Психодерматология: взгляд на проблему

Шавловская О.А. Психодерматология: взгляд на проблему. Consilium Medicum. Дерматология (Прил.). 2015; 4: 27–32.

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Shavlovskaya O.A. Psychodermatology: a look at the problem. Consilium Medicum. Dermatology (Suppl.). 2015; 4: 27–32.

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Аннотация

Психодерматология – недооцененная область науки, изучающая психические расстройства, имеющие как дерматологические, так и психиатрические характеристики. В статье поднята проблема недостаточной осведомленности врачей-дерматологов и психиатров о существующем направлении «психодерматология». Так, только 18% среди дерматологов и 21% среди психиатров имеют четкое представление о проблемах психодерматологии. Кожная сыпь, вызванная лекарственным препаратом, является наиболее распространенным диагнозом, требующим консультации дерматолога. Самыми распространенными диагнозами, связанными с кожными психическими расстройствами, среди дерматологов считаются акне, атопический дерматит, псориаз, очаговая алопеция, а такие психические расстройства, как дерматозойный бред, невротические экскориации, трихотилломания, – наиболее частые состояния, с которыми дерматологи направляли пациентов к психиатру. Лишь немногие врачи-дерматологи готовы взять на себя ответственность, назначить психотропные препараты и оказать больному должную психотерапевтическую поддержку.

Ключевые слова: психодерматология, кожа, самоповреждения кожи, невротические экскориации, психогенные экскориации, МКБ-11, DSM-5.

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Psychodermatology is an underappreciated field that studies psychocutaneous disorders, which are conditions that have both dermatologic and psychiatric characteristics. The article raised the problem of insufficient awareness among dermatologists and psychiatrists on the current direction of «psychodermatology». So only 18% among dermatologists and 21% of psychiatrists have a clear view of the problems of psychodermatology. Skin rash caused by a drug, is the most common diagnosis that requires consultation of a dermatologist. The most common diagnoses associated with the skin mental disorders among dermatologists, are considered as acne, atopic dermatitis, psoriasis, alopecia areata, and patients with psychiatric manifestations such as delusion of parasitosis, neurotic excoriation, trichotillomania the most common conditions that dermatologists send their patients to a psychiatrist. Very few dermatologists are willing to take responsibility and prescribe psychotropic medications, and provide patient needs psychotherapeutic support.

Key words: psychodermatology, skin, self-induced skin lesions, self-inflicted cutaneous lesions, neurotic excoriations, excoriation disorder, skin-picking disorder, psychogenic excoriation, ICD-11, DSM-5.

