Psychodermatology in Clinical Practice

Description

This book represents a simple, practical resource for all healthcare professionals working with dermatological patients with psychological aspects to their disease. The emphasis is on effective guidance rather than exhaustive case reviews, providing readers with a manual on the appropriate way to approach management of the patient in each case. Comprehensive in coverage, but concise in its delivery of information, Psychodermatology in Clinical Practice presents an idealized approach to management of psychodermatology patients within a global perspective, and provides practical tools to aid assessment of patients and in the decision-making process. It is suitable for dermatologists, psychiatrists and psychologists, dermatology nursing staff, primary care physicians and pediatricians. Preface to the Handbook of Psychodermatology Acknowledgements Contents About the Authors Part I: Principles 1: Psychodermatology History and Examination Initial Assessment General Considerations in Conducting a Psychodermatological Assessment Psychodermatological Assessment Medical History Priority Areas at Initial Assessment Psychiatric History Priority Areas at Initial Assessment Physical Examination and Investigation Is Crucial at the Initial Assessment: See Box 1.4 for Suggested Investigations Use of Questionnaires in Psychocutaneous Clinics 2: Approaches to Patients Introductions and Scene Setting for the Patient Opening Up a Psychosocial Agenda in a Dermatology Consultation Consultation Environment Factors A Note on Record Keeping and Confidentiality Issues Behaviours and Techniques with Which to Engage Patients in Discussing Their Psychological Health Useful Interview Techniques Correspondence and Communication of Mental Health Assessments in the Joint Psychodermatology Setting (Where This Model Is Possible) Why Are Mental Health Disorders Missed in Dermatology Outpatients? Factors to Look Out for in Dermatology Patients Which May Suggest There Is an Underlying Psychiatric Disorder Approaches to Patient in Specific Clinical Situations: Some Questions to Use and Things to Notice Assessing Mood Assessing Anxiety Assessing Obsessional Symptoms Obsessional Disorders in the Skin Clinic Assessing Psychosis in the Skin Clinic Risk Assessment Assessment of Suicide Risk How to Ask About Suicidal Ideas? 3: Capacity Introduction Having Capacity Lack of Capacity Patients at Risk of Incapacity Capacity in Dermatology Assessing Capacity An Example of Legislation Important Pointers for Dermatologists References 4: Protecting the Psychodermatology Health Care Professional Introduction Complaints Burnout Burnout in Dermatology and Psychodermatology Contributing Factors to Burnout and Mental Illness Current Situation Recommendations Bibliography 5: Psychopharmacology for Dermatologists Introduction Antidepressants Antipsychotics Mood Stabilisers Benzodiazepines Summary 6: Psychological Interventions Introduction Prevalence Efficacy of Psychological Interventions Principles of Skin Care Regimes Mode of Therapy Principles and Set Up Benefits and Disadvantages Treatment Pathway/Stepped Care Model Principles Stepped Care What Can Dermatologists Do? Self-Help Approaches Self-Help Psychological Approaches/Therapies Behavioural Therapies Behavioural Activation Exposure Response Prevention Habit Reversal Therapy Cognitive Behavioural Therapy (CBT) Relaxation Trauma-Based Therapy Schema Therapy Acceptance and Commitment Therapy (ACT) Mindfulness Systemic Family Therapy Overview of Talk Therapies Formulation Principles Consequences for Clinical Set Ups References 7: Cognitive Behavioural Therapy for Skin Conditions Introduction What Is CBT? CBT Protocols CBT and Skin Conditions CBT Techniques The Impact that Skin Conditions Can Have on Psychosocial Functioning Prevalence of Distress in Skin Conditions Impact Overlapping Categories of Psychological Distress The Different Types of CBT Background How CBT Works Development of CBT Over Time Mindfulness-Based Cognitive Therapy CBT Approaches Within Stepped Care Stepped Care Pure Self-Help Based on CBT CBT-Based Guided Self-Help, Psychoeducational Groups, cCBT High-Intensity CBT Signposting Patients to Places Where They Can Gain some Access to CBT and Mindfulness-Based Self-Help Information Part II: Specific Illnesses 8: Dermatitis Artefacta Definition Classification Epidemiology Etiopathology Clinical Presentations Psychopathological Factors and Comorbidities Evaluation and Diagnosis Investigations Management DA or Malingering? Prognosis References 9: Psoriasis Aetiology Psychiatric Comorbidities Anxiety and Depression (Fig. 9.1) The Brain–Skin Axis (Table 9.1) Brain Changes Suicide Alcohol and Smoking Misuse Quality of Life Physical Factors (Table 9.2) Pruritus Functional Impairment Sexual Dysfunction Sleep Disturbance Psychosocial Factors Psychological Factors and Schemas (Table 9.3) Social Factors (Table 9.4) Quality of Life Questionnaires (Table 