Psychiatric Diseases

Abstract

The interaction between psychic functioning and somatic expression is long known and studied. The common ectodermal embryonic origin of the central nervous system and the skin, in addition to several possible emotional and social languages attributable to the skin, make this organ a scenario for physical and mental health manifestations, as well as a territory of personal, social, and cultural expression. Skin-related complaints correspond to up to 58% of the reasons for consultation in primary health care services, and a quarter of these patients have associated psychological distress. Psychodermatology studies the psychiatric manifestations that derive from skin diseases, the triggering and aggravating factors of the dermatosis, the influence of stress and drugs, and the social prejudice and emotional damage resulting from this interaction. This chapter addresses skin complaints resulting from psychiatric illnesses (i.e., those where the genesis of skin manifestations can be primarily attributable to psychic functioning), its epidemiology, and theories that seek to explain the etiopathogenesis, clinical and laboratory findings, and dermatologic, psychotherapeutic, and psychopharmacologic management of psychodermatosis.

Glossary

Anagen phase

The growth phase in the hair growth cycle during which a newly formed hair continues to grow. It is generally the longest phase and is followed by catagen.

Borderline personality disorders (BPDs)

BPD is a pattern of abnormal behavior characterized by extreme fears of abandonment, unstable relationships with other people, sense of self, or emotions, feelings of emptiness, frequent dangerous behavior, and self-harm. Symptoms may be triggered by seemingly normal events. This pattern of behavior typically begins by early adulthood, and occurs across a variety of situations. People with BPD often engage in idealization and devaluation of others, alternating between high positive regard and great disappointment. Substance abuse, depression, and eating disorders commonly coexist with borderline personality disorder. About 6% die by suicide.

Catagen phase

The catagen phase is a short transition stage that occurs at the end of the anagen phase. It signals the end of the active growth of a hair. This phase lasts for about 2–3 weeks while the hair converts to a club hair. A club hair is formed during the catagen phase when the part of the hair follicle in contact with the lower portion of the hair becomes attached to the hair shaft. This process cuts the hair off from its blood supply and from the cells that produce new hair. When a club hair is completely formed, about a 2-week process, the hair follicle enters the telogen phase.

Histopathology

Refers to the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine histopathology refers to the examination of a biopsy or surgical specimen by a pathologist, after the specimen has been processed and histologic sections have been placed onto glass slides. In contrast, cytopathology examines free cells or tissue fragments.

Intermittent explosive disorder

Intermittent explosive disorder (sometimes abbreviated as IED) is a behavioral disorder characterized by explosive outbursts of anger and violence, often to the point of rage, which are disproportionate to the situation at hand (e.g., impulsive screaming triggered by relatively inconsequential events). Impulsive aggression is unpremeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst (e.g., tension, mood changes, energy changes).

Munchausen syndrome

A psychiatric factitious disorder whereby those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. Casually referred as hospital addiction syndrome, thick chart syndrome, or hospital hopper syndrome. Munchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but patients also have a history of recurrent hospitalization, traveling, and dramatic, extremely improbable tales of their past experiences. The condition derives its name from the fictional character Baron Munchausen.

Onychophagy

Also known as nail biting or onychophagia, it is an oral compulsive habit sometimes described as a parafunctional activity, the common use of the mouth for an activity other than speaking, eating, or drinking. Onychophagy is considered an impulse control disorder in the DSM-IV-R, and is classified under obsessive–compulsive and related disorders in the DSM-5. The ICD-10 classifies it as “other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence.”

Paraphilia

Paraphilia (also known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, or individuals. No consensus has been found for any precise border between unusual sexual interests and paraphilic ones. The number and taxonomy of paraphilias is under debate. The DSM-5 has specific listings for eight paraphilic disorders. Several subclassifications of the paraphilias have been proposed, and some argue that a fully dimensional, spectrum or complaint-oriented approach would better reflect the evidence.

Prader–Willi syndrome

A rare genetic disorder whereby seven genes (or some subset thereof) on chromosome 15 (q 11–13) are deleted or unexpressed (chromosome 15q partial deletion) on the paternal chromosome. It was first described in 1956 by Andrea Prader (1919–2001), Heinrich Willi (1900–1971), Alexis Labhart (1916–1994), Andrew Ziegler, and Guido Fanconi of Switzerland. Characteristic of PWS are “low muscle tone, short stature, incomplete sexual development, cognitive disabilities, behavior problems, and a chronic feeling of hunger that can lead to excessive eating and life-threatening obesity.” The incidence of PWS is between 1 in 25,000 and 1 in 10,000 live births.

Psychodermatology

The study of skin disorders using psychological and psychiatric techniques, a subspecialty of dermatology. Frequently treated conditions are psoriasis, eczema, hives, genital and oral herpes, acne, warts, skin allergies, pain and burning sensations, hair loss, and compulsive skin picking and hair pulling. Psychological or psychiatric treatments are the primary treatments for some dermatologic disorders, including trichotillomania and skin picking. Techniques include relaxation, meditation, hypnosis and self-hypnosis, psychotropic medications, biofeedback, and focused psychotherapy.

Schizophrenia

A mental disorder characterized by abnormal social behavior and failure to understand reality. Common symptoms include false beliefs, unclear or confused thinking, hearing voices, reduced social engagement and emotional expression, and a lack of motivation. People with schizophrenia often have additional mental health problems such as anxiety disorders, major depressive illness, or substance use disorder. Symptoms typically come on gradually, begin in young adulthood, and last a long time.

Social phobia

Also known as social anxiety disorder (SAD), it is an anxiety disorder characterized by a significant amount of fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life. These fears can be triggered by perceived or actual scrutiny from others. It is the most common anxiety disorder and one of the most common psychiatric disorders, with 12% of American adults having experienced it.

Telogen phase

The telogen phase is the resting phase of the hair follicle. When the body is subjected to extreme stress, as much as 70% of hair can prematurely enter a phase of rest, called the telogen phase. This hair begins to fall out, causing a noticeable loss of hair. This condition is called telogen effluvium. The club hair is the final product of a hair follicle in the telogen stage, and is a dead, fully keratinized hair. Fifty to 100 club hairs are shed daily from a normal scalp.

Tourette’s disorder

Tourette’s disorder (also called Tourette’s syndrome, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette’s or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical (motor) tics and at least one vocal (phonic) tic. These tics characteristically wax and wane, can be suppressed temporarily, and are preceded by a premonitory urge. Tourette’s is defined as part of a spectrum of tic disorders, which includes provisional, transient, and persistent (chronic) tics.

Trichobezoar

Trichobezoars or human hairballs are complications of trichophagia or eating of the hair. Trichophagia occurs when hair that is pulled out is chewed and then swallowed. The hair will eventually collect in a sufferer’s stomach and will cause stomach problems such as indigestion and pain. Trichophagia is very commonly associated with trichotillomania.

Trichomalacia

A rare genetic condition resulting in patchy hair loss in children. It is an abnormality of the hair shaft and can be due to a compulsive habit of pulling hair on the head or even eyelashes and eyebrows.

Trichotillomania

Also known as trichotillosis or hair pulling disorder, trichotillomania is an obsessive–compulsive disorder characterized by the compulsive urge to pull out one’s hair, leading to hair loss and balding, distress, and social or functional impairment. It may be present in infants, but the peak age of onset is 9–13 years. It may be triggered by depression or stress. Owing to social implications, the disorder is often unreported and it is difficult to accurately predict its prevalence. Common areas for hair to be pulled out are the scalp, eyelashes, eyebrows, legs, arms, hands, nose, and the pubic areas.