الفهرس 
The Interaction between Dermatological Disorders and PsychiatryOnly 14 pages are availabe for public view
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Abstract
Psychodermatology or psychocutaneous medicine describes an interaction between dermatology and psychiatry. It encompasses disorders prevailing on the boundary between psychiatry and dermatology. Skin has a special place in psychiatry with its responsiveness to emotional stimuli and ability to express emotions such as anger, fear, shame and frustration, and by providing self-esteem, the skin plays an important role in the socialization process, which continues from childhood to adulthood. Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension.
Psychodermatology is divided into three categories according to the relationship between skin diseases and mental disorders.
Psychophysiologic (psychosomatic) disorders caused by skin diseases triggering different emotional states (stress), but not directly combined with mental disorders (psoriasis, eczema). Primary psychiatric disorders responsible for self-induced skin disorders (trichotillomania) and Secondary psychiatric disorders caused by disfiguring skin (ichthyosis, acne conglobata, vitiligo), which can lead to states of fear, depression or suicidal thoughts.
Drug reactions occur at the skin more often than at any other site. The incidence of drug-induced skin reactions due to psychotropic drugs has been reported at 0.1%. Clinically relevant cutaneous drug reactions span multiple classes of psychotropic agents, with 39% of these reactions due to mood stabilizers, 29% due to antidepressants, and19% due to neuroleptics. Moreover, the most commonly reported corticosteroid-induced psychiatric disturbances are affective, including mania, depression, or mixed states. Most often, patients receiving short-term corticosteroid therapy present with euphoria or hypomania, whereas long term therapy tends to engender depressive symptoms.
Most of the patients with psychocutaneous disorders can be broadly categorized under four diagnoses: Anxiety, depression, psychosis, and OCD
The rates of OCD are fairly consistent, with lifetime prevalence in the general population estimated at 2 to 3 percent. Some researchers have estimated that the disorder is found in as many as 10 percent of outpatient in non psychiatric clinics.
OC symptoms in dermatology clinics higher compared with general population. These symptoms could result in poor body image which leads to obsessive thoughts regarding physical appearance, consequently these patients will consult dermatologists more frequently. The percentage of (OCD) patients with skin diseases, who pri¬marily present to a dermatologist, ranges between 9 % and 35 %. The most symptoms were pathological doubt, fear of contamination and washing.
Cutaneous manifestations of OCD in adults are usually neurotic excoriations, acne excoriations (acne excoriée), eczemas, trichotillomania, onychotillomania, fears of contamination, and excessive concern with appearance.
These expressions which are known as dermatological or dermo-OCD was divided by Koblenzer (1993) into two groups of obsessions and compulsions. According to this grouping, hair loss, looking ugly, sexually transmitted diseases, skin cancer, fungal infection and acne scars might be examples of obsessions, trichotillomania, neurotic excoriations, onycho-tillomania, lip licking, localized neuro-dermatitis or irritant dermatitis caused by frequent hand washing may meet the criteria for compulsive behaviors.
Management of OCD includes non-pharmacological management cognitive behavior therapy (CBT) for patients who are unwilling or unable to initiate behavioral modification, pharmacological therapy can be helpful. There is a significant psychosomatic/behavioral component in many dermatologic conditions hence complementary non-pharmacological psychotherapeutic interventions like biofeedback, CBT, hypnosis, placebo, and suggestion have positive impacts on many dermatologic disorders. Three SSRIs-fluoxetine, paroxetine, and sertraline-are the first-line therapy for the management of OCD
The study was conducted in the dermatology cosmetic outpatient clinic of Ain Shams university Hospital, to assess the OC symptoms among patients seeking dermatological help. They were recruited every Saturday clinic in the period from August 2015 till February 2016.Therefore 101 patients were recruited, above the age of 18 and below the age of 50 with no gender preference using GHQ for mental illness screening, MINI for the diagnosis of OCD, YBOCS for the symptoms and severity of the OCD symptoms and quality of life index to assess the quality of life of the patients.
Our study aimed to identify the OC symptoms and it’s severity among patients with different dermatological diseases. Also, to correlate the OC symptoms with the quality of the life in this group of patients Among our population, Using the Mini International Neuropsychiatric Interview for diagnosis of different psychiatric disorders in the sample with positive General health questionnaire which were 76 patients: the highest for Generalized Anxiety Disorder found in 24.8% of the population then OCD in 18.8% then past depression episode in 7.9% with suicidal risk in 2% whereas current depression found in 3%. Also substance abuse found in 6%, panic attacks in 3% and Bulimia in 2%.
Our results found OCD in 18.8% this confirm other studies that showed the percentage OCD present to a dermatologist, ranges between 9 % and 35 %
Among the patient with positive OCD it was found according to Yale brown obsessive compulsive scale is the most common obsessions were contamination 57.9%,each of somatic and aggression is 26.3% lastly sexual 10.5% whereas the most common compulsions were cleaning 47.4%, each of checking and hoarding 36.8% and lastly each of collecting and arranging is 5.3%. Among the patients with OCD the severity of the symptoms using YBOCS, it was found that subclinical cases 5.3%, mild cases 36.8% moderate cases 31.6% whereas severe cases 15.3 and extreme cases 10.5%. This means that mild cases is the most common in the sample.
The OCD was most found in eczema accounts 50% of this group then alopecia then acne and trichotillomania and lastly warts and vitiligo
Moreover comparison of quality of life between the patients with OCD and non OC group it was found that it is more affected in OCD with all its domains health, Social, Spiritual and family subscales. yet no correlation found between the severity of OC symptoms and the quality of life in these patients.