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Biomedical subjects

C S Koblenzer

Publications and source records attributed to C S Koblenzer.

34 records · Page 2Linked to original sources
PubMed1990

Psychogenic purpura: a most distressing case.

A case of psychogenic purpura is likely to be unforgettable for everyone concerned. The patient's bizarre and dramatic appearance can frighten both the patient and medical personnel unfamiliar with the condition, causing panic and intense demands for drastic, inappropriate remedies. Our second experience with this condition was such a memorable case. We stress how difficult it can be to withstand the pressures of colleagues, the patient, and his or her family, and how important it sometimes is to be resolute regarding the need for conservative management.

Adolescent↗
PubMed1988

Chronic intractable atopic eczema. Its occurrence as a physical sign of impaired parent-child relationships and psychologic developmental arrest: improvement through parent insight and education.

Atopic eczema of infancy and childhood responds readily and predictably to treatment; only a small percentage remains intractable. Lack of therapeutic response in a proportion of these patients can be attributed to dysfunctional parent-child relationships that lead to physical and emotional developmental arrest. Improvement in parent-child relationships following parental insight into their conflicted feelings permits acceptance of educational recommendations from the physician; it also allows normal development to be resumed and eczema to improve. Eight illustrative cases are reported in which aggressive dermatologic measures were combined with an approach that helped parents recognize conflict and provided education that permitted more appropriate behavioral limit setting. Rapid and sustained improvement in skin, emotional development, and social adjustment resulted.

Child↗
PubMed1986

Successful treatment of a chronic and disabling dermatosis by psychotherapy. A case report and discussion.

It behooves us all to help contain rising medical costs. Accurate diagnosis and institution of appropriate treatment contribute to cost containment. A patient is described who entered psychotherapy after 14 years of competent dermatologic care for incapacitating and painful skin lesions with arthralgias. Drug and alcohol abuse, deteriorating peer and family relationships, and poor job performance had supervened. The successful outcome of her treatment is discussed.

Adult↗
PubMed1985

The dysmorphic syndrome.

A 49-year-old woman complained of pain and distortion of the facial skin of five years' duration. She had notable psychological depression, and the distortion she described was not apparent to others. She had sought relief for many years from many physicians and had tried numerous therapeutic regimens to no avail. After a diagnosis of "dysmorphic syndrome," haloperidol was prescribed at a dosage of 1 mg twice daily. With this regimen, the patient experienced a slow but steady improvement, although her compliance was erratic.

Adolescent↗
PubMed1983

Psychosomatic concepts in dermatology. A dermatologist-psychoanalyst's viewpoint.

Few experienced clinicians remain unimpressed both by the influence of psychological and social factors on the physical state and by our relative inability to deal adequately with this aspect of the practice of dermatology. This article reviews the historical development of psychosomatic concepts, describes some theories concerning the process whereby somatization takes place and why a particular disease is "chosen," reviews some of the relevant basic science findings, offers a working classification of psychocutaneous disease, and, finally, makes some suggestions as to how we may become more effective in handling this important part of our clinical practice.

Alopecia↗
PubMed1976

Perianal rhabdomyosarcoma in childhood.

The case of a child with a stage I perianal embryonal botryoid rhabdomyosarcoma is presented, with description of coordinated management utilizing local excision, irradiation, and cyclic chemotherapy resulting in a 3-year tumor-free survival. Previously reported pediatric cases are summarized.

Anal Canal↗
PubMedDate not supplied

Liaison dermatology.

Explore the source record for details and available documents.

Dermatology↗
PubMedDate not supplied

Dermatitis artefacta. Clinical features and approaches to treatment.

In dermatitis artefacta, the patient creates skin lesions to satisfy an internal psychological need, usually a need to be taken care of. The clinical presentation is characteristic, and differs from that of neurotic excoriations, delusional disorders, malingering, and Munchausen's syndrome. Munchausen's syndrome by proxy is a form of dermatitis artefacta. Except where disease is mimicked, lesions that do not conform to those of known dermatoses are shrouded in mystery, appearing fully formed on accessible skin, within the context of a characteristic psychological constellation. The patient is friendly but bewildered, and the relatives, angry and frustrated. Because of lack of diagnostic stringency, quoted female-to-male ratios range from 3:1 to 20:1, with the highest incidence of onset in late adolescence to early adult life. Most patients have a personality disorder; borderline features are common. The patient's denial of psychic distress, and negative feelings aroused in healthcare personnel, make management difficult. Limit-setting for the protection of both the physician and patient; creation of an accepting, empathic, and nonjudgmental environment; and close supervision of symptomatic dermatologic care will permit development of a therapeutic relationship in which psychological issues may gradually be introduced, that may occasionally permit psychiatric referral. Issues of etiology should be sidestepped because confrontation is counter productive. When psychiatric referral is refused by the patient, the use of psychotropic drugs by dermatologists is helpful and appropriate. The upper dose range of selective serotonin reuptake inhibitors (SSRIs), or low dose atypical antipsychotic agents, may be effective. Except in mild transient cases triggered by an immediate stress, the prognosis for cure is poor. The condition tends to wax and wane with the circumstances of the patient's life. Lesions can be kept to a minimum, the patient can be protected from unnecessary and intrusive studies, and society can be protected from escalating and unnecessary expenditure of medical resources if, rather than discharging the patient, the dermatologist continues to see the patient on an ongoing basis for supervision and support, whether or not lesions are present. Research studies are necessary to document more accurately the expectable cause, treatment outcome, and prognosis for this group of patients.

Dermatitis↗