9.5) Stigma (Table 9.6) Alexithymia Treatment Treatment of the Skin Cognitive Behavioural Therapy (CBT) Psychotropic Medication Bibliography 10: Eczema and Psychodermatology Definition of Illness Classification Clinical Presentation General Symptoms Dermatological Symptoms Psychiatric Symptoms Systemic Symptoms Why Is This so Debilitating? Epidemiology Diagnostic Process Treatment Prognosis References 11: Somatoform Disorders Definition of the Disorder Aetiology and Classification Prevalence and Age of Onset Clinical Features and Presentation Deferential Diagnosis and Comorbidity Assessment and Treatment 12: Delusional Infestation Aetiology and Classification Primary and Secondary DI Patho-Aetiology Shared Beliefs and Unusual Presentations of DI Historical Names for Delusional Infestation (Main Terms Out of Over 30 Terms Used Since 1894) Clinical Presentation General Considerations Delusional Theme Specimen Sign Why DI Is so Debilitating Epidemiology and Aetiology Prevalence Epidemiology Course and Duration of Illness Diagnostic Process General Considerations Diagnosing Process Delusional Themes Differential Diagnosis Treatment General Considerations Pharmacological Treatment Non-Pharmacological Interventions Discussing the Diagnosis and Management with a Patient Prognosis Existing Prognosis Data Duration of Treatment Considerations of Insight Considerations of Capacity Additional Guidance References 13: Psycho-Dermato-Oncology: Psychological Aspects of Skin Cancer Introduction The Patient Experience of Being Diagnosed and Treated for Skin Cancer Psychological Intervention Psychosocial and Quality of Life Assessment Breaking Bad News Specific Forms of Psychosocial Support Psycho-Education Cognitive Behavioural Therapy Based Techniques Including ‘Third Wave’ CBT Case Histories References 14: Body Dysmorphic Disorder (BDD) Definition Prevalence Aetiology and Pathophysiology Key Clinical Features Techniques for Addressing the Diagnosis of BDD with Patients Assessment and Use of Screening Instruments Differential Diagnosis Referral Treatment References 15: Nodular Prurigo Definition Demographics Clinical Features (Figs. 15.1 and 15.2) Aetiology (Fig. 15.3 and Table 15.1) Pathogenesis Differential Diagnosis Clinical Assessment Management of Nodular Prurigo (Fig. 15.3) Treatment of the Psychological and Psycho-Social Co-morbidities Talk Therapies Psychopharmacology Treatments Outlook Bibliography 16: Trichotillomania (Hair Pulling Disorder) Definition Etiology and Pathogenesis Classification Main Classification Subtypes Clinical Presentations General Symptoms Dermatological Symptoms Psychiatric Symptoms Epidemiology Diagnostic Process General Considerations Diagnosing Process Investigations Differential Diagnosis (Table 16.2) Treatment Psychotherapy Psychoeducation Functional Analysis Awareness Training and Self-Monitoring Stimulus Control (Table 16.4) Competing Responses Prognosis Bibliography 17: Depression and Anxiety Depression Definition of the Disorder Classification Clinical Features and Presentation Epidemiology and Aetiology Diagnosis and Differential Diagnosis Treatment Anxiety Disorders Definition of the Disorder Classification Clinical Features and Presentation Epidemiology and Aetiology Diagnosis and Differential Diagnosis Treatment 18: Trigeminal Trophic Syndrome Definition Aetiology and Classification Trigeminal Trophic Syndrome Atypical Trigeminal Trophic Syndrome Clinical Presentation Why Is TTS so Debilitating? Epidemiology Prevalence Epidemiology Course and Prognosis Diagnosis General Considerations Differential Diagnoses Diagnostic Process History and Examination Investigation Treatment Psychological Interventions Wound Management Pharmacological Management Surgical Management Prognosis References 19: Skin Picking Disorders Background Clinical Presentation General Symptoms Dermatological Signs Differential Diagnosis Epidemiology Diagnostic Process Investigations Treatment Communication Treatment of the Skin/Itch (See also Pruritus Chapter) Topicals Phototherapy and Systemic Treatments Treatment of the Psychological or Psychiatric Disease Non-pharmacological Therapy (See also Chapter on Habit Reversal and Cognitive Behavioural Therapy) Pharmacological Therapy Prognosis Bibliography 20: Gardner–Diamond Syndrome Definitions Epidemiology Aetiology and Potential Pathogenesis Clinical Presentation Dermatologic Manifestations Mental Health Associations Psychological Assessment Psychiatric Examination Concomitant Disorders Diagnostic Process Laboratory Examination Histopathology Differential Diagnosis The Course of the Disease Treatment Prognosis 21: Acne and Psychodermatology Introduction Prevalence of Psychological Impact Associated with Acne Pathogenesis of Psychological and Psychiatric Disorders in Acne Coping Skills that Become the Problem Clinical Presentations of Psychological Impact Poor Self-Esteem and Lack of Confidence A Mismatch of Severity of Disease and Impact Social Withdrawal Failure