Obsessive-compulsive disorder in dermatology

Patients with obsessive-compulsive (OCD) and related disorders - primarily trichotillomania, body dysmorphic disorder, and skin picking disorder - frequently present to dermatologists due to associated hair and skin symptoms. It is therefore crucial that dermatologists be familiar with these disorders. In this review article, we provide an update on clinical features, neurobiology factors, and treatment options for OCD spectrum disorders. Employing PubMed and Cochrane Library databases, a selective literature search was conducted using keywords related to dermatological disorders within the OCD spectrum. OCD and its related disorders share several phenomenological as well as pathophysiological similarities, thus warranting their classification within a separate nosological category of psychiatric disorders. Another similarity of OCD spectrum disorders is the frequent concurrence of hair and skin diseases. Besides symptomatic dermatological treatment, the combination of psychotherapy (behavioral therapy) and psychopharmacotherapy (SSRIs) may be helpful. Although recent insights into OCD have contributed to a better understanding and treatment thereof, more research is required, especially with respect to OCD spectrum disorders, for which large controlled treatment studies are still lacking.

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Delusions of parasitosis

The most common monosymptomatic hypochondriacal psychosis encountered by a dermatologist is delusions ofparasitosis. In this condition, patients have an "encapsulated" fixed, false belief that they are infested with parasites or have foreign objects extruding from their skin. The patient will often experience feelings of biting, crawling and stinging related to the delusion. Most patients do not have other major psychiatric problems outside of their encapsulated delusion. The patient usually presents with a long history of symptoms and multiple visits to physicians in more than one specialty. Without an informed approach to these patients that focuses on the development of therapeutic alliance, clinical interactions can become very unpleasant. However, when treated with pimozide, risperidone, or other antipsychotic medications, patients have a very high response rate. Therefore, it is important for dermatologists to be able to handle these cases and know that the development of the therapeutic alliance is the key step to successful management.

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Delusions of parasitosis; suggested dialogue between dermatologist and patient

Delusions of parasitosis (DoP) is a psychocutaneous condition characterized by a fixed false belief that one is infested by skin parasites. Patients afflicted with DoP generally experience sensations of biting, stinging or crawling in the absence of any objective evidence of infestation. The most definitive treatment for DoP is antipsychotic agents. Though the diagnosis and treatment options are rather straightforward, the difficulty lies in the art of building a therapeutic rapport with the patient in order to encourage acceptance of antipsychotic treatment. This article is a practical guide that suggests verbatim how dermatologists might talk to a delusional patient in order to establish a strong therapeutic rapport. Strategies on how to optimize the initial encounter, build rapport and prescribe antipsychotic medications that are likely to be accepted by the patient are discussed.

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