Dr. M. A. Gupta - Academia.edu (original) (raw)

Papers by Dr. M. A. Gupta

The Journal of clinical psychiatry, 1992

Dermatologic Clinics, 1991

Neuroimmunology of the Skin

International Journal of Eating Disorders, 2000

Eating disorders(ED) have been classically associated with a concern about body shape and size th... more Eating disorders(ED) have been classically associated with a concern about body shape and size that manifests mainly as an intense fear of weight gain (DSM-IV criteria). To further examine the nature of the body image disturbance in ED, we surveyed the prevalence of nonweight-related body image concerns among ED patients and nonclinical controls. We examined 53 women (M +/- SD age: 28.1 +/- 6.8 years) with anorexia nervosa and/or bulimia nervosa (DSM-III-R criteria) and 73 randomly selected nonclinical women (M +/- SD age: 30.2 +/- 6.6 years) from the community. The participants rated (by checking a "Yes" or "No") whether they were satisfied with the appearance of the following body regions: their skin, teeth, jaw, nose, eyes, ears, hair, and height and completed the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorders Inventory (EDI). The frequencies of dissatisfaction with the appearance of various physical attributes among the ED patients versus the nonclinical controls were as follows: skin: 79.2% vs. 52.1%, p =.002; teeth: 62.3% vs. 39.7%, p =. 012; jaw: 24.5% vs. 9.7%, p =.026; nose: 45.3% vs. 24.7%, p =.015; eyes: 22.6% vs. 12.3%, p =.12; ears: 20.8% vs. 2.7%, p =.001; hair: 52.8% vs. 39.7%, p =.14; and height: 28.3% vs. 13.7%, p =.04. As expected, the M +/- SD DT (EDI): 14.0 +/- 6.1 vs.3.5 +/- 4.6, p <. 0001 and the M +/- SD BD (EDI): 19.7 +/- 5.8 vs. 10.1 +/- 7.3, p <. 0001, were both higher in the ED group. Furthermore, greater dissatisfaction with nonweight-related body image was associated with higher DT and BD scores. The higher prevalence of dissatisfaction with appearance of most of the nonweight-related physical attributes is probably an indication of the core ego deficits that are often present in ED and an index of the severity of the overall body image disturbance in these patients, and not indicative of another condition (e.g., body dysmorphic disorder) as the current nosology (DSM-IV) suggests.

Cutis, 2000

Self-inflicted dermatoses are often difficult to treat. We present three patients with excoriated... more Self-inflicted dermatoses are often difficult to treat. We present three patients with excoriated acne, self-induced skin ulcers, and trichotillomania, respectively, whose symptoms responded favorably to a 2- to 4-week course of the atypical antipsychotic olanazpine at a dosage of 2.5 to 5.0 mg daily. In two of three patients, the efficacy of the olanzapine was most likely related to an attenuation of dissociative symptoms that were associated with the self-induced skin ulcers and trichotillomania.

Cutis, 1993

A fifteen-year-old girl with a two-year history of severe neurotic excoriations and an obsessive-... more A fifteen-year-old girl with a two-year history of severe neurotic excoriations and an obsessive-compulsive disorder experienced a dramatic improvement of her neurotic excoriations after a six-week course of fluoxetine 20 mg per day. This is in contrast to most previously reported treatments, which typically were only moderately effective. The neurobiological basis for the efficacy of fluoxetine, an antidepressant that is a potent serotonin reuptake inhibitor, in the treatment of neurotic excoriations associated with an obsessive-compulsive disorder, is reviewed.

Cutis, 1995

We present two patients with a history of chronic idiopathic urticaria occurring in conjunction w... more We present two patients with a history of chronic idiopathic urticaria occurring in conjunction with a panic disorder (DSM-IIIR), in whom both the urticaria and panic disorder responded favorably to a course of the selective serotonin reuptake inhibitor antidepressants fluoxetine and sertraline, respectively. Both patients had previously required systemic corticosteroids to manage their urticaria. Panic disorder is an anxiety disorder characterized by the presence of recurrent unexpected panic attacks. Serotoninergic mechanisms play an important role in panic disorder. In contrast to antidepressants such as doxepin, which have previously been found to be effective in the treatment of chronic urticaria, the newer selective serotonin reuptake inhibitor antidepressants are only weakly antihistaminic and anticholinergic. The response of both the urticaria and panic disorder to selective serotonin reuptake inhibitor antidepressants may suggest a common pathogenic factor involving seroton...