to Attend or Progress in Education and Work Excoriation Disorder Assessment Tools Identifying Psychiatric Conditions Body Dysmorphic Disorder Treating Underlying Psychological and Psychiatric Disease Psychological Interventions Cognitive Behaviour Therapy (CBT) Habit Reversal Techniques for Excoriation Disorder Prescribing Antidepressants Prescribing Isotretinoin Suicide and Isotretinoin References 22: Hair Disorders and Impact on Quality of Life Introduction Hair Loss Excess Hair and Hair in the Wrong Place Classification and Aetiology Patho-aetiology Clinical and Psychodermatological Approach on Patients with Hair Loss Alopecia Areata Psychodermatology in AA Androgenetic Alopecia—Pattern Hair Loss (Males and Females) Psychodermatology in AGA/PHL Telogen Effluvium Anagen Effluvium Scarring Hair Loss Psychiatric Disorders That Can Present with Hair Loss Trichotillomania Delusional Infestation Body Dysmorphic Disorder Scalp Disease Appliances/Wigs, Camouflage and Support Groups Bibliography 23: Psychogenic Pruritus Definition Classification Pathophysiology Clinical Presentation Why Is Psychogenic Pruritus so Debilitating? Epidemiology Diagnostic Process Treatment Prognosis Bibliography Part III: Concepts 24: Personality Disorders in Dermatology Definitions Classification Overview Aetiology and Pathology Environmental Factors Genetic Factors Biological Aspects Clinical Presentation Personality Disorders and Skin Principles PDs and Associated Primary Psycho-dermatologic Conditions PDs Mediated Reactions in Dermatoses Sociophobic Reactions Overvalued Reactions Ideas of Reference Reactions PDs as a Predisposition to Dermatoses Why PDs Are so Debilitating Epidemiology Prevalence in the Population PD in Dermatology Epidemiology Course and Duration Diagnostic Process General Considerations Diagnosing Process Differential Diagnosis Treatment General Considerations Non-pharmacological Interventions Pharmacological Treatment Discussing the Diagnosis and Management with a Patient Prognosis Existing Prognosis Data Duration of Treatment Bibliography 25: Dysaesthetic Disorders Differential Diagnosis Localised Neuropathic Disorders Trigeminal Syndromes Regional Dysaesthesia Approach to the Patient with Dysaesthesia History Examination Investigations Management References 26: Delusional Disorders in Dermatology Definitions Clinical Presentation Delusional Disorders in Dermatology (Hypochondriacal or Somatic Delusions Related to Skin) Why DD of Somatic Type Is so Debilitating Epidemiology and Aetiology Diagnostic Process Treatment Prognosis Bibliography 27: Psychodermatology in Children Skin Conditions That Result in Psychological Morbidity Skin Conditions That Are Exacerbated by Stress/Psychosocial Factors Skin Conditions Due to Psychological/Psychiatric Disturbance/Neurodevelopmental Disorders Attention Deficit and Hyperactivity Disorder (ADHD) Trichotillomania/Compulsive Hair Pulling Treatments Self-Harm Dermatitis Artefacta/Unexplained Skin Lesions in Children Summary Skin Picking and Self-Injury Psychological Assessment in Paediatric Dermatology Standardised Measures Psychological Risk Assessment Referral to Child and Adolescent Mental Health Service (CAMHS) Other Areas of Support Psychological Interventions for Paediatric Skin Disease Psychopharmacology in Paediatric Dermatology Depression Anxiety Psychosis Attention Deficit Disorder (ADD) Bibliography 28: Habit Reversal Therapy Background Motivation and Success; What Influences Therapy? Increasing Adherence Suggested Adaptations to Increase Adherence and Positive Treatment Outcomes Conclusion References 29: Quality of Life Introduction References 30: Complementary and Alternative Medicine and Psychodermatology Introduction CAM and Psychodermatology Disease Seen in Terms of Function Meaning of the Disease to the Patient Expanding the Patient’s Sense of Self Purpose of Treatment Herbal Medicine and Phytotherapy Herbal Pharmacology Efficacy and Safety of Plant Medicine Consultation and Diagnosis Treatment Plan Basic Self-Care The Gut–Brain–Skin Axis Sleep: Self-Care and Herbal Medicine Example of a Herbal Prescription for Patient with Eczema and Anxiety Other Examples Bibliography 31: Hypnosis and Relaxation Techniques Hypnosis Chronology of Important Figures in Hypnosis Current Hypnotherapies What Is Cognitive-Behavioural Hypnosis? Clinical Application in Psychodermatology? Using Basic Hypnosis? Relaxation Techniques What Is Relaxation? When to Use Relaxation Techniques in Psychodermatology? The Relaxation Response Bibliography 32: Substance Abuse Introduction Substances: Clinical and Cutaneous Findings, Diagnosis and Treatment Alcohol Clinical and Cutaneous Findings Diagnosis Treatment Opioids Clinical and Cutaneous Findings Diagnosis Treatment Stimulants Clinical and Cutaneous Findings Diagnosis Treatment Clinical and Cutaneous Findings Diagnosis Treatment Cannabis and Cannabinoids Clinical and Cutaneous Findings Diagnosis Treatment Hallucinogens Diagnosis Treatment