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EDITORIAL |
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| Year : 2006 | Volume
: 51
| Issue : 1 | Page : 5-7 |
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| Psychocutaneous disorders |
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Hemangi Jerajani1, Rajiv Jerajani2
1 Department of Dermatology, LTM Medical College and Hospital, Mumbai, India
2 Department of Psychiatry, Kripa Foundation, Mount Carmel Church, 80-A, Chapell Road, Bandra West, Mumbai, India
Correspondence Address:
Hemangi Jerajani
Department of Dermatology, LTM Medical College and Hospital, Mumbai - 400 022
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.25174
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Keywords: Psychocutareous, Psychiatry, Skin and mind
How to cite this article:
Jerajani H, Jerajani R. Psychocutaneous disorders. Indian J Dermatol 2006;51:5-7 |
Psyche or mind is the largest function in the body, while skin is the largest organ in the body. The anatomical and physiological integrity is maintained when they are congruent in their diverse elements. Discomfort, Disease or Disorder are the terms used when the normality in structure and or function is altered. Pathology connotes altered levels in intensity, duration and/or frequency of any of these manifestations of mind or body.
Dermatologists have difficulties in understanding mind and psychiatrists have limitations of skills in examination and intervention of skin lesions. It is therefore imperative for both to have a reasonable knowledge of the other for responsible therapeutic interventions.
[Table - 1] displays the classification correlating skin and psychiatric diseases:
| Psychological manifestations of skin condition | |  |
Anxiety and depression are the most common psychological manifestations encountered in subjects with skin diseases.
Anxiety: Psychological term used to connote underlying apprehension originating out of uncertainty of outcome related to skin ailment results into associated physical manifestations. Apprehension or excessive thinking and preoccupation with the skin condition result in associated fluctuations in mood. This results in symptoms like fine tremulousness, increased frequency of micturation and dryness of mouth. At times palpitations become reason to consult the physician. The intensity of symptoms will increase with further course of the disease. Apprehension results in anxiety which in turn, transforms into panic attacks. The neurotic repression leads to severe pathological regression resulting in delusional thoughts. Somatic, paranoid, dysmorphophobic and/or nihilistic delusions often develop if the condition remains unabated and, With higher preoccupation, symptoms become more intense.
Perceptions change with interventions. Failure to give initial symptom relief causes progressive deterioration and increased anxiety with panic attacks. The physician must help to reduce intensity of both the systems of skin and mind.
Anxiolytic Medicines
Benzodiazepines are indicated in treatment of variety of disorders, including anxiety, panic attacks, insomnia and muscle spasm of primary or associated conditions. Benzodiazepines are indi-cated for the short-term relief (two to four weeks only) of anxiety that is severe and disabling.
Nevertheless, benzodiazepines do cause side effects in some patients and these drugs can be addictive and may interfere with complex sensory-motor tasks such as driving.
Depression: Symptoms appear with increased preoccupation of skin condition followed by loss of interest in all activities of life especially associated changes in food habits and sleep patterns. Hyper or hypo-phagia with hyper or hypo-somnolence is diagnostic. Suicidal thoughts, nihilistic beliefs and lowered self esteem are significant. Social awkwardness, refusal to interact, withdrawn attitudes, preference of solitude with melancholy is prominent. Adjustment with the significant others due to preoccupation with skin conditions can cause irritation in moods, snapping behaviour, intolerance any and all actions, fault finding, blaming, voluntary sexual deprivation with difficulty in interpersonal relationships can cause further deterioration.
Antidepressants
Antidepressants groups are based on their brain effects
• Selective serotonin reuptake inhibitors (SSRIs)
citalopram
escitalopram
fluoxetine
paroxetine
sertraline
Comparatively these medicines have fewer side effects than other antidepressants. Some side effects caused by SSRIs are dry mouth, nausea, nervousness, insomnia, sexual problems and headache.
• Tricyclics antidepressants
amitriptyline
desipramine
imipramine
nortriptyline
Common side effects are dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma. Impaired thinking and tiredness can affect blood pressure and heart rate.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
venlafaxine
duloxetine
Side effects of these medicines are nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss and sexual problems. Increased heart rate and increased cholesterol levels can also occur.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs)
bupropion
Some of the common side effects taking NDRIs include agitation, nausea, headache, loss of appetite and insomnia. It can also cause increase blood pressure in some people.
• Combined reuptake inhibitors and receptor
blockers
trazodone
nefazodone
maprotiline
mirtazpine
Common side effects of these medicines are drowsiness, dry mouth, nausea and dizziness. Nefazodone is contraindicated with abnormal liver profile. Maprotiline should not be prescribed in presence of seizures.
• Monamine oxidase inhibitors (MAOIs)
isocarboxazid
phenelzine
tranlcypromine
MAOIs used less commonly than the other antidepressants as they have serious side effects like weakness, dizziness, headaches and trembling. It requires instructions about foods and alcoholic beverages one should avoid while you are taking an MAOI. It is usually not mixed with other antidepressants. MAOI medicines are not available in INDIA.[7]
| References | | |
| 1. | http://www.antidepressantsfacts.com/  |
| 2. | http://familydoctor.org/012.xml |
| 3. | http://www.nlm.nih.gov/medlineplus |
| 4. | druginfo/uspdi/202084.html |
| 5. | http://salmon.psy.plym.ac.uk/ |
| 6. | Lesley M, Arnold MD. Psychocutaneous Disorders. In: Kaplan H I Saddock BJ eds. Comprehensive Textbook of Psychiatry, Baltimore: Williams & Wilkins, Vol 2, 6th edition; 2005: 2164-73. |
| 7. | Millard LG, Cotterill JA. Psychocutaneous disorders. In: Burns T Breathnach S, Cox N, Griffiths C eds. Rook's Textbook of Dermatology, Oxford: Blackwell Publishing Company, Vol 4, 7th ed, 2004: 61.1-61.41. |
Figures
[Figure - 1] Tables
[Table - 1], [Table - 2] |
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| This article has been cited by | | 1 |
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| Ul Bari, A., Ishfaq, M., Butt, U.A., Hanif, I. | | Journal of Pakistan Association of Dermatologists. 2007; 17(3): 149-153 | | [Pubmed] | |
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