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Biomedical subjects

M A Gupta

Publications and source records attributed to M A Gupta.

69 records · Page 4Linked to original sources
PubMed1987

Psoriasis and psychiatry: an update.

Psychosocial factors are important in the onset and/or exacerbation of psoriasis in 40%-80% of cases. Yet psoriasis has received little attention in the recent psychiatric literature. A subgroup of psoriatics appear to be "stress reactors" and these patients may have a better long-term prognosis. Identification of such patients early in the course of treatment and incorporation of specific psychosocial interventions in their overall treatment regimen may improve the course of illness. Psoriasis has also been associated with suicide and an increased prevalence of alcoholism. The disturbances in body image perception and the effect of psoriasis on interpersonal, social, and occupational functioning can further contribute to the overall morbidity, especially if psoriasis first occurs during a developmentally critical period like adolescence. Certain biochemical and physiologic correlates of psoriasis of interest to the psychiatrist such as exacerbation of psoriasis with lithium therapy and increased cutaneous blood flow are discussed. Finally, some practical guidelines are provided for psychosocial interventions in psoriasis.

Arousal↗
PubMed1987

The self-inflicted dermatoses: a critical review.

The self-inflicted dermatoses, namely dermatitis artefacta, neurotic excoriations, and trichotillomania, have been reported to be associated with various degrees of psychopathology in the dermatologic literature, but have received surprisingly little emphasis in the psychiatric literature. This probably reflects, firstly the fact that most of these patients initially deny any psychologic problems and hence may not receive psychiatric interventions, and secondly a lack of adequate collaboration between the psychiatrist and dermatologist. These disorders may be associated with serious sequelae, such as suicide and repeated major surgical procedures. Their treatment is also primarily psychiatric. This article critically reviews the literature and comments upon the salient clinical features and treatments for these disorders, which are relevant for the psychiatrist doing consultation-liaison work. Knowledge of these disorders is important in the evaluation of any psychiatric patient, as these disorders are essentially a cutaneous sign of psychopathology.

Dermatitis↗
PubMed1987

Dermatologic signs in anorexia nervosa and bulimia nervosa.

The dermatologic changes in anorexia nervosa and bulimia nervosa may be the first signs to give the clinician a clue that an eating disorder is present, as many of these patients either deny their symptoms or secretly refuse to comply with treatment. The dermatologic signs are a result of (1) starvation or malnutrition, eg, lanugolike body hair, asteatotic skin, brittle hair and nails, and carotenodermia; (2) self-induced vomiting, eg, hand calluses, dental enamel erosion, gingivitis, and a Sjögrenlike syndrome; (3) use of laxatives, diuretics, or emetics and their dermatologic side effects; and (4) other concomitant psychiatric illness, eg, hand dermatitis from compulsive handwashing. Further, as most of the cutaneous signs are not specific to anorexia nervosa and bulimia nervosa, failure to include eating disorders in the differential diagnosis may lead to misdiagnosis of the cutaneous symptoms.

Anorexia Nervosa↗
PubMed1987

Antidepressant drugs in dermatology. An update.

Recent studies indicate that antidepressant medications may be effective treatments for dermatologic disorders such as chronic urticaria and angioedema, nocturnal pruritus in atopic eczema, and postherpetic neuralgia, even in the absence of coexisting psychopathologic conditions. Their efficacy may be related to their antihistaminic, anticholinergic, and centrally mediated analgesic effects and appears to be independent of their antidepressant effect. It is likely, therefore, that more dermatologists will be prescribing these drugs without a psychiatric consultation.

Administration, Oral↗
PubMed1986

Psychotropic drugs in dermatology. A review and guidelines for use.

A review of the literature on the use of psychotropic drugs in dermatologic practice--including the antipsychotic, antidepressant, antianxiety, and hypnotic medications, as well as their pharmacologic properties, guidelines for clinical use, and a profile of adverse effects--is presented. After adverse effects and current guidelines for use are taken into consideration, it is suggested that psychotropic drugs be restricted to dermatologic conditions with clearly discernible psychiatric symptoms, for example, psoriasis and major depression, vitiligo resulting in social anxiety, and delusions of parasitosis. The pharmacologic properties of psychotropic drugs, such as the analgesic properties of certain antidepressants, may be of benefit in the treatment of dermatologic symptoms such as intractable pruritus, since pain and pruritus share the same central nervous system pathways. This use of psychotropic drugs remains to be evaluated by well-designed clinical trials.

Anti-Anxiety Agents↗
PubMed1986

Is chronic pain a variant of depressive illness? A critical review.

A critical review of the literature on the association of chronic pain of obscure origin and depression suggests the following: the nosological confusion in defining these two commonly occurring symptom complexes; poor sampling methods and widely ranging selection criteria; occasional lack of appropriate controls and use of unreliable instruments to measure pain and depression; and the frequently erroneous assumption that response of the pain to "antidepressant" medications implies that pain is masquerading some form of depression. All of the above observations lead to incomparable and sometimes opposing conclusions regarding the nature of the association between these two common symptom complexes. Some widespread recurring clinical features of the various studies include; a premorbid history of perfectionistic traits, an apparently minor precipitating event; and pain involving the head, face and musculoskeletal system. Otherwise, chronic pain of obscure origin appears to be a multifactorial and multifaceted problem, with each patient requiring a complete physical and psychosocial evaluation. Further understanding of this group of disorders requires studies of specific chronic pain syndromes using proper controls.