Advances in dermatology, 1990

The contribution of psychosomatic factors toward the morbidity associated with psoriasis should b... more The contribution of psychosomatic factors toward the morbidity associated with psoriasis should be evaluated in the context of the patient's developmental stage and life situation. The skin, as a sensory organ, plays a critical role in an individual's physical and emotional growth in early life. The skin also plays an integral role as an organ of communication throughout life and greatly affects an individual's body image and self-esteem. If these factors are not taken into consideration, the morbidity associated with psoriasis may increase, or the patient may remain dissatisfied with treatment even in the face of clinically satisfactory treatment outcome. Some recent studies indicate that the adverse impace of psoriasis upon the quality of life can result in significant chronic stress, which may in turn exacerbate the psoriasis in a subgroup of patients. As disease-related stress is present in every patient to some degree, the dermatologist should regularly assess the p...

International Journal of Dermatology, 2000

Patients who are human immunodeficiency virus (HIV) positive are predisposed to the development o... more Patients who are human immunodeficiency virus (HIV) positive are predisposed to the development of infections including tinea pedis and onychomycosis. While smaller studies have been reported, there has been no large study evaluating the prevalence of onychomycosis in HIV-positive individuals, or comparing the development of onychomycosis in a typical temperate area with that in a typical tropical area. HIV-positive individuals were evaluated at five clinics: four in Ontario, Canada and one in Sao Paulo, Brazil. The subjects were asked questions to determine the epidemiology of onychomycosis in HIV-positive individuals. The feet were examined and nail material was obtained for mycologic examination to determine the causative organism of onychomycosis. A total of 500 subjects were examined (415 men and 85 women; age (mean +/- SE), 39 +/- 0.4 years; 400 Canadian, 100 Brazilian). The racial origins of the Canadian patients were: Caucasian, 83.8%; Asian, 4.3%; African-American, 8.1%; Hispanic, 3.3%; American Indian, 0.3%. The Brazilian origins were: Caucasian, 68.7%; African, 18.1%; mixed race, 13.3%. Abnormal appearing nails and mycologic evidence of onychomycosis were present in 200 (40.0%) and 116 (23.2%), respectively, of 500 subjects. The prevalence of onychomycosis in the Canadian and Brazilian samples was 24.0% (96 of 400) and 20.0% (20 of 100), respectively. The projected prevalence of onychomycosis in HIV-positive individuals in Canada was 19.9% (95% CI: 16.0-23.9%) after taking into account the age and sex distribution of HIV-positive individuals in the population. When nails appeared clinically abnormal, the prevalence of onychomycosis was 50.5% (Canada, 51.3%; Brazil, 45.5%). For comparison, published data indicate that the prevalence of onychomycosis in immunocompetent individuals living in Canada is 6.9%. The clinical presentation of onychomycosis for the whole sample (n=500) was: distal and lateral subungual onychomycosis (DLSO), 20.0%; white superficial onychomycosis (WSO), 3.6%; proximal subungual onychomycosis (PSO), 1.8% (Canadian and Brazilian samples: DLSO 21.2% vs. 15.0%, WSO 3.3% vs. 5.0%, and PSO 1.5% vs. 3.0%). The distribution of the causative fungal organisms was: dermatophytes: Candida species: nondermatophyte molds, 73:2:2 (Canadian and Brazilian samples: dermatophytes 95.5% vs. 90.9%, Candida species 3.0% vs. 0%, and nondermatophyte molds 1.5% vs. 9.0%). The use of protease inhibitors, reverse transcriptase inhibitors, or oral antifungal agents did not make a significant difference in the prevalence of onychomycosis for both the Canadian and Brazilian groups. Patients with onychomycosis were aware of their abnormal appearing nails (chi2(1)=69.7, P<0.001), embarrassed by the appearance of their nails (chi2(1)=29.7, P<0.001), and took measures to hide their nails from other individuals. A higher proportion of individuals with onychomycosis experienced discomfort compared with those without the disease (chi2(1)=9.0, P=0.003). Also, individuals who experienced pain in the nail unit were more likely to have onychomycosis (risk odds ratio (ROR), 2.2; 95% CI: 1.0-4.7, P=0.05). The prevalence of onychomycosis in HIV-positive individuals in the sample of 500 patients was 23.2%. In the Canadian (n=400) and Brazilian (n=100) samples, the corresponding figures were 24% and 20%, respectively, with the predominant causative organisms being dermatophytes. The projected prevalence of onychomycosis in HIV-positive Canadians is 19.9%. Predisposing factors include a CD4 count of approximately 370, a positive family history of onychomycosis, a history of tinea pedis, and walking barefoot around pools. Onychomycosis can be symptomatic, a source of embarrassment, and a potential cause of morbidity.

