CUTANEOUS PATHOMIMIA IN ADULTS: A SIGN OF PSYCHIATRIC ILLNESS. (original) (raw)

Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

Clinical Interventions in Aging, 2014

The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods: Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results: The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion: These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to choose the proper therapy is mandatory for all these cases. Dermatologists and all physicians who take care of old patients must recognize the disorder in order to provide optimum care for this chronic condition. We emphasize therefore the importance of psychiatric evaluation and treatment to avoid the major risk of suicide. Skin lesions must be regarded as an alarm signal in critical cases, especially in senior people.

A STUDY OF CUTANEOUS MANIFESTATIONS OF PATIENTS WITH PSYCHIATRIC DISORDER

Skin is an organ that has a primary function of tactile receptivity and reacts to both external and internal emotional stimuli. Dermatological practice certainly embeds a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. AIMS AND OBJECTIVES The aim of present study is to evaluate the prevalence of cutaneous manifestations in patients with psychiatric disorder. MATERIALS AND METHODS Twenty five psychiatric in-patients admitted in the psychiatry ward of a Tertiary Care Hospital were examined for the presence of cutaneous manifestation over a period of 6 months. Appropriate laboratory investigations such as scraping for Acarus, skin biopsy etc. were performed wherever required. The observations were noted. RESULTS The commonest cutaneous manifestations seen in this study were (i) Parasitic infestations like scabies (20%), pediculosis capitis (16%), (ii) Xerosis (28 %), (iii) Prurigo nodularis (4%), (iv) Lichen simplex chronicus (4%), (v) Venereophobia (4%) and (vi) Delusion of parasitosis (4%). CONCLUSION A high incidence of parasitic infestations was noted in our study. The healthcare personnel should be sensitized on the significance of such parasitic infestations in institutionalized patients and the importance of early detection and treatment.

Case series of primary psychiatric skin disorders with multi-disciplinary approach

Journal of General - Procedural Dermatology & Venereology Indonesia, 2020

Background: The incidence of psychodermatologic diseases, a group of skin abnormalities associated with psychosomatic factor, are increasing recently. About 20-40% patients with skin symptoms have concurrent psychiatric problems which are often difficult to diagnose and treat. The new classification of primary psychiatric skin disorders are delusional disorders, obsessive-compulsive and related disorders, and factitious disorders. This classification could be used for effective treatment in each patient which involves multidisciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Illustration: The first case was a 39-year-old unmarried female, with anemia and dermatitis artefacta occurred as wound due to blade cuts. Patient was with schizoaffective depressive type and was not under regular treatment. The second case was a 61-year-old male referred with unresolved prurigo nodularis for the past 30 years. After in-depth assessment, there were delusional parasitosis and neurotic excoriations disorders. The third patient was a 50-year-old female admitted with recurrent ulcer on her face. She was aware that the lesions were intentionally manipulated by her own fingers when she was depressed. Discussion: All patients were classified as primary psychiatric skin disorders with varied skin manifestations. Symptoms usually occurred when the patient was in the depression state or low compliance for the psychotropic drugs. Patients generally had poor insight and refused to be associated with psychiatric factors. Dermato-venereologists are expected to conduct early detection and treat this disease. Conclusion: It is important to approach psychocutaneous disease in multidisciplinary manner, especially with the psychiatrist.

A study of skin disorders in patients with primary psychiatric conditions

Indian journal of dermatology, venereology and leprology

The skin occupies a powerful position as an organ of communication and plays an important role in socialization throughout life. The interface between dermatology and psychiatry is complex and of clinical importance. To document the incidence of cutaneous disorders in patients with primary psychiatric conditions. Three hundred patients with a primary psychiatric condition who had cutaneous disease were entered into the study group. The patients were classified appropriately based on the classification of psychocutaneous disorders. The control group included 300 patients presenting with a skin disorder and without any known psychiatric complaint. The majority of the cases in the study group were in the 3rd-5th decade. In this study, the most common primary psychiatric conditions were manic depressive psychosis (53.33%), depression (36.33%), schizophrenia (8.33%) and anxiety (2%). Of the study group, 68.66% patients had infective dermatoses and the rest had non-infective dermatoses. A...

