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Biomedical subjects

Madhulika A Gupta

Publications and source records attributed to Madhulika A Gupta.

12 recordsLinked to original sources
PubMed2006

Medically unexplained cutaneous sensory symptoms may represent somatoform dissociation: an empirical study.

OBJECTIVE: We examined the relation between medically unexplained cutaneous symptoms and dissociation [measured by the Dissociative Experiences Scale, or DES; Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727-35] among participants with no history of primary dermatologic disorders. METHODS: Three hundred sixty consenting participants (44 psychiatric outpatients and 316 nonclinical participants from the community at large) rated the severity of nine medically unexplained cutaneous symptoms (sum of all ratings comprised the Cutaneous9 variable) and completed the DES. RESULTS: The Cutaneous9 variable correlated significantly (Pearson r=.56, P<.001) with DES scores. Stepwise multiple regression analysis using the nine cutaneous symptoms as independent variables revealed that Pain, Itching, and Numbness were the best predictors of the DES scores (adjusted R2=.34, P<.001). CONCLUSION: Our findings have empirically shown that itching, like pain and numbness, may be a symptom of somatoform dissociation. Second, even milder degrees of dissociation in the nonclinical range may play a role in the genesis of unexplained cutaneous sensory symptoms.

Adolescent↗
PubMed2006

Somatization disorders in dermatology.

This paper reviews a wide range of somatization-related symptoms that are encountered in dermatology. These include the unexplained cutaneous sensory syndromes especially the cutaneous dysesthesias associated with pain, numbness and pruritus; traumatic memories in post-traumatic stress disorder (PTSD) which are experienced on a sensory level as 'body memories' and may present as local or generalized pruritic states, urticaria and angioedema; and unexplained flushing reactions and profuse perspiration, in addition to unexplained exacerbations of stress-reactive dermatoses such as psoriasis and atopic eczema secondary to the autonomic hyperarousal in PTSD; classic 'pseudoneurologic' symptoms associated with dissociation including unexplained loss of touch or pain, in addition to the self-induced dermatoses such as dermatitis artefacta and trichotillomania that are encountered with dissociative states; and body dysmorphic disorder where the patient often presents with a somatic preoccupation involving the skin or hair.

Adult↗
PubMed2005

Evaluating clinical rating scales for evidence-based dermatology: some basic concepts.

Evidence-based dermatology has necessitated the development of rating scales that measure multidimensional and abstract constructs, such as quality of life. This article discusses some basic psychometric concepts, such as reliability, validity, standardization, and measurement precision, which need to be considered when choosing a clinical rating instrument. Also discussed is the impact of these parameters on increasing the statistical power of a clinical trial.

Dermatology↗
PubMed2005

Psychiatric evaluation of the dermatology patient.

Over one third of dermatologic disorders have significant psychiatric comorbidity. The impact of the skin disorder on quality of life, the role of psychosocial stressors, and use of substances should be assessed. Major depressive disorder is the most frequently encountered psychiatric disorder in dermatology and is often associated with suicide risk. Other psychiatric syndromes comorbid with dermatologic disorders include obsessive-compulsive disorder, social phobia, posttraumatic stress disorder associated with dissociation and conversion symptoms, body image pathologies, delusional disorder, and a wide range of personality disorders. This article reviews psychiatric guidelines that may be used to assess psychopathology in the dermatology patient.

Humans↗
PubMed2005

Psychosocial aspects of aging skin.

Many older individuals use products and procedures to conceal or delay the signs of aging. For most, this provides a helpful ego boost, but some suffer from pathologies such as eating disorders and body dysmorphic disorder. The impact of aging skin may include social anxiety and social isolation. Poor self-image is associated with chronic illness and fewer preventive health behaviors, such as exercise. Aged appearance, especially in women, is also associated with workplace discrimination. Patients should therefore be offered treatments for aging skin, ensured that society's negative views not be unnecessarily reinforced, and maintain a realistic treatment expectations.

Humans↗
PubMed2005

Depression and skin disease.

The occurrence of depression in association with dermatologic disease is common. Psychiatric disturbance is reported in approximately 30% of dermatology patients. Depression can have varied presentations and is more relevant clinically in dermatology patients during critical psychosocial periods of development. Early recognition and treatment of depression associated with skin disorders can lead to improved therapeutic outcomes and may avert disastrous outcomes, including suicide.

Depressive Disorder↗
PubMed2005

Psychologic trauma, posttraumatic stress disorder, and dermatology.