Adolescent↗
PubMed1986

Dysthymic disorder and rheumatic pain modulation disorder (fibrositis syndrome): a comparison of symptoms and sleep physiology.

It has been suggested that "fibrositis" or rheumatic pain modulation disorder (RPMD) is a variant of depressive illness. Both disorders are associated with abnormalities in sleep physiology. Since the clinical features of RPMD do not meet all the criteria for a major depressive disorder, the symptoms and sleep physiology in subjects with dysthmic disorder (DSM III criteria) (N = 6), and RMPD (N = 6) were compared, in order to determine the similarity between the two groups. The sleep physiology in dysthymic disorder was first examined over three consecutive nights since a systematic evaluation of the sleep physiology in this group of disorders has not yet been reported. All dysthymic patients showed episodic bursts of high-amplitude (75-150 microvolts) theta (3-5 Hz) bursts in stage 2 sleep, and REM onset latency was abbreviated only on night 2. The theta bursts have not been previously reported, and may be an early marker of disorganization of non-REM sleep in the dysthymic subjects. The comparison of the two groups revealed that RPMD subjects reported more pre- and post-sleep pain (p less than 0.01), lighter sleep (p less than 0.01), and more physical ailments during sleep (p less than 0.01), and had more alpha (7-11.5 Hz) in non-REM sleep (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Psychological factors affecting self-excoriative behavior in women with mild-to-moderate facial acne vulgaris.

The authors examined the psychological factors associated with self-excoriative behavior among 56 women (mean +/- SE age: 24.0 +/- 1.0 years) with mild-to-moderate facial acne vulgaris. Ratings associated with poor self-concept, such as perfectionistic and compulsive personality traits, correlated more strongly with self-excoriative behavior than the dermatologic indices of acne severity. The study's findings suggest that psychological factors, independent of acne severity, play an important role in the perpetuation of the self-excoriative behavior exhibited by some women with acne.

Acne Vulgaris↗
PubMedDate not supplied

Depression modulates pruritus perception: a study of pruritus in psoriasis, atopic dermatitis, and chronic idiopathic urticaria.

Pruritus, or itching, is the most common symptom of dermatologic disease. Psychologic factors can affect pruritus, and in an earlier study of inpatients with moderate to severe psoriasis, we observed that the degree of depressive psychopathology directly correlated with pruritus severity. In this study we investigated the relation between pruritus and depression among a group of patients (N = 252) with a wide range of pruritic skin disorders, including outpatients with mild to moderate psoriasis (N = 77), atopic dermatitis (N = 143) and chronic idiopathic urticaria (N = 32). All patients self-rated the severity of their pruritus on a 10-point scale and completed a battery of psychologic ratings, including the Carroll Rating Scale for Depression (CRSD). We observed a direct correlation (Pearson's r = .34, p < .0001) between pruritus severity and the CRSD score. The correlations between pruritus severity and CRSD scores for each individual diagnostic group were as follows: psoriasis: Pearson's r = .32, p = .004; atopic dermatitis: Pearson's r = .21, p = .013; and chronic idiopathic urticaria: Pearson's r = .34, p = .06. When the subjects with pruritus scores less than 5.5 were compared with subjects with pruritus scores greater than 5.5, significant differences (p < .05) in depression scores were found for all three dermatoses by the Mann-Whitney U test. The depressed clinical state may reduce the threshold for pruritus.

Adult↗
PubMedDate not supplied

Olanzapine may be an effective adjunctive therapy in the management of acne excoriée: a case report.

BACKGROUND: The self-inflicted dermatoses such as acne excorieé and neurotic excoriations are often chronic, recurring, and resistant to standard dermatologic therapies. OBJECTIVE: We present a 28-year-old woman with longstanding acne excorieé, whose acne started at age 14 years and was followed by acne excorieé at age 16 years. The patient reported that her acne and self-excoriative behavior were exacerbated by psychological stress. The previously treatment-resistant acne excorieé responded favorably to treatment with the atypical antipsychotic agent olanzapine. METHODS: The patient was started on olanzapine 2.5 mg at bedtime. RESULTS: After 4 weeks of therapy with olanzapine she reported a significant decline in her self-excoriative behavior which was associated with an improvement in her acne excorieé. The patient used the olanzapine 2.5 mg for 6 months, during which time she also entered psychotherapy in order to deal with some psychosocial stressors that were exacerbating her self-excoriative behavior. The patient has not experienced a recurrence in her self-excoriative behavior or acne excorieé for 4 months after discontinuing the olanzapine. CONCLUSION: Olanzapine may prove to be a useful adjunctive therapy in some self-induced dermatoses including acne excorieé.

Acne Vulgaris↗