[Cutaneous self mutilation; course and treatment].
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Adolescent↗
Biomedical subjects
M Van Moffaert
Publications and source records attributed to M Van Moffaert.
Psychodermatology: an overview.
As the skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli, dermatological practice involves a psychosomatic dimension. It is, however, the high visibility of dermatoses and their easy accessibility which make the skin a direct target for behavioural problems. Furthermore, self-destructive tendencies and hypochondriacal features often express themselves through dermatological symptoms: dermatitis artefacta and skin hypochondriasis are among the specific psychocutaneous disorders discussed here. In view of the clinical interface between dermatology and psychiatry, general guidelines are formulated and specific aspects of psychotherapy, behavioural treatment and psychotropic drug treatment are discussed.
Body Image↗
Localization of self-inflicted dermatological lesions: what do they tell the dermatologist?
The dissimulating attitude of factitious patients creates the need for objective clinical features which cannot be faked and which have a genuine value for the psychiatric diagnosis and prognosis. The psychiatric significance of the localization of self-inflicted dermatological lesions is investigated in four psychiatric areas: the type of life events preceding specific localizations, underlying psychiatric profiles that are characteristic for a given localization, differential response to treatment and psychiatric sequels.
Adult↗
Somatization of psychiatric illness in Mediterranean migrants in Belgium.
Mediterranean migrants with acute psychiatric problems show a predominance of dramatic somatization in their symptom patterns, when compared with Belgian patients with similar psychiatric problems and admitted after identical recruiting and referral procedures. D.S.M. III diagnoses of the Mediterranean patients, however, reveal neither a correspondingly high incidence of somatoform disorders nor histrionic personalities. Adult and adolescent Mediterranean migrants appear to convey psychological problems through contrasting forms of somatization. Adolescents somatize mainly through self-inflicted symptoms, whereas adults express somatization in a more 'natural' way--insubjective bodily sensations, psychophysiological symptoms or psychosomatic syndromes. The main reason for acute psychiatric admission among Belgian adolescents is outward aggressive behaviour. In Mediterranean adolescents in Belgium it is a combination of somatization and aggression in self-inflicted physical symptoms.
Adult↗
Depression after surgery for breast cancer. Comparison of mastectomy and lumpectomy.
The impact of the loss of the breast in women undergoing surgical treatment for breast cancer is subordinated to the confrontation with the diagnosis of a malignancy in causing depression. The equal distribution of depression in mastectomy and in lumpectomy patients supports the hypothesis that it is the confrontation with the potentially lethal outcome of the diagnosis which is decisive in causing depression. The grief reaction following mastectomy has two components: a depressive reaction to the loss of the breast and an anticipatory grief for anticipation of the potentially lethal outcome. Psychosocial therapeutic support in breast malignancy must give priority to coping with the diagnosis of cancer over the loss of the breast.
Adaptation, Psychological↗
Management of self-mutilation. Confrontation and integration of psychotherapy and psychotropic drug treatment.
The management of diverse types of self-mutilation is discussed with a particular emphasis on the selective use of open confrontation of the dissimulating patient with the self-inflicted nature of the lesions. Integration of psychotherapy with psychotropic drug treatment in self-mutilating patients is a necessity.
Cohort Studies↗
Training future dermatologists in psychodermatology.
The contents and design of a psychodermatology training programs (PTP) preparing future dermatologists to cope with the psychosomatic features of their practice are discussed. This program focuses on the psychosocial factors that may provoke, precipitate, and aggravate dermatoses. It singles out the secondary illness reaction which is the result of the particular somatopsychic consequences of the visibility of dermatoses, its repercussion on the patient's body image, and on his or her social and sexual life. The benefits and the risks of a grounding in psychodermatology as well as the dermatologist's specific resistance are pointed out.
Body Image↗
Dermatitis artefacta.
Self-inflicted dermatoses mainly refer to psychiatric disturbances such as psychoses, mental retardation, and personality disorders. Diagnostic clues are found in the nature and the evolution of the lesions as well as in the ambivalent combination of dependency on doctors and hostility toward them revealed in the patient's medical history. Management of dermatitis artefacta patients means dealing with the complex emotional issue of a basic antagonism in the dermatologist-patient relationship. Both the dermatologist and the dermatologic nursing staff should show an understanding and nonaggressive attitude.
Adolescent↗
Social reintegration of sexual delinquents by a combination of psychotherapy and anti-androgen treatment.
The high frequency of recidivism with convicted sexual perverts is mainly due to the compulsive character of perversion. The classical methods of treatment are seldom satisfactory: Surgery provokes ethical objections, psychopharmaca and oestrogens lead to disagreeable side effects, psychotherapy of any kind is unlikely to be efficacious because of the unfavourable atmosphere the nature of perversion causes it to take place in. However, the climate of both psychoanalytical treatment and suggestive and directive psychotherapy can be enhanced by a combination with an anti-androgen treatment, which eliminates the patient's fear of conviction by inhibiting his sexual urge. Two cases illustrate this combined method. On the basis of a positive disposition, which arises from the improved climate, sublimation of the sex drive and the achievement of a feeling of social responsibility is aimed at. The advantages of the combined therapy are then discussed in comparison with the existing treatments. It is concluded that this combined treatment, next to social guidance and an attempt at solving the fundamental problem of loneliness, can promote the social reintegration of the convicted sexual pervert.
Adult↗
An update of panic disorders. Somatization, biological markers and treatment outcome.
Psychiatric underdiagnosis of panic disorders is due to its particular somatization profiles. Cardial somatization is very common, but focal neurological symptoms and a pattern of gastro-intestinal complaints deserve more attention. Recent research into biological data is discussed, and the importance of psychological issues--childhood separation or sexual victimisation--and cognitive factors is stressed. Breaking up outcome data in degree of remission and relapse rate for an exact judgment of different treatment strategies is needed.
Alprazolam↗
A Belgian multicentre study of fluvoxamine in depressive outpatients.
Fluvoxamine, a new antidepressant that specifically inhibits serotonin reuptake, was studied in 272 outpatients in a six-week multicentre trial in Belgium. On the Hamilton Depression Scale, the mean score dropped from 25.2 to 8 after six weeks (p less than 0.00001). The Clinical Global Impression scores showed similar evolution. Fluvoxamine is a real antidepressant with a marked effect on mood. Its effective dosage is 100 mg to 200 mg/day. Its tolerance, notably at the cardiovascular level, is excellent.
Adult↗
The importance of permanent psychiatric consulting in the dermatological clinic.
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Counseling↗
Factitious affections in dermatology.
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Adult↗