1st line is risperidone)) appear effective w/ improved side-effect profile
What is body dysmorphic disorder?
Patients are preoccupied by appearance of their bodies and start to obsessively checking in mirrors for perceived imperfections and may have repeated cosmetic procedures
What areas are generally of concern in body dysmorphic disorder?
face, hair, breasts, and genitalia
Treatment for body dysmorphic disorder?
SSRI for OCD variant and antipsychotics for delusional variant.
What is dermatitis artefacta?
Patient self-inflict cutaneous lesions and deny personal involvement *denial of personal involvement is a key distinguisher from neurotic excoriations and acne excoriee
Epidemiology of dermatitis artefacta?
Occurs in adolescents/young adult females who may work in healthcare fields or have personal disorders
Treatment of dermatitis artefacta?
supportive wound and psych care; antidepressants, antianxiety, or antipsychotic medications may be necessary
Clinical of neurotic excoriations?
Excoriations in different stages of evolution w/ geographic /angulated shapes; favors extensor arms, scalp, face, upper back, buttocks
Cause of neurotic excoriations?
Caused by conscious, repetitive, and uncontrollable picking/scratching Patients admit to picking, but cannot control their behavior
Tx for neurotic excoriations?
Doxepin (TOC), SSRI, behavior modification, behavior and CBT, topical antipruritics, wound care
What is acne excoriee?
Scratching and picking directed at acne lesions Frequently seen in young women Part of broader spectrum of neurotic excoriations
What conditions is acne excoriee a/w?
OCD
Treatment for acne excoriee?
Treatment includes doxepin & SSRIs as well as treatment of underlying acne
What is trichotillomania?
Hair pulling impulse control or OCD p/w large, irregular/geometric areas of alopecia (scalp> eyebrows> eyelashes> genital hair) w/ coexistent areas of completely nl, uninvolved scalp A/w trichophagy (chewing and swallowing of hair) may cause intestinal obstruction and trichobezoars
Most common areas affected by trichotillomania?
Scalp> eyebrows> eyelashes> genital hair
One key diagnostic clue to trichotillomania?
Affected areas contain hair of varying lengths
Sex predilection for trichotillomania?
Female>male (5:1)
Age of onset for trichotillomania?
Avg age of onset: 8yo (boys), 12yo (girls)
Histology of trichotillomania?
huge “catagen/telogen shift” (increased catagen/telogen hairs; often >50% of hairs in catage or telogen phase), pigmented hair casts, empty anagen follicles (due to hair shafts being pulled out), trichomalacia (distorted hair shafts), and hemorrhage
What will trichoscopy of trichotillomania show?
mult broken hairs of diff lengths and shapes w/o perifollicular changes
What is a confirmatory test that can be done for trichotillomania?
hair growth window During repeated shaving of a specific area, hair of nl density regrows (since hairs are too short to manipulate)
Tx for trichotillomania?
behavior modification therapy, clomipramine (TOC), SSRI, prognosis better in younger children than older children/ adolescents
What are psychophysiologic disorders?
Exacerbation of a skin disorder (psoriasis, AD) by emotional factors
What are secondary psychiatric disorders?
Somatic symptom disorder, illness anxiety disorder, adjustment disorder, other specific anxiety or depressive disorders that are occurring on top of cutaneous findings
What are primary psychiatric disorders in the setting of cutaneous dz?
So these are primary psychiatric disorders that then trigger cutaneous dz. I.e OCD –> body dysmorphic, or schizophrenia and delusions of parasitosis
Whawt is Gardner-Diamond syndrome?
Pts traumatically induce lesions causing sudden onset of painful, swollen, ecchymosis at sites of trama
Treatment for Gardner-Diamond syndrome?
Difficult, can try antidepressants and psychotherapy