Journal of the American Academy of Dermatology, 1994

The psychosocial aspects of the treatment of photodamaged skin have received little attention. We... more The psychosocial aspects of the treatment of photodamaged skin have received little attention. We prospectively examined the psychosocial correlates of the treatment of mildly to severely photodamaged skin. Sixty subjects (age, 53.3 +/- 1.3 years [mean +/- standard error]; 35 receiving retinoic acid and 25 the inactive vehicle) completed a battery of psychosocial ratings before starting therapy and after 24 weeks of therapy with retinoic acid or vehicle. Before therapy, the subjects had pathologically high obsessive-compulsiveness scores (measured by the Brief Symptom Inventory [BSI]). From before to after therapy, the retinoic acid group reported decreased obsessive-compulsiveness (BSI) (p = 0.01), and decreased phobic anxiety (BSI) (p = 0.04), whereas the vehicle group reported an increase (p < 0.05) in both these symptom dimensions. High obsessive-compulsiveness (BSI), which is associated with excessive perfectionism and need for control, probably predisposed the subjects to seek treatment of their wrinkles. In the retinoic acid group but not the vehicle group there was an improvement in obsessive-compulsiveness and decreased anxiety in previously anxiety-provoking situations.

Journal of the American Academy of Dermatology, 1991

Recent studies have shown that topical tretinoin clinically improves certain features of photoage... more Recent studies have shown that topical tretinoin clinically improves certain features of photoaged or aging skin, such as fine wrinkles. The psychosocial aspect ofaging skin, however, has received relatively little attention in the medical literature. In this study we have examined some psychosocial aspects of the treatment of mildly to moderately photoaged skin with topical 0.05% tretinoin in an emollient vehicle and have compared them with the effects of treatment with emollient alone.

Journal of the American Academy of Dermatology, 1989

Pruritus that interferes with sleep is generally diagnosed as having an organic rather than a psy... more Pruritus that interferes with sleep is generally diagnosed as having an organic rather than a psychogenic basis. We compared the dermatologic and psychosocial parameters of 79 inpatients with psoriasis with moderate to severe pururitus with (W group; n = 46) and without (NW group; n = 33) wakenings from sleep in association with pruritus. At the time of the patients' admission, compared with the NW group the W group had more severe depressive psychopathologic features (p less than 0.05); were possibly alcoholic, according to behavioral criteria for alcoholism (p less than 0.005); reported a higher daily alcohol consumption (p less than 0.05); and had symptoms suggestive of periodic movements in sleep, or nocturnal myoclonus (p less than 0.05), a sleep physiologic disorder. The two groups did not differ with respect to pruritus severity or other dermatologic parameters at the time of admission or during inpatient treatment. Contrary to the generally accepted criterion for the organicity of pruritus, psychiatric and possibly sleep pathologic factors rather than primary dermatologic factors determined the wakenings from sleep as a result of pruritus.

