Systematic review of pharmacological and behavioural interventions for reducing cardiovascular disease risk in people with severe mental illnesses (original) (raw)
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Systematic Review of Pharmacological and Behavioral Treatments for Skin Picking Disorder
Journal of Clinical Psychopharmacology, 2016
Skin picking disorder (SPD) is a newly recognized psychiatric disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A systematic review was conducted to assess the efficacy of pharmacological and behavioral interventions for SPD. Electronic databases were searched for randomized controlled trials (RCTs) or uncontrolled trials involving at least 10 subjects that examined the efficacy of pharmacological and behavioral interventions for SPD. We examined the improvement associated with interventions compared with inactive control conditions in RCTs and improvement over time in uncontrolled trials and within the treatment arms of RCTs. We stratified studies on the basis of intervention type. Meta-analysis included 11 studies. All interventions (including inactive control conditions) demonstrated significant improvement over the course of short-term clinical trials in SPD. Only behavioral treatments demonstrated significant benefits compared with inactive control conditions. There was no evidence from RCTs that pharmacotherapy with selective serotonin reuptake inhibitors or lamotrigine were more effective at treating SPD than placebo. Our meta-analysis suggests that subjects with SPD show significant improvement during short-term trials, regardless of the efficacy of the underlying intervention. This finding suggests that uncontrolled trials are of particularly limited utility for assessing efficacy of treatments in SPD. Future research should concentrate on developing larger placebo-controlled RCTs to examine efficacy of novel pharmacological agents. In addition, research should focus on improving accessibility of behavioral treatments with demonstrated efficacy for SPD.
Psychiatric Characteristics and Quality of Life in Patients with Pathologic Skin Picking
2008
This study aimed to detail the phenomenology and psychiatric co morbidities in patients with pathologic skin picking (PSP). Method: Forty five subjects (30% males) with PSP (mean± S.D. =33.2±10.9) were assessed. Subjects were assessed for psychiatric co morbidity using General Health Questionnaire (GHQ). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess obsessive compulsive symptoms; the Dermatology quality of life index(DLQI) was utilized to evaluate the quality of life in patients; and clinical severity using Visual Analogue Scale(VAS) was employed for evaluating skin picking behavior. Results: The mean time after (±S.D.) the onset of PSP was 6.6±2.4years. Twenty eight (62.2%) individuals had a bimodal GHQ score higher than five which implied probable mental disorder, and twenty two (48.9%) of the individuals with PSP had significant obsessive compulsive disorder. The severity of impairment of quality of life status was increased with increment of mental disorder severity. Conclusion: PSP appears to be time consuming and frequently associated with psychiatric co morbidities. Considerations should be made on the relationship between psychiatric co morbidity and quality of life in PSP diagnosis and treatment of mental disorders.
Acta Medica …, 2008
Various studies suggest that selective serotonin reuptake inhibitors (SSRIs) may be useful in treating pathological skin picking (PSP). This study sought to assess effectiveness of citalopram in comparison with placebo in treating PSP. Forty five individuals with PSP were recruited in a four-week, randomized clinical trial of citalopram (20 mg/day) in comparison with placebo. Study measures assessing skin picking severity, mental health status, obsessive compulsive disorder and quality of life were given at baseline, weeks 2 and 4. PSP severity, general health status, obsession-compulsion severity and quality of life level were similar between two groups at baseline (P > 0.05). Treatment analyses revealed significant improvements in quality of life, general health status and obsessioncompulsion severity in citalopram group compared to placebo group (P < 0.05). Mean PSP severity reduction in citalopram group was more than placebo group but this difference was not significant. Citalopram can improve general health status and quality of life in individuals with PSP but its effect on skin picking behavior doesn't differ significantly with placebo. Other trials with longer duration are needed to determine the exact efficacy of citalopram on PSP.
ANTIPSYCHOTICS FOR TREATMENT OF SKIN-PICKING: CASE REPORT (Atena Editora)
ANTIPSYCHOTICS FOR TREATMENT OF SKIN-PICKING: CASE REPORT (Atena Editora), 2024
Skin-picking disorder is a psychiatric condition defined by the compulsive behavior of frequently squeezing, biting or pinching one's own skin, which can cause psychological distress and significant damage to the routine of patients with the condition. The treatment of the pathology consists of a psychotherapeutic approach combined with pharmacotherapy. Antipsychotics such as aripiprazole, risperidone and haloperidol are considered first-line pharmacological treatment.
Fluoxetine in Pathologic Skin-Picking: Open-Label and Double-Blind Results
Psychosomatics, 2001
Various studies suggest that selective serotonin reuptake inhibitors (SSRIs) may be useful in treating pathologic skin-picking. The authors investigated the effectiveness of fluoxetine in treating this behavior. Fifteen subjects with clinically significant skin-picking were recruited by newspaper advertisement. They received 6 weeks of open-label treatment with fluoxetine. Responders were then randomized to 6 weeks of double-blind fluoxetine or placebo. Treatment effect was assessed with standardized rating scales. All 15 subjects completed open-label treatment, and 8 were responders. Of these eight, the four randomized to double-blind fluoxetine maintained clinically significant improvement. The four randomized to placebo returned to their baseline symptom level. Larger studies are needed to determine which individuals are likely to respond to fluoxetine and the relative effectiveness of fluoxetine, other SSRIs, and other forms of treatment.
