Basic knowledge in psychodermatology

Background The authors try to define the framework of this approach, what should be acquired by "well-informed" dermatologists and what is required to be a pyschodermatologist. Objective To better define the necessary knowledge to practice psychodermatology. Results 1) The first level is dermatology psychology: there is a psychotherapeutical implicit effect of the dermatological consultation with a goal that is not psychological change. This effect can be improved by acquiring better communication skills and information. The second level needs a possibility to change the emotional individual process and the relational context in a continuum between counselling and psychotherapy. To practice this level a complete psychotherapeutic education with some specificity is needed. This can be reached by a dermatologist also being a psychotherapist or by a team consisting of both dermatologist-psychotherapist. 2) The psychodermatological patient is characterized by alexithymia. He/she needs to be understood through the body language he/she presents. This kind of patient is coming from families where the theme of loss seems to dominate the histories and be associated with deep emotional experiences of separation anxiety. These characteristics must be known together with the different psychodermatological disorders and the mind-body interaction to handle these patients. 3) Taking all of this complexity into account, the psychodermatologist or the psychodermatological team should be able to integrate the different points and adapt attitudes to the patient's difficulty during the whole therapeutic process. 4) The evaluation of the problem should be done using psychological tools here described. Conclusion The European Academy of Dermatology and Venereology (EADV) together with the European Society for Dermatology and Psychiatry (ESDaP) are able to provide the specific education for dermatologist and psychotherapist. In the future, they could be responsible for the recognition of these special abilities and treatments on a governmental and European political level

The ESDAP diploma in psychodermatology

PS26 Psychodermatological consultations are a reality in most European countries nowadays. It is therefore important for health providers to be properly trained to deal with dermatological patients who present with specific needs. Throughout Europe, psychotherapy is being regulated and protected by law and the idea is for this diploma in Psychodermatology to be adapted to current regulations. ESDaP will offer these training courses on an international basis. Each teaching module offered will be the same in different European countries, and offered in different languages by a team of experts coordinated by an ESDaP EC member. The training program will consist of 3 levels. The levels and topics covered are as follows: Level 1: psychodermatologist, skin–psychologist, skin–psychiatrist. Acquiring competences in: doctor–patient relationship and communication skills, alexithymia, anxiety, depression, self-inflicted skin lesions, body dysmorphic disorders, delusion of parasitosis and other delusions, quality of life, psychopharmacological treatment, and psychological interventions. Level 2: Psychotherapeutic level A. Counsellor: first level dermatologist/psychologist/ psychiatrist trained as counsellor in various approaches (Habit reversal, atopy school, etc.) B. Practitioner: the same candidates reaching the requirements for the European Certificate in Psychotherapy Additionally, ESDaP will acknowledge and certify a multidisciplinary consultation dermatologist– psychologist/psychiatrist when one of the consultants reaches Level 2

Comorbidity of obsessive-compulsive disorder and schizotypal personality disorder: Clinical response and treatment resistance to pharmacotherapy in a 3-year follow-up naturalistic study

The present study aims to analyze the clinical and socio-demographic characteristics of patients with obsessive-compulsive disorder (OCD) in comorbidity with schizotypal personality disorder (SPD), as well as the response rate to pharmacological treatments. OCD+SPD patients had a younger age at onset, a higher probability to have more severe obsessive-compulsive symptoms, a higher rate of schizophrenia spectrum disorders in their first-degree relatives, and a poorer insight compared to OCD patients. During the 3-year follow-up period, these patients showed a lower rate of recovery, thus requiring augmentation with different psychotropic medications, including low doses of antipsychotics. Our findings suggest that the comorbidity of OCD and SPD causes a poor treatment response, and a reduced probability to recover using standard pharmacological treatment strategies. Further investigations are needed to identify alternative strategies, including psychoeducation and cognitive behavioral therapy, to manage such frequent comorbidity in clinical practice

Duration of untreated illness predicts 3-year outcome in patients with obsessive-compulsive disorder: A real-world, naturalistic, follow-up study

