Psychodermatology Flashcards
(16 cards)
Patients with delusional infestation typically recognize that their belief is false but continue to experience distress from their symptoms.
False
Patients with delusional infestation have a **fixed, false belief **that their skin is infested with parasites or foreign materials. They typically lack insight and do not recognize their belief as false, even when presented with evidence to the contrary.
What is the first-line therapy approach for both trichotillomania and excoriation disorder?
Cognitive Behavioral Therapy (CBT)—especially with Habit Reversal Training (HRT)—is the first-line behavioral therapy for both trichotillomania and excoriation disorder.
It targets the repetitive behavior cycle and helps patients develop alternative coping mechanisms.
In dermatitis artefacta, patients are consciously aware of the psychological motive behind their self-inflicted lesions
Dermatitis artefacta involves self-inflicted skin lesions, but the psychological motive is not consciously recognized by the patient.
They typically deny any role in causing the lesions, and the behavior serves an unconscious psychological need.
Which of the following most accurately describes Acne Excoriée?
A. Severe nodulocystic acne with superinfection
B. Compulsive picking of mild acne lesions leading to excoriations
C. Dermatitis artefacta involving pustular lesions
D. Trichotillomania variant affecting hair follicles over acne lesions
B
In body dysmorphic disorder, patients typically have excellent insight into the psychological nature of their preoccupations.
False
They are often convinced that their perceived physical defect is real and significant, even if it is nonexistent or minor. In severe cases, the belief may be delusional.
What is the name of the phenomenon where a patient with delusional infestation presents bits of skin, lint, or debris they believe are parasites?
The Matchbox sign
refers to when a patient with delusional infestation (a.k.a. delusions of parasitosis) brings samples (e.g. skin, lint, dust, hair) in a container (historically a matchbox) as “proof” of the infestation.
Occurs in delusions of parasitosis
Which of the following is most likely to produce irregularly irregular hair loss with hairs of varying lengths?
A. Alopecia areata
B. Trichotillomania
C. Tinea capitis
D. Telogen effluvium
B
In illness anxiety disorder, patients typically have prominent somatic symptoms that are medically unexplained.
False
In illness anxiety disorder, somatic symptoms are minimal or absent. The core feature is an excessive preoccupation with having or acquiring a serious illness, often despite reassurance and minimal physical findings.
Name one pharmacologic treatment supported by RCTs for excoriation disorder besides SSRIs.
Doxepin is a tricyclic antidepressant with antihistamine, anxiolytic, and sedative properties. It can be especially helpful in excoriation disorder when pruritus, anxiety, or insomnia are present.
🔹 Another RCT-supported option: N-acetylcysteine (NAC).
Which of the following statements about dermatitis artefacta is TRUE?
A. Patients consciously inflict lesions for secondary gain
B. It is typically associated with schizophrenia
C. Lesions often have bizarre or geometric shapes
D. Patients usually admit to causing the lesions
C
Excessive tanning behavior can be classified as an addictive disorder due to its compulsive and reward-driven characteristics.
True — Excessive tanning behavior is increasingly recognized as an addictive behavior. It shows characteristics such as impulse repetition, compulsion, and continued behavior despite harmful consequences (e.g., melanoma).
CBT is the first-line psychotherapy for patients with nonsuicidal self-injury, especially in the context of borderline personality disorder.
False - DBT is first line
What is the hallmark psychotropic treatment used for both trichotillomania and excoriation disorder when behavioral therapy alone is insufficient?
SSRIs (e.g. fluoxetine, sertraline)
What are the trichoscopic features of trichotillomania?
Coiled hairs
Tulip hairs
Flame hairs
V-sign hairs
Trichoptilosis (split ends)
What antipsychotic was traditionally first-line for delusional infestation due to its lack of psychiatric FDA labeling?
Pimozide has historically been used as first-line treatment for delusional infestation because:
It is effective at low doses
It does not have a formal psychiatric indication, which can make it more acceptable to patients who resist psychiatric labels
⚠️ However, second-generation antipsychotics like risperidone are now often preferred due to fewer extrapyramidal side effects.
