Alexithymia in adolescents in Poland: an important issue in the holistic approach to patients' care.

Introduction: Alexithymia is defined as a disturbed ability to identify and verbally express emotions with a limited imaginative capacity as well as externally oriented thinking. The literature on alexithymia is limited and scarce research concentrated on alexithymia in different gender groups. Aim: As alexithymia may influence the therapeutic outcome, the objective of the study was to assess the prevalence of alexithymia in adolescents in Poland, paying special attention to gender differences. Material and methods: This cross-sectional study was run on a group of 730 high school students in Poland. The mean age of this group was 17.05 ±1.18 years (age range: 15-19 years). Alexithymia was assessed with Toronto Alexithymia Scale (TAS-20). Results: Alexithymia was found in 31.0% of adolescents. 56.0% of subjects presented with signs of at least intermediate (borderline) alexithymia. Significantly more females than males suffered from alexithymia (37.0% and 20.8%, respectively; p < 0.001). TAS-20 scores were also significantly higher in females than males (55.59 ±12.32 points and 49.40 ±12.00, respectively; p < 0.001). The same phenomenon was observed for the following domains of alexithymia: difficulty in identifying feelings (DIF) and difficulty in describing feelings (DDF). However, there was no difference in gender distribution in the externally oriented thinking (EOT) domain. Conclusions: Alexithymia was shown to be common among adolescents in our country. More females than males suffer from this condition. This seems to be of importance in the holistic approach to patients' care.

Delusional infestation in clinical practice over a period of two decades.

INTRODUCTION: Patients presenting with cutaneous symptomatology may in fact suffer from underlying psychiatric conditions. Individuals diagnosed with delusional infestation (DI) have a fixed false belief of being infested with certain organisms or objects. AIM: To analyse clinical features of subjects with DI who were admitted to the tertiary dermatology ward. MATERIAL AND METHODS: A retrospective analysis concerning DI patients hospitalized between 1997 and 2019 was carried out. The emphasis was put on the duration of symptoms, psychiatric symptomatology (including the "specimen sign"), comorbidities as well as therapy. RESULTS: We gathered data regarding 21 consecutive patients with DI. The mean age of subjects was 65.2 ±13.3 years, the majority were females (76.2%). The mean time span between the disease onset and diagnosis was 1.9 ±1.7 years. Previous psychiatric consultations were attended by 57.0% of patients. The specimen sign was present in 47.6% of cases, whereas the most common suspected causative factors were described as worms (52.4%), unspecified parasites (42.9%), "something" (33.3%) and flies (19.0%). Primary delusional disorder was diagnosed in 76.2%, followed by shared delusional disorder and secondary delusional disorder of organic origin (9.5% each). Risperidone monotherapy was initiated in 61.9% of patients. In total, only 33.3% of patients attended the follow-up visit. CONCLUSIONS: DI features a wide spectrum of clinical signs and symptoms. Risperidone remains the drug of choice in the majority of cases. Successful management of each DI case requires collaboration between dermatologists and psychiatrists and still remains a major challenge.

Trichotillomania Among Young Adults: Prevalence and Comorbidity.

Trichotillomania is an impulse control disorder characterized by repetitive pulling out of one's hair. The aim of this study was to estimate the prevalence of trichotillomania in young adults and its association with anxiety and obsessive-compulsive disorders (OCD). A total of 339 individuals completed a questionnaire to determine the presence of trichotillomania. OCD and anxiety disorders were diagnosed according to the diagnostic criteria of the International Classification of Diseases 10th Revision (ICD-10), based on the Composite International Diagnostic Interview. Twelve persons (3.5%) reported hair pulling during their lifetime, but only 8 of them met the criteria of trichotillomania according to the ICD-10. Four individuals had stopped their behaviour prior to the study participation. The lifetime anxiety disorders were diagnosed in 5 participants with trichotillomania (62.5%), while in the group without trichotillomania, 67 persons (20.2%) met the diagnostic criteria for anxiety disorders (p < 0.01). OCD were not diagnosed in individuals with trichotillomania, among participants without trichotillomania, 14 persons (4.2%) reported symptoms of OCD.

Onychophagia is associated with impairment of quality of life.

Onychophagia is defined as a chronic nail biting behaviour affecting about 20-30% of the general population. However, nail biting seems to be an ignored problem in a daily clinical practice. We have analysed the influence of onychophagia on quality of life (QoL) and stigmatisation level among 339 medical students with and without nail biting. Those with onychophagia demonstrated significantly higher QoL impairment compared to the controls (p < 0.001). Subjects who had been unable to stop nail biting behaviour in the past (p < 0.01) had visible nail abnormalities (p = 0.03), spent more time on nail biting (p = 0.02) and with a higher number of involved fingernails (p = 0.03), demonstrated further impaired QoL. Furthermore, tension before or when trying to resist nail biting (ß = 12.5; p < 0.001), suffering due to nail biting (ß =12.6; p = 0.001) and nail eating behaviour (ß = -7.5; p < 0.01) were independent variables influencing QoL. Participants with onychophagia also demonstrated higher level of stigmatisation (0.6 ± 1.2 vs. 0.2 ± 0.6 points, p < 0.01), although in both groups the stigmatisation level was low.

