Psychodermatology: An evolving paradigm

Psychodermatology is a specialty that highlights admix between psychiatry and dermatology. It is emerging as a new subspecialty in dermatology. The skin and central nervous systems are related through their common embryonic origin – ectoderm. They also have common neuromodulators, peptides, and biochemical systems of internal information. Psychiatry is more focused on the internal invisible symptoms, and dermatology is focused on the external visible signs. This connection between skin disease and psyche has unfortunately been underemphasized. Increased pathophysiological understanding of these issues, with biopsychosocial approaches and clinics of psychodermatology would be highly beneficial. Multicenter research such as prospective case–controlled studies and therapeutic trials about the association of skin and psyche can provide more insight into this unexplored and exciting field of medicine

Malignant catatonia and neuroleptic malignant syndrome in relation to disulfiram overdose

Disulfiram is a widely used drug in the management of alcohol dependence syndrome as an aversive agent. Although a drug of high efficacy, it has a large number of side effects. Disulfiram-induced catatonia is a known rare side effect of the drug and herein we report a case of what appeared to be the sequential development of malignant catatonia and neuroleptic malignant syndrome in a patient with a diagnosis of alcohol dependence syndrome and co-morbid paranoid schizophrenia following disulfiram overdose. Clinicians need to be vigilant on the emergence of such rare side effects

A Descriptive Analysis of Psychosocial Factors Associated With Non- fatal Adolescent Suicide Attempts

Introduction: Adolescence is the tender, vulnerable transition period with umpteen challenges and individual vulnerability. Various Psychosocial factors play a determinantal role in the genesis of adolescent suicide attempts and the present descriptive study tries to analyze some common psychosocial factors in cases of non-fatal adolescent suicide attempters. Method: Fifty subjects were recruited in the study. Detailed assessment of psychiatric morbidity and attempted suicide was done by clinical interview and validated by M.I.N.I.- KID, Beck Suicide Intent Scale and Adolescent Suicide Assessment Protocol-20. Psychosocial factors associated with the attempt were documented with the semi-structured proforma and descriptive statistical analysis was done with the help of SPSS version 15. Results: Majority of the suicide attempters were in the age group of 18-19 years and females (54%) outnumbered males (46%). Most of the subjects were single (88%), Hindu (86%) by religion, belonged to middle socioeconomic class (82%) and were from the urban background (80%). Two third of them belonged to nuclear family and half of them were students. In our evaluation of various psychosocial factors, 76% of subjects were found to have psychosocial stressor, in that 10% had two or more stressors. Family related factors were the most common (60%) followed by college related factors (26%) in which most common was love failure (12%). Conclusion: A sizeable proportion of subjects had various psychosocial factors associated with non-fatal adolescent suicide attempts and emphasis on these factors can help in prevention and hence monitoring of at-risk adolescents

Factors associated with suicide methods among non-fatal suicide attempters in a general hospital

Background: Suicide is a major public health concern. A number of socio-demographic and clinical variables interplay in determining the chosen method and hence influence the outcome of suicidal behavior. Materials and Methods: Two hundred subjects fulfilling the inclusion and exclusion criteria were recruited in the study. The socio-demographic details were recorded in the semi structured proforma. Detailed assessment of Psychiatric morbidity and attempted suicide was done by clinical interview and validated by M.I.N.I.-Plus 5.0 and Beck Suicide Intent Scale. Data was analyzed using SAS Version 9.2 & SPSS Version 17.0. Results: In the present study, the three most common method of attempting suicide was by poison consumption (50.5%), followed by drug overdose (35%) and hanging (9.5%). Most of the study participants who attempted suicide by poison consumption and drug overdose were in the age group of 11-40 years (P= 0.010 and P=0.050) and female gender had the highest risk of attempting suicide by poison consumption (P=0.005). Most of the subjects in the drug overdose group belonged to urban domicile (P=0.023). Majority of the attempters were first time attempters with low intentionality, low lethality and high impulsivity. Psychosocial factors played an important precipitating role and the most common psychiatric morbidity was adjustment disorder followed by MDD. The influence of alcohol prior to the attempt was significant in the poison consumption group (P=0.040). Conclusions: There are various demographic, clinical and psychosocial factors that play a determinantal role in the choice of method in non-fatal suicide attempters and understanding the interplay of these factors can help devising better preventive strategies in the future

A gender-specific analysis of suicide methods in deliberate self-harm

Background: Deliberate self-harm (DSH) is a major public health concern. Gender differences in suicide methods are a controversial realm with various regional and cultural variations. This study compared and assessed the methods used in DSH attempters as undertaken by men and women, and investigated the possible role of gender and other clinical variables in the selection of suicide method. Materials and Methods: Two hundred subjects fulfilling the inclusion and exclusion criteria were recruited in the study. The sociodemographic details were recorded in the semi-structured pro forma. Detailed assessment of psychiatric morbidity and DSH was done by clinical interview and validated by Mini International Neuropsychiatric Interview-Plus 5.0 and Beck Suicide Intent Scale. Data were analyzed using SAS version 9.2 and SPSS version 17.0. The sample was disaggregated by gender to compare the known correlates of suicide risk on the two most common methods of suicide – poison consumption and drug overdose using multivariate analyses. Results: The analysis revealed that majority of the attempters were in the age group of 11–40 years (91%). Females (63%) outnumbered males (37%); poisoning was the most common type of method (50.5%), followed by drug overdose (35%). There were no statistical differences between the two genders with respect to other sociodemographic variables. Males from urban/semi-urban background (odds ratio [OR] = 4.059) and females living alone (OR = 5.723) had high odds ratio of attempting suicide by poison consumption. Females from urban/semi-urban background (P = 0.0514) and male subjects from nuclear families had an increased odds ratio (OR = 4.482) to attempt suicide by drug overdose. There were no statistical differences when the two genders were compared for other variables such as intentionality, lethality, impulsivity, and number of attempts. Conclusions: It appears that gender differences among DSH attempters appear less pronounced in the Indian setting compared to the worldwide literature on the subject. Nevertheless, the unique, gender-specific characteristics pertaining to DSH attempters in our population emphasize the need for gender-specific interventions in future clinical treatment