Skin Picking – A Case Report

IntroductionCompulsive skin picking and trichotillomania are both impulse control disorders, characterized by the need or urge to touch, scratch, scrub, friction, rub, bite, press or dig in the skin; it is often an answer to minimum skin defects or to mild acne. The resulting tissue damage can be moderate to severe.ObjectiveCase report of a woman with Skin picking resistant to treatment.MethodsClinical observation.Results43-year-old woman who was admitted in emergency in June 2014 because of her skin lesions. After observation by Dermatologist she was sent to the Psychiatric due to injuries caused by her. She referring compulsion to scratch, bite and tear the skin since she was 3 years old. After introduction of psychotropic drugs, the patient was referred to the Psychiatric consultations. After 1 year consultation there is some clinical improvement.ConclusionDespite clinical advances in psychiatry, the Skin Picking disease is still little known today, requiring more research and knowledgement in terms of phenomenology and of treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Incest in the Schizophrenic patient: Case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.895 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S588-S588

Author(s):

M. Mezghani ◽

F. Fekih-Romdhane ◽

F. El Ghali ◽

M. Zghal ◽

G. Jmii ◽

...

Keyword(s):

Case Report ◽

Sexuality Education ◽

Clinical Observation ◽

Criminal Responsibility ◽

Patient Case ◽

Annihilation Anxiety ◽

Psychiatric Expertise ◽

Competing Interest ◽

The Individual ◽

The Relationship

IntroductionIncest may be defined as sexual relations between close blood relatives. Legally, incest and sexual aggression toward minors are classified as a criminal behaviour. Tunisia is among the countries from which incest cases are rarely reported.Objectives and methodThe aim of this study is to investigate the relationship between the psychotic structure and incest, and to describe the individual, clinical, and criminal traits of the incestuous father through clinical observation.Case reportMr T.G is 46 years old. He is married and has six daughters. His wife appears to be passive, and largely dependent on her husband. Mr T.G has had incestuous relationships, initially, with his two eldest daughters. The acts were followed by the mother's complicit silence and the non-denunciation of the daughters. Two years later, he starts an incestuous behavior with his third daughter. Incest took place in the context of delusion. The patient was convinced that he is responsible of his daughters’ sexuality education. He develops an incoherent theory of purification with a tendency towards morbid rationalism. It is only after four years of insufferable paternal incestuous relationships that the third daughter filed a complaint to the police. A psychiatric expertise concluded that the accused is exempt from criminal responsibility.ConclusionIncest is a multi-faceted phenomenon, which makes its approach, comprehension, and treatment quite complex. For a psychotic patient incest is a means to deny alterity by crushing other. It also allows him to find, in this complete power, control over his annihilation anxiety.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Seizure as a conversion symptom, a case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1423 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S396-S396

Author(s):

N. Salgado ◽

S. Benavente ◽

B. Macias ◽

J.M. Coll

Keyword(s):

Case Report ◽

Ct Scan ◽

Clinical Improvement ◽

Pharmacologic Treatment ◽

Short Stay ◽

Psychiatric Unit ◽

Clinical Presentations ◽

Competing Interest ◽

Made In

IntroductionPatients with conversive disorder could show atypical clinical presentations with neurological symptoms that are not frequently seen currently.Case ReportA 21-year-old female who was diagnosed of conversive disorder was admitted into a short-stay psychiatric unit for two weeks to introduce treatment and receiving a diagnosis. She presented few seconds long seizures in members without bitting her tongue and keeping control of sphincters, always surrounded by relatives. A neurological study was made with CT scan and electroencephalography and no evidences of neurological abnormalities were found. Various treatments were used but seizures went worse. Venlafaxine (150 mg/day) was prescribed after hipothymc reactive symptoms were observed, which together with pshycotherapy achieved clinical improvement in the two months follow-up.DiscussionPatients with conversive disorder don’t respond appropriately to pharmacologic treatment. In order for patients to understand the situation it is important to keep themupdated in an empathic manner. It is important to exclude other causes.ConclusionsA detailed psychopathological exploration should be made in all conversive patients, to explore symptoms and comorbidities that could reveal new therapeutic treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Drug eruption due to bupropion, a case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2317 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S619-S620 ◽

Cited By ~ 2

Author(s):

N. Salgado ◽

S. Benavente ◽

J.M. Coll ◽

A. Vives

Keyword(s):