Haloperidol augmentation of fluvoxamine in skin picking disorder: a case report
Journal of Medical Case Reports, 2012
Introduction: Compulsive skin picking, being part of the broader category of impulse control disorders, is considered a residual diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. It is characterized by excessive scratching or picking of normal skin, or skin with minor surface irregularities, and occurs in 2% of patients attending dermatology clinics. Despite the clinical relevance of this disorder, no clear guidelines are available yet; clinical management is, therefore, compromised and the day-today clinical practice is burdened by difficulties. Studies on selective serotonin reuptake inhibitors and anti-epileptic drugs have provided limited results. The association between anti-depressants and anti-epileptics has been found to be beneficial in some impulse control disorders, but in skin picking no previous studies have been conducted on this pharmacological approach. There are very few reports on the efficacy of anti-psychotics in skin picking. Case presentation: The therapeutic path described in this case report produced good results for a 59-year-old Caucasian woman. The first therapeutic approach, with fluvoxamine and oxcarbazepine was partially effective; then, the suspension of oxcarbazepine and haloperidol augmentation of fluvoxamine were adopted. After 10 weeks, a significant improvement of the disease was observed: the clinical picture and the associated symptoms were nearly solved. Conclusions: To the best of our knowledge, this is the first article reporting the association of fluvoxamine and haloperidol in skin picking disorder. It might be useful to perform further research regarding the treatment of skin picking disorder: in clinical practice, several variables might limit the choice of certain drugs. Therefore, it would be useful for the clinician to be aware of other therapeutic options.
2017
Objective: Hair-pulling disorder (HPD or trichotillomania) and Skin-picking disorder (SPD or excoriation disorder) are relatively common psychiatric problems with significant public health impact, and may have a chronic course if left untreated. The most common treatment for individuals with HPD/SPD is SSRI medications, but is largely ineffective. The objective of this study was to examine the efficacy of cue-exposure with response prevention (CERP) for HPD/SPD. Habit Reversal Training (HRT), implemented with CERP, was compared to HRT implemented with stimulus control (SC), which is the first-line treatment for HPD and SPD. Method: Participants were 20 university students diagnosed with either HPD (n=5) or SPD (n=15). They were randomized to receive four one-hour weekly sessions with either HRT-CERP (n=10) or HRT-SC (n=10). Assessment interviews took place pre-and post-treatment and after one month follow-up. Results: A significant reduction in symptom severity was observed in both treatment groups on all primary outcome measures. No significant group differences were observed on selfreport scales but significant differences were found on interview-based measures with HRT-CERP being more effective than HRT-SC in reducing symptom severity. Effect sizes (Cohen's d) were larger in HRT-CERP (2.27-2.96) compared to HRT-SC (1.28-1.30) on all primary outcome measures. Conclusions: HRT-CERP seems to be an effective treatment strategy for individuals with HPD and SPD when compared to HRT-SC, and should be developed further for this patient group. The sample in the present study was homogeneous in nature, with all participants being female and university students. This should be addressed in future studies.
Open-label escitalopram treatment for pathological skin picking
International Clinical Psychopharmacology, 2007
Pathological skin picking is characterized by dysfunctional, repetitive and excessive manipulation of the skin resulting in noticeable tissue damage. This study sought to assess the effectiveness of escitalopram in treating pathological skin picking. Twenty-nine individuals with pathological skin picking were enrolled in an 18-week, open-label trial of escitalopram. Study measures assessing skin picking severity and impact, anxiety, depression, and quality of life were given at baseline and weeks 2, 4, 6, 10, 14, and 18. The mean maximally tolerated dose was 25.0 mg (standard deviation = 8.4). For the 19 study completers, pre-posttreatment analyses revealed significant improvements (P < 0.05) on measures of skin picking severity and impact, quality of life, and self-rated anxiety and depression. Completer as well as intent-to-treat analyses indicated that approximately half of the sample satisfied full medication response criteria and one-quarter were partial medication responders. Correlational analyses indicated that changes in depression, anxiety, and quality of life co-occurred with reductions in skin picking severity but not impact. A high percentage of variance in severity, however, remained unexplained. These results suggest that escitalopram can be an effective agent in reducing pathological skin picking. The lack of medication response in a subset of our sample suggests the possibility of pathological skin picking subtypes.
Excoriation (skin-picking) disorder: a systematic review of treatment options
Neuropsychiatric disease and treatment, 2017
Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking) disorder (ED), also known as neurotic excoriation, psychogenic excoriation, or dermatillomania), is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive-compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder). Arguably, its inclusion and delineation in the diagnostic nomenclature will lead to increased awareness of the condition, more research, and ultimately in treatment advances. This systematic review aims to provide readers with an up-to-date view of...