Onychophagia and onychotillomania: prevalence, clinical picture and comorbidities.

Onychophagia is defined as chronic nail biting behaviour, which usually starts during childhood. Onychotillomania results from recurrent picking and manicuring of the fingernails and/or toenails, leading to visual shortening and/or estraction of nails. The aim of this study was to assess the prevalence of onychophagia and onychotillomania in young adults, and the comorbidity of these conditions with anxiety disorders and obsessive compulsive disorders (OCD), as well as to determine factors related to these behaviours. A total of 339 individuals were interviewed with a structured questionnaire. Onychophagia was present in 46.9% of participants (including 19.2% active and 27.7% past nail biters), and an additional 3 people (0.9%) had onychotillomania. The majority of subjects (92.2%) described nail biting as an automatic behaviour. Tension before nail biting was reported by 65.7% of nail biters, and feelings of pleasure after nail biting by 42%. Among the participants with lifetime onychophagia, 22.5% met criteria of anxiety disorder and 3.1% of OCD, while in the group without onychophagia at least one anxiety disorder was diagnosed in 26.2% and OCD in 5.0%. We did not find any correlation between nail biting and other anxiety disorders or OCD. In conclusion, no single condition was associated with nail biting or influenced such behaviour; multiple psychological factors were involved.

Delusions of Parasitosis: An Update.

Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a relatively infrequent psychotic disorder characterized by an unwavering false belief that there is a parasitic infestation of the skin, despite the absence of any medical evidence that could support this claim. Delusional parasitosis can be categorized into primary, secondary, and organic forms. Sometimes, close relatives also experience identical delusions. This phenomenon was reported to occur in 5-15% of cases, and is known as shared psychotic disorder-delusional parasitosis with folie à deux. Patients with delusional parasitosis frequently seek help from many physicians. Close multidisciplinary cooperation between clinicians is often key to shortening the time taken to diagnose this disorder. Initiation of psychopharmacological therapy is a challenge, as many patients refuse any psychiatric treatment because of the stigma associated with mental illness and because of their firm belief that they have a parasitic infestation, not a psychiatric condition. For many patients, a sense of a lack of understanding leads to isolation and the development of depression symptoms, which is why it is crucial to earn the trust of such patients while taking care of them.

Frequency and treatment of trichotillomania in Poland.

Although trichotillomania is a relatively common disorder no large epidemiological studies are available. The aims of this study were to determine the frequency of trichotillomania as identified by Polish dermatologists, and to evaluate the treatment modalities used. A questionnaire was sent to 172 dermatologists; 118 (68.6%) responded. The questions covered demographic data, frequency of trichotillomania and treatments used. During the course of their working lives 68% of respondents had observed at least one patient with trichotillomania and 11% were currently treating such a patient. More than 30% of respondents had observed one or two cases of trichotillomania during the past 5 years, 11% had seen 3-5 cases, 3% had seen 6-10 cases, and 5% had seen more than 10 patients. Of the respondents, 40.7% always and 28.8% often asked for a psychiatric opinion. Dermatologists with more experience more frequently (p < 0.05) obtained a psychiatric opinion. Some dermatologists (15.3%) used their own pharmacological treatment (anxiety-relieving drugs and sedatives). Trichotillomania is a relatively common disorder; however, not all dermatologists are sufficiently prepared to treat it.

Onychophagia as a spectrum of obsessive-compulsive disorder.

Onychophagia can be explained as a kind of a compulsion that may cause destruction of the nails. Habitual nail biting is a common behaviour among children and young adults. By the age of 18 years the frequency of this behaviour decreases, but it may persist in some adults. Nail biting is an under-recognized problem, which may occur on a continuum ranging from mild to severe. Nail biting has received little attention in the psychiatric and dermatological literature. Its position in widely accepted classifications of psychiatric disorders (ICD-10 and DSM-IV) remains unclear. This disorder seems to be related to obsessive-compulsive spectrum disorder. Here, we present three case reports of onychophagia and co-occurring psychopathological symptoms and discuss the close relationship of onychophagia to obsessive- compulsive spectrum disorder and possible treatment modalities. Psychiatric evaluation of co-occurring psycho pathological symptoms in patients with onychophagia, especially those with chronic, severe or complicated nail biting, may be helpful in making a choice of individual therapy. Serotonin re-uptake inhibitors seem to be the treatment of choice in severe onychophagia.