Case Report ◽

Food Additives ◽

Skin Lesions ◽

Acute Onset ◽

Diagnostic Features ◽

Inflammatory Drugs ◽

Competing Interest ◽

Antidepressive Medication ◽

Diagnostic Criterion

IntroductionWe present a clinical case of eruption caused by the use of bupropion. Bupropion is known to cause hypersensitivity reactions.Case reportWe report the case of a 48-year-old female who was diagnosed of depressive disorder. She went to emergency because a few days after prescribing bupropion (150 mg/24 h) scaly skin eruptions were found distributed along the skin. In the present case, after its introduction, bupropion was found to be a probable etiological agent. The patient was successfully treated with corticosteroids. Because of that, bupropion dosage was stopped and replaced with fluoxetine. No remissions and exacerbations were noticed in a month's follow up.DiscussionIn this case report, we present a patient with an eruption related to bupropion. The aetiological spectrum of eruption include drugs, infectious agents and food additives. Drugs attributing eruption include nonsteroidal anti-inflammatory drugs, antibiotics, and anti-epileptic drugs, antidepressive medication amongst others.ConclusionsNo specific diagnostic criterion exists for eruption and the diagnosis is purely based on clinical presentation. Diagnostic features, which suggest eruption, are the acute onset (or recurrent nature) and skin lesions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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When to Choose Paroxetine Treatment in Skin-Picking Disorder: A Case Report

Clinical EEG and Neuroscience ◽

10.1177/15500594211073390 ◽

2022 ◽

pp. 155005942110733

Author(s):

Mehmet K. Arıkan ◽

Muazzez Ç. Oba ◽

Reyhan İlhan ◽

Mehmet C. Mat

Keyword(s):

Case Report ◽

Selective Serotonin Reuptake Inhibitors ◽

Treatment Success ◽

Skin Lesions ◽

Alpha Power ◽

Obsessive Compulsive ◽

Skin Picking ◽

Compulsive Disorder ◽

Skin Picking Disorder ◽

Paroxetine Treatment

Skin picking disorder (SPD) characterized by repetitive compulsive scratching in the absence of a primary skin disease is strongly associated with psychiatric comorbidities, including obsessive-compulsive disorder (OCD) and depression (MDD). Selective serotonin reuptake inhibitors (SSRIs) have been used in the treatment of SPD with variable success. Nevertheless, the optimum treatment choice for SPD is an issue for clinicians. This case report presents a 32-year-old female SPD patient treated with four-week paroxetine monotherapy. Based upon the clinical interview and standardized questionnaires, the patient was diagnosed with OCD with depressive features and Skin Picking Disorder. In addition to symptom severity scales, quantitative electroencephalography (qEEG) was also applied. Paroxetine treatment was started (titrated from 5 to 40 mg/day) and doubled each week. After four-week paroxetine monotherapy, OCD symptoms were diminished, and skin lesions were completely regressed leaving solely post inflammatory hyperpigmentation. Post-treatment qEEG assessment also showed a normalization of frontal alpha power and amplitude asymmetry. It can be concluded that if OCD includes SPD with abnormal EEG patterns; then the treatment success using paroxetine will be very high.

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Excoriation: What Counselors Need to Know About Skin Picking Disorder

Journal of Mental Health Counseling ◽

10.17744/mehc.38.4.01 ◽

2016 ◽

Vol 38 (4) ◽

pp. 281-297

Author(s):

Gina E. Jagger ◽

William R. Sterner

Keyword(s):

Emotional Distress ◽

Functional Impairment ◽

Tissue Damage ◽

Skin Lesions ◽

Diagnosis And Treatment ◽

Case Scenario ◽

Skin Picking ◽

Suggested Approach ◽

Skin Picking Disorder

Excoriation is a disorder in which individuals repetitively scratch or pick their skin, resulting in visible tissue damage. The skin lesions that occur from excoriation can lead to physical disfigurement, functional impairment, and emotional distress. Although skin picking is a common behavior that can negatively impact various domains of a person's life, many clinicians are unaware that there are instances in which this condition can be classified a pathological disorder. This article focuses on the prevalence, course, etiology, assessment, diagnosis, and treatment of excoriation. A case scenario is included to demonstrate how a client may present in session, followed by suggested approach to treatment. Implications for clinicians are also discussed.

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Disruptive behaviour's treatment with paliperidone in autistic disorder: Review and case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2371 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S631-S631

Author(s):

M. García Moreno ◽

A. De Cós Milas ◽

L. Beatobe Carreño ◽

B. Poza Cano

Keyword(s):