Psychologic trauma refers to events (such as sexual assault, major earthquake, or plane crashes) that overwhelm an individual's capacity to cope. Psychologic trauma can result in chronic and recurring dermatologic symptoms that persist after the trauma subsides. Examples are cutaneous sensory flashbacks (which may be fragments of the sensory component of the traumatic experience), autonomic hyperarousal (with symptoms such as profuse sweating or flare-up of an underlying stress-reactive dermatosis), conversion symptoms (such as numbness, pain, or other medically unexplained cutaneous symptoms), and cutaneous self-injury (manifesting in many forms, including trichotillomania, dermatitis artefacta, and neurotic excoriations--tension-reducing behaviors in patients who have posttraumatic stress disorder).

Adult↗
PubMed2003

Recall of emotional states in posttraumatic stress disorder: an fMRI investigation.

BACKGROUND: The goal of this study was to examine the neuronal circuitry underlying different emotional states (neutral, sad, anxious, and traumatic) in posttraumatic stress disorder (PTSD) in traumatized subjects versus traumatized subjects without PTSD. METHODS: Traumatized subjects with (n = 10) and without (n = 10) PTSD were studied using the script-driven symptom provocation paradigm adapted to functional magnetic resonance imaging (fMRI) at a 4 Tesla field strength. RESULTS: Compared to the trauma-exposed comparison group, PTSD subjects showed significantly less activation of the thalamus and the anterior cingulate gyrus (area 32) in all three emotional states (sad, anxious, and traumatic). CONCLUSION: These findings suggest thalamic and anterior cingulate dysfunction in the recollection of traumatic as well as other negative events. Thalamic and anterior cingulate dysfunction may underlie emotion dysregulation often observed clinically in PTSD.

Adult↗
PubMed2003

Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management.

Psychiatric and psychological factors play an important role in at least 30% of dermatologic disorders. In many cases the impact of the skin disorder upon the quality of life is a stronger predictor of psychiatric morbidity than the clinical severity of the disorder as per physician ratings. Furthermore, in certain disorders such as acne and psoriasis, the psychiatric co-morbidity, which can be associated with psychiatric emergencies such as suicide, is an important measure of the overall disability experienced by the patient. The severity of depression and increased suicide risk are not always directly correlated with the clinical severity of the dermatologic disorder. Consideration of psychiatric and psychosocial factors is important both for the management, and for some aspects of secondary and tertiary prevention of a wide range of dermatologic disorders. It is useful to use a biopsychosocial model which takes into account the psychological (e.g. psychiatric comorbidity such as major depression and the impact of the skin disorder on the psychological aspects of quality of life) and social (e.g. impact upon social and occupational functioning) factors, in addition to the primary dermatologic factors, in the management of the patient. Some dermatology patients are likely to benefit from psychotherapeutic interventions and psychotropic agents for the management of the psychosocial comorbidity, in addition to the standard dermatologic therapies for their skin disorder.

Acne Vulgaris↗
PubMed2002

Use of eye movement desensitization and reprocessing (EMDR) in the treatment of dermatologic disorders.

BACKGROUND: The use of psychological therapies in dermatology is being increasingly recognized because stress and negative emotions are major factors in a wide range of dermatologic disorders. Eye movement desensitization and reprocessing (EMDR) is a relatively new psychological intervention which was first described to be effective in post-traumatic stress disorder, a condition associated with extremely stressful life situations. OBJECTIVE: We evaluated the efficacy of EMDR in primary dermatologic disorders where psychological stress plays an important part in the pathogenesis of the disorder, and in clinical situations where the dermatologic symptom is the feature of a stress-related psychiatric disorder. METHODS: Four patients (two patients with atopic dermatitis and psoriasis, respectively, whose symptoms were exacerbated by stress, one patient with acne excoríee associated with body image pathology as a result of childhood emotional abuse, and one patient with generalized urticaria associated with post-traumatic stress disorder) were treated using the standard EMDR protocol with 3-6 sessions for a period ranging from 4 to 12 weeks, and followed up for 6-12 months after the end of EMDR therapy. RESULTS: All 4 patients experienced a marked improvement in their symptoms after 3-6 sessions of EMDR, within a period of </= 3 months, and maintained improvement during followup periods of 6-12 months. CONCLUSION: Our preliminary findings suggest that EMDR may be beneficial in the treatment of a wide range of stress-mediated dermatologic symptoms.

Adult↗