Phrenotropic drugs in psychosomatic disorders (skin)

Stress Management for Atopic Dermatitis

Atopic dermatitis (AD) is a chronic, debilitating skin disorder that accounts for up to 20% of dermatological diagnoses. A 6-week psychoeducational stress management program was developed, implemented, and evaluated as an adjunctive treatment for AD. The participants (n = 17) were randomly assigned to a treatment or waiting-list control group. Participants in both the intervention and waiting-list control groups were assessed for dermatitis severity by a blind rater both pre and posttreatment and at a follow-up conducted 8 weeks after the conclusion of the program. At posttest the intervention group had significantly reduced pruritus and global severity of atopic dermatitis, and reduced levels of social anxiety and private self-consciousness. At an 8-week follow-up, pruritus was entirely absent and global severity was continuing to decrease, as were levels of social anxiety and private self-consciousness. The psychoeducational stress-management program provided a short effective treatment that resulted in reduction of symptoms and provided long-term management strategies to sufferers of atopic dermatitis.

Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles

Acne vulgaris is a common dermatological disorder, one that is frequently associated with depression, anxiety and other psychological sequelae. In recent years there has been an increasing focus on the extent to which oxidative stress is involved in the pathophysiology of acne. Emerging studies have shown that patients with acne are under increased cutaneous and systemic oxidative stress. Indeed, there are indications that lipid peroxidation itself is a match that lights an inflammatory cascade in acne. The notion that lipid peroxidation is a 'starter gun' in acne is not a new one; here we review the nearly 50-year-old lipid peroxidation theory and provide a historical perspective to the contemporary investigations and clinical implications.

In addition, we present a novel hypothesis in which lipid peroxidation may be priming an increased susceptibility to co-morbid depression and anxiety in those with acne. The emerging research on the systemic burden of oxidative stress in acne sheds further light on the brain-skin axis. The recent findings also suggest potential avenues of approach for the treatment of acne via specific nutrients, dietary modifications, oral and topical interventions.

Adverse cutaneous reactions to psychotropic drugs

Psychotropic drugs are frequently used in both psychiatric and general medical practice. Familiarity with common side effects and their management may assist psychiatrists in the selection of agents to suit individual patient needs. The authors describe the morphologic features and pathologic basis of cutaneous reactions to drugs and discuss the common and reported cutaneous side effects of psychotropic drugs. Although most dermatologic reactions to drugs follow a benign course after drug discontinuation, more serious effects are known to occur with certain agents. An overview of the diagnosis and management of these adverse drug reactions is provided.

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.

An overview of atopic dermatitis: toward a bio-behavioural integration

Atopic dermatitis (AD) is a chronic, pruritic skin inflammation with suspected pathophysiological and psychological mechanisms. These factors are reviewed along with related treatment approaches. Current medical intervention for AD is palliative and only partially effective. Although encouraging, psychological treatment is not well developed and has not been adequately evaluated. It is concluded that multidisciplinary research is needed so that improved understanding and treatment of AD can be achieved.

Psychotropic drugs in somatic disorders

Current trends in the employment of psychotropic medication in somatic illness are considered, and some of the theoretical issues raised by this practice are explored. While much further clinical investigation is needed, a review is made of currently available knowledge regarding psychopharmacotherapy in specific clinical settings: pain, delirium, ischemic heart disease, gastrointestinal disorders, dermatological illness, and in renal, hepatic and pulmonary insufficiency.

Behaviour therapy of psoriasis--a hypnoanalytic and counter-conditioning technique

In the case described, an account is given of psoriasis in a female aged 38 who presented with a history of a rash of increasing severity for 20 years, originating during a period of severe emotional stress in a susceptible personality type.

During the whole of this period, there was never a time when she had been clear, and exacerbations had been most severe during her two pregnancies.

She was treated under hypnosis by a six-point schedule. This involved analysis and discussion, with interpretive (insight) psychotherapy and desensitization by reciprocal inhibition as described by Wolpe.

As well as the disappearance of the rash, overall improvement in personality was a notable impression gained from the self-rating Personality Schedule score at the end of treatment.

Psychiatric treatment of eczema: a controlled trial

Seventy-two patients with eczema were randomly allotted to one of two treatment groups: A, those receiving dermatological treatment only, and B, those receiving the same dermatological treatment plus psychiatric treatment, limited where possible to four months. Cases were followed up at six-monthly dermatological assessments, 57 (79%) for 18 months. The findings suggest that in the presence of overt emotional disturbance, of new psychological or psychophysiological symptoms preceding the rash by up to a year, and of high motivation for it, brief psychiatric treatment improves the outcome in eczema (the proportion clear at 18 months was about doubled), whereas in their absence such treatment may worsen it, especially in the short term.