Case Report ◽

Adverse Effects ◽

Clinical Improvement ◽

Autistic Disorder ◽

Behavioral Symptoms ◽

Aberrant Behavior Checklist ◽

Behavioural Symptoms ◽

Self Injury ◽

Competing Interest ◽

Clinical Global Impression Improvement

IntroductionAutistic disorder (AD) is a neuropsychiatric disorder that often presents significant disruptive symptoms such as irritability, aggression and self-injury in addition to impairment of social skills and communication. These symptoms interfere both individuals with AD and their families and social environment.ObjectiveShow paliperidone effect in behavioural symptoms in AD.MethodsLiterature review about behavioural symptoms in AD and paliperidone effect in its treatment, followed by a case report of clinical improvement after treatment with paliperidone in a patient with autism. Agitation subscale Aberrant Behavior Checklist (ABC-I) scores was compared prior and 4 weeks after paliperidone treatment, and clinical improvement was assessed with Clinical Global Impression-Improvement Scale (CGI-I).ResultsAlthough risperidone has been one of the most studied atypical antipsychotic to treat this symptoms, its use should be limited in order to avoid extrapyramidal and metabolic symptoms. Paliperidone – the major metabolite of risperidone – has shown effectiveness in the treatment of behavioral symptoms in patients with autism, even in subjects with a prior ineffective trial of risperidone. Our patient, 21-years-old male with AD and significant disruptive symptoms was treated with paliperidone 9 mg/day. We observed a 20-points reduction in ABC-I scores 4 weeks later, with most significant improvement in items like auto-agression, heteroaggressivity, irritability and slams. CGI-I scores showed a much better improvement, and no significant adverse effects appeared.ConclusionsPaliperidone is an effective and safe treatment in behavioral symptoms associated to AD, with reduction in ABC-I subscale scores. More studies are needed to confirm our data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cerebellar atrophy supporting diagnosis of alcohol dependence: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1063 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S311-S311

Author(s):

F. Pavez Reyes ◽

M. Sánchez ◽

E. Moral ◽

M. Terradillos ◽

N. López ◽

...

Keyword(s):

Case Report ◽

Alcohol Dependence ◽

Cerebellar Atrophy ◽

Clinical Suspicion ◽

Gamma Glutamyl Transferase ◽

The Family ◽

Other Information ◽

Diagnostic Hypothesis ◽

Competing Interest ◽

Glutamyl Transferase

Chronic use of alcohol is a known cause of cerebellar atrophy. This finding could be a valuable diagnosis support when there are not other information sources. In this case report, we describe a 65-year-old male patient who was referred from primary care to specialized consultation because a depressive syndrome it was unresponsive to treatment with desvenlafaxine and lorazepam. In psychopathological exploration we found overvalued ideas of suffering some kind of injury and damage by the family, which oriented the diagnostic hypothesis of delusional disorder with secondary mood symptoms, although the clinical suspicion of abuse of alcohol was proposed as a differential diagnosis. The continuing minimization and denial of consumption by the patient as well as their reluctance to incorporate an external informant made that the workup was a key element to elucidate the diagnosis. We found a discrete increase in transaminases, gamma glutamyl transferase and alkaline phosphatase. Magnetic resonance imaging showed cerebellar atrophy (vermian and, in a lesser extent, in both hemispheres). Once the patient was confronted with these results, he agreed to disclose his problem, which fulfilled alcohol dependence criteria. After that, he accepted to initiate treatment and detoxification in a specialized unity.ConclusionsAlthough psychiatric diagnosis is based on the clinical features and the exclusion of associated medical conditions, in this case the workup provided support to our clinical suspicion, favouring recognition of the problem and willingness to treatment by the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Scabies superimposed on skin lesions of adult T-cell leukemia/lymphoma: case report and literature review

International Journal of Dermatology ◽

10.1111/j.1365-4632.2008.03707.x ◽

2008 ◽

Vol 47 (11) ◽

pp. 1168-1171 ◽

Cited By ~ 5

Author(s):

Rieko Kabashima ◽

Kenji Kabashima ◽

Ryosuke Hino ◽

Takatoshi Shimauchi ◽

Yoshiki Tokura

Keyword(s):

Case Report ◽

T Cell ◽

Literature Review ◽

Skin Lesions ◽

T Cell Leukemia ◽

Cell Leukemia ◽

Adult T Cell Leukemia

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Tuberothalamic Infarct after Division of a Hypoplastic Posterior Communicating Artery for Clipping of a Basilar Tip Aneurysm: Case Report

Neurosurgery ◽

10.1227/00006123-199103000-00023 ◽

1991 ◽

Vol 28 (3) ◽

pp. 456-459 ◽

Cited By ~ 23

Author(s):

Luca Regli ◽

Nicolas de Tribolet

Keyword(s):

Case Report ◽

Clinical Observation ◽

Significant Risk ◽

Posterior Communicating Artery ◽

Microsurgical Anatomy ◽

Parent Vessel ◽

Pterional Approach ◽

Basilar Tip Aneurysm

Abstract The authors present a case of a tuberothalamic infarct subsequent to division of the posterior communicating artery for clipping of a high-lying aneurysm of the basilar bifurcation using the pterional approach. In view of this clinical observation and some particular aspects of the microsurgical anatomy of the perforating vessels of the posterior communicating artery, we conclude that interrupting this parent vessel carries a significant risk of infarction.

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