Training future dermatologists in psychodermatology

Psychodermatology: An Overview

“…It is important to realize that the psychiatric symptoms will decrease before the dermatosis improves [45], Psychosomatic dermatological patients should not be referred to a psychiatrist unless a serious psychiatric illness is present or un less the dermatologist feels unable to practise a psychological approach. Clinicians who have been trained in a setting that incorpo rates a psychiatric liaison service have experi enced the scope of their possibilities in treat ing these patients [13,56,68,69], They find that they can cope much better with the psy chosomatic patient and need to refer to the psychiatrist only in exceptional situations. This practical training in co-operation with the liaison psychiatrist and the willingness to adopt a comprehensive patient approach are the main grounds for a rewarding psychoso matic approach in dermatology.…”

“…Palliative dermatological measures such as occlusive bandages, ointments or placebo drugs, as well as hospitalization that includes bathing and massaging by nurses, can have a therapeutic impact on the psychiatric prob lem by symbolizing the medical attention and care that the dermatitis artefacta patient is basically craving for [ 13], Trichotillomania, or hair-pulling, may be either a habit or a tick, or a deliberate, though often benign, form of self-inflicted physical change. More often than is generally believed the patient deliberately selects the part of the scalp to be pulled.…”

Psychotherapeutische behandeling van dermatitis artefacta in een klinische setting

“…Hoewel het effect van psychotherapeutische interventies nauwelijks is onderzocht, zou uit onderzoek wel gebleken zijn dat de kans op verdere verslechtering kleiner is, indien sprake is van een psychiatrisch consult of behandeling ( Van Moffaert, 1989). Een behandeling die plaatsvindt in een medische setting zou daarbij een grotere kans van slagen hebben, omdat deze meer aansluit bij de beleving van de patie¨nt, die immers meent aan een somatische aandoening te lijden ( Van Moffaert, 1986).…”

Management of Self-Mutilation

“…Systemic desensitization techniques are appropriate for the treatment of self-mutilation which feature anticipatory anxiety. Also cutaneous self-mutilation that is the result of compulsive behavior is re sponsive to a behavior modification pro gram that includes sessions of prescribed and ritualized skin grooming [Van Moffaert, 1986]. Patients who bottle up their emotions and who have difficulties in expressing feel ings of anger tend to express these repressed feelings in bouts of self-mutilative behavior.…”

“…A comprehensive treatment of selfmutilators requires adequate liaison with the medical colleagues simultaneously or se quentially treating the physical damage of the self-mutilation [Van Moffaert, 1986],…”