ABSTRACT
Delusional infestation (DI) is the fixed false belief of pathogenic infestation of the skin or body despite no supporting medical evidence. It is a relatively rare condition with a reported prevalence of 1.48 per million people. Successful treatment can be challenging as patients are often reluctant to accept referral or involvement of psychiatric services. We report a retrospective cohort study of 49 consecutive patients with a diagnosis of DI, assessed in a regional psychodermatology service over a 6-year period. Low-dose antipsychotics (risperidone or olanzapine) were prescribed in 44 patients. We use our data to explore possible reasons why DI can be challenging to treat. Response to treatment and engagement with services is multifactorial. Our study emphasizes the importance of early assessment and supports the expansion of psychodermatology services in the UK.
Subject(s)
Antipsychotic Agents , Humans , Retrospective Studies , Antipsychotic Agents/therapeutic use , Risperidone/therapeutic use , Olanzapine , PrevalenceABSTRACT
Psychodermatology is a specialist area which refers to the assessment and treatment of the psychosocial aspects of dermatology. This includes the management of patients with primary psychiatric disorders, psychosocial co-morbidities of existing skin disease or psychological distress caused by their skin conditions. We report the benefits and cost savings of a recent pilot of an integrated service of a consultant dermatologist and a liaison psychiatrist providing coordinated care to complex psychodermatology patients.
ABSTRACT
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of delusional infestation (DI) in adults. Linked Comment: I. Coulson. Br J Dermatol 2022; 187:457.
Subject(s)
Delusional Parasitosis , Dermatologists , Adult , Delusional Parasitosis/diagnosis , Delusional Parasitosis/therapy , HumansSubject(s)
Deodorants/adverse effects , Dermatitis/etiology , Dermatitis/pathology , Self-Injurious Behavior/psychology , Skin Diseases, Vesiculobullous/chemically induced , Adolescent , Aerosols/adverse effects , Biopsy, Needle , Child , Dermatitis/psychology , Female , Humans , Immunohistochemistry , Prognosis , Risk Assessment , Skin Diseases, Vesiculobullous/pathologyABSTRACT
Genetic conditions are increasingly recognised as a cause of multisystem diseases in children. We report a 6-year-old boy with hypohidrotic ectodermal dysplasia, immunodeficiency, osteopetrosis and lymphoedema, associated with a novel mutation in the NF-κß essential modulator (NEMO) gene. He is the longest surviving of three reported boys with these clinical features. Hypohidrotic ectodermal dysplasia, a congenital disorder of teeth, hair and eccrine sweat glands is most commonly inherited as an X-linked recessive trait. Associated immunodeficiency (HED-ID) may give rise to serious infections in early life. Mutations in the NEMO gene give rise to a heterogeneous group of disorders, including the X-linked dominant disorder incontinentia pigmenti. This is characterised by typical skin changes leading to linear pigmentary change and variable associated features; in males, prenatal death usually occurs. Our patient, like one if the previous cases and all of their mothers, demonstrates features of incontinentia pigmenti.
Subject(s)
DNA/genetics , I-kappa B Kinase/genetics , Immunologic Deficiency Syndromes/genetics , Lymphedema/genetics , Mutation , Osteoporosis/genetics , Child , DNA Mutational Analysis , Ectodermal Dysplasia/complications , Ectodermal Dysplasia/genetics , Ectodermal Dysplasia 1, Anhidrotic , Humans , Immunologic Deficiency Syndromes/complications , Incontinentia Pigmenti/complications , Lymphedema/complications , Male , Osteoporosis/complicationsABSTRACT
Dermatitis artefacta or factitious disease may be unrecognized in children. We present a 12-year-old girl who had an unusual facial lesion on the chin, which was self-inflicted but histologically mimicked cutaneous T-cell lymphoma. Our report emphasizes both the potential diagnostic pitfalls and the importance of clinicopathologic correlation.
Subject(s)
Dermatitis/diagnosis , Self-Injurious Behavior/diagnosis , Skin/injuries , Child , Dermatitis/etiology , Dermatitis/psychology , Diagnosis, Differential , Female , Humans , Lymphoma, T-Cell, Cutaneous/diagnosisABSTRACT
Nurses lack a comprehensive body of scientific knowledge to guide the palliative care of patients with nonmalignant conditions. Current knowledge and practice reveal that nurses in many instances are not well prepared to deal with death and dying. Focus groups were used in an exploratory study to examine the perceptions of palliative care among cardiorespiratory nurses (n = 35). Content analysis was used to reveal themes in the data. Four major themes were found: (1) searching for structure and meaning in the dying experience of patients with chronic disease, (2) lack of a treatment plan and a lack of planning and negotiation, (3) discomfort in dealing with death and dying, and (4) lack of awareness of palliative care philosophies and resources. The information derived from this sample of cardiorespiratory nurses represents a complex interplay between personal, professional, and organizational perspectives on the role of palliative care in cardiorespiratory disease. The results of the study suggest a need for nurses to be equipped on both an intellectual and a practical level about the concept of palliative care in nonmalignant disease.