Journal of the American Academy of Dermatology, 1996

Journal of Psychosomatic Research, 2001

Objective: Sociocultural factors are important in the pathogenesis of eating disorders. We examin... more Objective: Sociocultural factors are important in the pathogenesis of eating disorders. We examined some core (DSM IV) features of eating disorders, i.e., drive for thinness and dissatisfaction with the weight of the abdomen, hips, and thighs among women in Canada and India. Methods: A total of 65 Canadian (mean S.D. age: 21.4 2.0 years) and 47 Indian (mean S.D. age: 18.7 4.1 years) women completed the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorder Inventory (EDI) and in addition rated the degree to which they believed all major regions of their body were overweight. Results: After the effects of body mass index (BMI) were partialled out statistically, the DT (EDI) and BD (EDI) scores were not significantly different between the two countries. In both groups, concerns about the weight of the abdomen, hips, thighs, and legs loaded on a factor that essentially described the`body dissatisfaction' construct. After the effects of BMI were partialled out, however, the factor scores from this factor correlated with BD (EDI) in the Canadian but not the Indian sample. Discussion: In contrast to the Canadian women, the Indian women did not overestimate the`fatness' of their abdomen, hips, thighs, and legs. Among the Indian women, concerns about the weight of the upper torso (i.e., face, neck, shoulders, and chest) emerged as a distinct body image construct. In conclusion, after the effect of BMI was controlled for statistically, the Canadian and Indian women scored similarly on some of the core features of eating disorders, as measured by the DT (EDI) and BD (EDI) subscales, however, the nature of the underlying body image construct was different between the two groups.

General Hospital Psychiatry, 1989

Psoriasis is a chronic, relapsing, cutaneous condition with a I%-2% prevalence in thegeneral popu... more Psoriasis is a chronic, relapsing, cutaneous condition with a I%-2% prevalence in thegeneral population. About 40% of psoriafics report that psychosocial stress significantly exacerbates their condition. However, the clinical characferistics of the subgroup of psoriatic patients who are stress reactors have not been delineated. At a practical clinical level if is fherefore difficult to implement specific psychosocial treatments among the psoriatic population. In this study, we compared the psychocutaneous characteristics of patients who reported that stress exacerbated their psoriasis, i.e., the high stress reactors (N = 64) to the subgroup who reported no significant association between stress and their psoriasis, i.e., the low stress reactors (N = 63). The high stress reactors had more disfiguring disease clinically (p < 0.02); psychologically they fended to rely more upon the approval of others (p < 0.05) and experienced more psoriasis-related daily stress (p < 0.005). The high stress reactors also reported more flare-ups of their psoriasis during the 6 months prior to admission (p < 0.05). We have shown that the high stress reactors can be clinically delineated from the low stress reactors. Certain psychosocial interventions will most likely decrease the morbidity associated with psoriasis among the high stress reactors, and may possibly even result in a decline in the number of major flare-ups of the psoriasis. Psoriasis is a chronic, relapsing, cutaneous condition with a l%-2% prevalence in the general population [l]. The characteristic lesions of psoriasis are erythematous, thickly scaling plaques that may affect any region of the skin [l]. Psychosocial stress

General Hospital Psychiatry, 1987

Psychosocial factors are important in the onset and1 or exacerbation of psoriasis in 40%-80% of c... more Psychosocial factors are important in the onset and1 or exacerbation of psoriasis in 40%-80% of cases. Yet psoriasis has received little attention in the recent psychiatric literature. A subgroup of psoriatics appear to be "stress reactors" and these patients may have a better long-term prognosis. ldentification of such patients early in the course of treatment and incorporation of specific psychosocial interventions in their overall treatment regimen may improve the course of illness. Psoriasis has also been associated with suicide and an increased prevalence of alcoholism. The disturbances in body image perception and the effect of psoriasis on interpersonal, social, and occupational functioning can further contribute to the overall morbidity, especially if psoriasis Frst occurs during a developmentally critical period like adolescence. Certain biochemical and physiologic correlates of psoriasis of interest to the psychiatrist such as exacerbation of psoriasis with lithium therapy and increased cutaneous blood flow are discussed. Finally, some practical guidelines are provided for psychosocial interventions in psoriasis. Psoriasis is a chronic cutaneous condition with a l%-2% prevalence in the general population [l]. Both genetic and environmental factors are believed to play an important role in the pathogenesis of this disorder [l]. Psoriasis is associated with an increased rate of proliferation of the epidermal cells; the characteristic lesions are deep red, thickly scaling plaques that may affect any region of the *Currently also with the

