Psychoderm

Question 1

Define delusions of parasitosis

Answer 1

• Fixed unshakeable belief that infested by things
• Outside of what would be considered normal cultural beliefs
• monosymptomatic (this is the only delusion)
• Functional (maintaining job etc)
• may or may not be underlying psychiatric disorder but doesn’t meet criteria for schizophrenia
• not attributable to other condition

Question 2

How does Morgellon’s differ from delusions of parasitosis

Answer 2

Associated arthralgia, myalgia, fatigue, poor concentration as well as the belief/sensation of fibres under the skin

Question 3

Mx approach

Answer 3

ASSESS FOR SUICIDE RISK/ SELF HARM
Treat any itch/irritation - general measures, menthol
Pre-antipsychotic Ix - lipids, BSL, HbA1c, weight, bp
Risperidone 0.5mg
Olanzapine 2.5mg
Quetiapine 25mg

Question 4

Newer antipsychotics vs older

Answer 4

Older - more significant AEs - extrapyramidal, QT prolongation
Newer - sedation, weight gain, anticholinergic, metabolic syndrome

Question 5

Define body dysmorphic disorder

Answer 5

preoccupation with real (out of proportion) /imagined defect in physical appearance
Can be associated w mood disorders, OCD, social phobia, SI, substance abuse, eating disorders, prior sexual abuse

Question 6

Mx of prurigo nodularis

Answer 6

general measures
menthol
TCS, ILCS
Occlusion
Phototherapy
SSRIs, mood stabilisers
immunosuppressants
thalidomide 100mg/day
N-acetylcysteine

Question 7

Definition trichotillomania

Answer 7

recurrent hair pulling causing hair loss
Strong desire to pull hair
Tension increasing just prior to pulling hair
pleasure when hair pulled

Question 8

Epidemiology of trichotillomania

Answer 8

bimodal - habit tic in young children, psychological in older adolescents/ young adults

Question 9

How to assess depression

Answer 9

SADFACES

= sleep disturbance, appetite change, depressed mood, fatigue, anhedonia, poor concentration, esteem reduced, SI

Question 10

how to assess suicide

Answer 10

SADPERSONS
= sex male, age <20 or >45, depressed, prior attempt, excess drugs/alcohol, rationality lost, social supports lacking, organised plan, no spouse, sick