The Importance of Dual Dermatologic and Psychiatric Approach in Psychocutaneous Disorders

2016

Psychodermatology or psychocutaneous medicine is a relatively old domain, built on well studied and documented connections between mental / psychic and skin. Numerous studies highlight the idea that evolution of a significant percentage of dermatoses is negatively influenced by psychological factors and stress and that mental state affects not only how the disease is perceived but its severity as well. It is estimated that 30-40% of dermatological patients show a concurrent mental disorder or psychological problems that may be the causative, predisposing or aggravating factor of the cutaneous disease. Morbid conditions such as psoriasis, atopic dermatitis, alopecia areata, vitiligo, severe acne have a marked negative impact on patient quality of life through both debilitating and chronic character of the diseases and by their psychosocial consequences: decreased self-esteem, embarrassment, depression, social phobia, social discrimination to employment, family and couple relations al...

A study of skin manifestations in patients with psychiatric disorders

International Journal of Research in Dermatology

Background: The interaction between psychological factors and skin diseases has long been hypothesized. Considerations of psychiatry and psychosocial factors are important for better management of dermatological disorders as coexistence of psychiatric and dermatological disorders are mostly seen. The aim of the study was to identify skin manifestations in individuals suffering from psychiatric disorders.Methods: A total of 100 patients attending dermatology OPD were screened for history of any psychiatric illness and patients with a positive history of psychiatric illness were recruited into study. The skin lesions were categorised as per the classification of psychodermatology and results were analysed accordingly.Results: The patients recruited belonged to age groups ranging from 12 to 70 with a higher female to male ratio (54% females and 46% males). The psychophysiological disorders constituted 29 %, among them chronic urticaria (34.4%) followed by psoriasis (27.58%) constituted...

The self-inflicted dermatoses: A critical review

General Hospital Psychiatry, 1987

The self-inflicted dermatoses, namely dermatitis artefacta, neurotic excoriations, and trichotillomania, have been reported to be associated with various degrees of psychopathology in the dermatologic literature, but have received surprisingly little emphasis in the psychiatric literature. This probably reflects, firstly the fact that most of these patients initially deny any psychologic problems and hence may not receive psychiatric interventions, and secondly a lack of adequate collaboration between the psychiatrist and dermatologist. These disorders may be associated with serious sequelae, such as suicide and repeated major surgical procedures. Their treatment is also primarily psychiatric. This article critically reviews the literature and comments upon the salient clinical features and treatments for these disorders, which are relevant for the psychiatrist doing consultation-liaison work. Knowledge of these disorders is important in theevaluation ofanypsychiatricpatient. as these disorders are essentially a cutaneous sign of psychopathology.

Managing the patient with psychiatric issues in dermatologic practice

Clinics in Dermatology, 2013

Patients often communicate emotions through their bodies and physical symptoms; the skin commonly serves as a means of expression in the patient-doctor relationship. It is important for the dermatologist to be able to indentify psychological issues that manifest in the skin and the interplay between psychiatric and dermatologic conditions. Delusional parasitosis, dermatitis artefacta, trichotillomania, and somatoform disorders all represent dermatologic conditions with underlying emotional causes. Many chronic dermatoses, such as psoriasis, atopic dermatitis, and acne, modulate and are influenced by psychosocial factors. Special issues, including significant medication interactions and the treatment of the "difficult" patient, are reviewed.

Management of psychocutaneous disorders: A practical approach for dermatologists

Dermatologic Therapy, 2020

Psychodermatology is a growing specialty which is gaining momentum in different parts of the world. It focuses on the connection between skin and psyche. Psychocutaneous conditions are characterized by those disorders where stress is the key element in exacerbating skin conditions or flare ups of dermatoses like psoriasis and atopic dermatitis. There is a direct relationship of stress with the course, and prognosis of the skin disease. In some situations, there is no skin condition but the lesions are self-inflicted and such disorders are always associated with underlying psychopathology or psychological conflicts. Sometimes emotional problems are more prominent as a result of having skin disease and the psychological consequences may be more severe than the physical symptoms. Management of these conditions require a combination of psychpharmacology, psychotherapy and liaison clinics of psychiatry and dermatology. This review focuses on the common management approach which can be adopted by deramtologists in treating patients with psychodermatological disorders, improving doctor-patient relationship and therapeutic bond.