Duration of untreated illness (DUI) is a predictor of outcome in psychotic and affective disorders. The few available data on the effect of DUI in obsessive-compulsive disorder (OCD) suggest an association between longer DUI and poorer response to treatments. This is a real-world, naturalistic, follow-up study evaluating the impact of DUI on long-term clinical outcomes. The sample consists of 83 outpatients with OCD with a mean DUI of 7.3 (5.8) years. Patients with symmetry/ordering cluster symptoms were younger at onset of the disease (20.4 ± 7.9 vs. 27.8 ± 10.6; p<.05, d = 0.79), had a longer duration of the illness (10.1 ± 4.6 vs. 6.8 ± 4.6, p<.05; d = 0.53) and a longer DUI (7.9 ± 6.5 vs. 5.4 ± 3.6, p<.05, d = 0.49) compared to patients not presenting with those symptoms. Fifty-nine patients completed the follow-up, and 33.9% (N = 20) met the criteria for partial remission, scoring <15 at the Y-BOCS for at least eight weeks. Patients in partial remission for more than 40% of the follow-up were defined as “good outcome” and they had a significantly shorter DUI compared to patients with “poor outcome”. Access to adequate treatments is highly delayed in patients with OCD. DUI is strongly associated with poor treatment outcomes. Therefore, strategies to ensure an early diagnosis and treatment are needed

Impairment of Sexual Life in 3,485 Dermatological Outpatients From a Multicentre Study in 13 European Countries

Skin conditions may have a strong impact on patients' sexual life, and thus influence personal relationships. Sexual issues are difficult to discuss directly in clinical practice, and a mediated instrument may be useful to capture such information. In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation.Peer reviewedFinal Published versio

coping strategies in melanoma patients

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A Multivariate Analysis of Depression Prevalence in Psoriasis Patients: A Cohort Study

The literature reported higher depression rates in psoriasis patients compared to the general population. Our study aimed to verify whether variability in depression prevalence was due to using different diagnostic tools. We also aimed to determine whether dysfunctional coping strategies might increase the depression burden. We assessed psoriasis severity by the Psoriasis Area Severity Index (PASI) and PSOdisk. We analyzed mental alterations of 120 outpatients by Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), Symptom Checklist-90-Revised (SCL-90-R), plus coping strategies and quality of life by Coping Orientation to Problems Experienced (COPE) Inventory and 36-Item Short Form Health Survey (SF-36). We divided our cohort into five subgroups from minimal to severe psoriasis using the PSOdisk total score. Depression prevalence varied according to the assessment criteria for specificity, frequency, and severity. Different mood disorders other than major depression emerged when we used DSM-IV-TR criteria. Correlation analysis of the criteria we used to diagnose depression or depressed mood indicated that a dysfunctional coping strategy was highly and positively correlated only in patients of the severe subgroup. Differently, a negative correlation emerged between the SF-36 Mental Summary Component (MSC) and behavioral disengagement, thus suggesting that psychopathological distress might induce patients with a marked/severe psoriasis to adopt dysfunctional coping strategies. Dermatologists are fundamental in detecting comorbid depression, referring psoriasis patients to mental health specialists to achieve adequate treatments, and preventing suicide risk

Teaching anatomy in a modern medical course: an integrated approach at Vialba Medical School in Milan

Introduction The course of Anatomy in Vialba Medical School \u2013 University of Milan, integrates systemic, topographic and development anatomy, dissection laboratory, peer-teaching, flipped classroom, clinical correlation to radiology and surgery. Methods An anonymous questionnaire based on a five-point Likert scale was submitted to 162 students who had passed the exam of Anatomy. Students evaluated the importance given during study to morphology, relations and variations of organs, the usefulness of different tools in preparing the exam of anatomy. Finally, the impact of the new design course of Anatomy on students\u2019 progress was assessed. Results The results showed that most of the students found very useful dissections, multimedia sources and 3D virtual models. 3D virtual models, dissections and physical models were indicated as the most important tools that should be available for learning Anatomy; instead, medical imaging received a low score. Students focused the study on morphology and relations between organs much more than anatomical variations. Lastly, students who followed the new design course of anatomy showed a significant better performance when compared to students of the previous academic years, in particular on the anatomy of neck, thoracic and abdominopelvic cavity, and neuroanatomy. Conclusions Our study underlines the positive impact of the integration of traditional methods and innovative solutions in learning anatomy, but also the critical approach to radiologic imaging and anatomical variability