British Journal of Dermatology, 2001

We have recently observed that women with the eating disorders (EDs) anorexia nervosa and bulimia... more We have recently observed that women with the eating disorders (EDs) anorexia nervosa and bulimia nervosa report a significantly greater (P = 0.002) dissatisfaction with the appearance of their skin than do non-clinical controls. To examine further the nature of the dissatisfaction with skin appearance in women with EDs. Several psychosocial and body image parameters, including whether or not the subjects were satisfied with a wide range of attributes associated with non-diseased skin, were surveyed in women aged < or = 30 years. Survey data from 32 women with EDs and 34 randomly selected community-based non-clinical controls were examined. Eighty-one per cent of the patients with EDs vs. 56% of the controls reported dissatisfaction with the appearance of their skin (P = 0.03), particularly with respect to its dryness and roughness. Other attributes that were rated more frequently were 'bags' and 'darkness' under the eyes, freckles, fine wrinkles and patchy hyperpigmentation. There is a high prevalence of dissatisfaction with skin appearance among women aged < or = 30 years, which is even higher among patients with EDs.

Facial Plastic Surgery, 1995

The cutaneous stigmata of aging may affect an individual's mental well-being, body image, and qua... more The cutaneous stigmata of aging may affect an individual's mental well-being, body image, and quality of life. Before proceeding with treatment, the dermatologist should take into consideration the patient's overall life situation and evaluate whether or not there is severe psychopathology and body image distortion ] Dermatol Surg Oncol

Acta dermato-venereologica, 1996

Early onset (< age 40 years) psoriasis has been reported to be more readily triggered by envir... more Early onset (< age 40 years) psoriasis has been reported to be more readily triggered by environmental factors such as stress, in contrast to late onset (> or = age 40 years) psoriasis. We examined whether certain psychopathologic factors differentiated the psoriasis patient with early onset versus late onset disease. One hundred and thirty-seven psoriasis inpatients completed a battery of psychosocial questionnaires. Logistics regression analysis, using the psychologic measures, age and TBSA affected as independent variables, revealed that higher Anger-in (Anger Expression Scale) scores significantly (p < 0.05) increased the odds or probability of having early versus late onset psoriasis. Psoriasis with onset prior to age 40 is comorbid with greater difficulties with assertion and expression of anger, a personality trait that may adversely affect the patient's capacity to cope with stress.

International Journal of Dermatology, 1995

Background. The impact of psoriasis upon the quality of life contributes significantly to the ove... more Background. The impact of psoriasis upon the quality of life contributes significantly to the overall morbidity associated with the disease. An older age at onset of psoriasis and being a man have been associated previously with lower psychosocial morbidity. In order to further evaluate these potentially important mitigating factors, we examined the relation of age and gender on some aspects of psoriasis-related psychosocial morbidity. Methods. Two hundred and fifteen consenting psoriasis patients, representing a wide range of disease severity, were studied. They included 110 men and 105 women, age range 19-87 years (age: mean ± SD: 48.0 ± 15.9 years); all endorsed a list of 30 items (by checking a "Yes" or "No") pertaining to life events related to psoriasis that they had experienced in the previous one month. The patients selfrated the severity of their psoriasis. The patients were categorized into four age groups of 18-29 years (N = 28), 30-45 years (N = 77), 46-65 years (N = 76), and > 65 years (N = 34), respectively, forthe statistical analyses.