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Список литературы

1. Brown GE, Malakouti M, Sorenson E et al. Psychodermatology. Adv Psychosom Med 2015; 34: 123–34.
2. Koblenzer CS, Gupta R. Neurotic excoriations and dermatitis artefacta. Semin Cutan Med Surg 2013; 32 (2): 95–100.
3. Picardi A, Porcelli P, Pasquini P et al. Integration of multipile criteria for psychosomatic assessment of dermatological patients. Psychosomatics 2006; 47 (2): 122–8.
4. ICD-11 Beta Draft – Joint Linearization for Mortality and Morbidity Statistics http://id.who.int/icd/entity/334423054
5. ICD-11. World Psychiatry 2011; 10: 175–80.
6. Tyrer P. A comparison of DSM and ICD classifications of mental disorder. Adv Psychiatr Treat 2014; 20 (4): 280–5. DOI: 10.1192/apt.bp.113.011296
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th Ed. Arlington, VA: American Psychiatric Association, Press Inc. 2013.
8. DSM-5 // www.psychiatry.org/dsm5
9. Sartorius N. МКБ-11 и DSM-V: пересмотр классификаций психических болезней. НейроNews. 2010; 7 (26). / Sartorius N. MKB-11 i DSM-V: peresmotr klassifikatsii psikhicheskikh boleznei. NeiroNews. 2010; 7 (26). [in Russian]
10. Фильц А.О., Педак А.А. На пути создания МКБ-11 и DSM-5: очерки по проблеме психопатологии и нозологических систематик психических расстройств. Николаев, 2012. / Fil'ts A.O., Pedak A.A. Na puti sozdaniia MKB-11 i DSM-5: ocherki po probleme psikhopatologii i nozologicheskikh sistematik psikhicheskikh rasstroistv. Nikolaev, 2012. [in Russian]
11. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry 2013; 12 (2): 88–94.
12. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry 1970; 126: 983–7.
13. Turner GA, Sutton S, Sharma A. Augmentation of Venlafaxine with Aripiprazole in a case of treatment-resistant excoriation disorder. Innov Clin Neurosci 2014; 11 (1–2): 29–31.
14. Misery L, Chastaing M, Touboul S et al. Psychogenic skin excoriations: diagnostic criteria, semiological. Analysis and psychiatric profiles. Acta Derm Venereol 2012; 92: 416–8.
15. Gieler U, Consoli SG, Tomas-Arag L et al. Self-inflicted lesions in dermatology: terminology and classification – a position paper from the European Society for Dermatology and Psychiatry (ESDaP). Acta Derm Venereol 2013; 93: 4–12.
16. Wong JW, Nguyen TV, Koo JYM. Primary psychiatric conditions: dermatitis artefacta, trichotillomania and neurotic excoriations. Indian J Dermatol 2013; 58 (1): 44–8. doi: 10.4103/0019-5154.105287
17. Шавловская О.А. Тревожные расстройства в дерматологической практике. Consilium Medicum. Дерматология (Прил.). 2014; 3: 33–5. / Shavlovskaia O.A. Trevozhnye rasstroistva v dermatologicheskoi praktike. Consilium Medicum. Dermatology (Suppl.). 2014; 3: 33–5. [in Russian]
18. Arbabi M, Farnia V, Balighi K et al. Psychiatric characteristics and Quality of Life in patients with pathologic skin picking. Iran J Psychiatry 2008; 3: 16–9.
19. Jafferany M, Vander Stoep A, Dumitrescu A et al. The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol 2010; 49 (7): 784–9. doi: 10.1111/j.1365-4632.2009.04372.x
20. Ocek T, Kani AS, Baş A et al. Psychodermatology: Knowledge, Awareness, Practicing Patterns, and Attitudes of Dermatologists in Turkey. Prim Care Companion CNS Disord. 2015; 17 (2). doi: 10.4088/PCC.14m01628. eCollection 2015.
21. Jafferany M, Stoep AV, Dumitrescu A et al. Psychocutaneous disorders: a survey study of psychiatrists' awareness and treatment patterns. South Med J 2010; 103 (12): 1199–203. doi: 10.1097/SMJ.0b013e3181fa73ef
22. Park KK, Koo J. Use of psychotropic drugs in dermatology: unique perspectives of a dermatologist and a psychiatrist. Clin Dermatol 2013; 31 (1): 92–100. doi: 10.1016/j.clindermatol.2011.11.013
23. Orion E, Wolf R. Psychological factors in skin diseases: stress and skin: facts and controversies. Clin Dermatol 2013; 31 (6): 707–11. doi: 10.1016/j.clindermatol.2013.05.006
24. Gee SN, Zakhary L, Keuthen N et al. A survey assessment of the recognition and treatment of psychocutaneous disorders in the outpatient dermatology setting: how prepared are we? J Am Acad Dermatol 2013; 68 (1): 47–52. doi: 10.1016/j.jaad.2012.04.007
25. Poulos GA, Alghothani L, Bendo S et al. Neurotic excoriations. A diagnosis of exclusion. J Clin Aesthet Dermatol 2012; 5 (2): 63–4.

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1. Brown GE, Malakouti M, Sorenson E et al. Psychodermatology. Adv Psychosom Med 2015; 34: 123–34.
2. Koblenzer CS, Gupta R. Neurotic excoriations and dermatitis artefacta. Semin Cutan Med Surg 2013; 32 (2): 95–100.
3. Picardi A, Porcelli P, Pasquini P et al. Integration of multipile criteria for psychosomatic assessment of dermatological patients. Psychosomatics 2006; 47 (2): 122–8.
4. ICD-11 Beta Draft – Joint Linearization for Mortality and Morbidity Statistics http://id.who.int/icd/entity/334423054
5. ICD-11. World Psychiatry 2011; 10: 175–80.
6. Tyrer P. A comparison of DSM and ICD classifications of mental disorder. Adv Psychiatr Treat 2014; 20 (4): 280–5. DOI: 10.1192/apt.bp.113.011296
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th Ed. Arlington, VA: American Psychiatric Association, Press Inc. 2013.
8. DSM-5 // www.psychiatry.org/dsm5
9. Sartorius N. МКБ-11 и DSM-V: пересмотр классификаций психических болезней. НейроNews. 2010; 7 (26). / Sartorius N. MKB-11 i DSM-V: peresmotr klassifikatsii psikhicheskikh boleznei. NeiroNews. 2010; 7 (26). [in Russian]
10. Fil'ts A.O., Pedak A.A. Na puti sozdaniia MKB-11 i DSM-5: ocherki po probleme psikhopatologii i nozologicheskikh sistematik psikhicheskikh rasstroistv. Nikolaev, 2012. [in Russian]
11. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry 2013; 12 (2): 88–94.
12. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry 1970; 126: 983–7.
13. Turner GA, Sutton S, Sharma A. Augmentation of Venlafaxine with Aripiprazole in a case of treatment-resistant excoriation disorder. Innov Clin Neurosci 2014; 11 (1–2): 29–31.
14. Misery L, Chastaing M, Touboul S et al. Psychogenic skin excoriations: diagnostic criteria, semiological. Analysis and psychiatric profiles. Acta Derm Venereol 2012; 92: 416–8.
15. Gieler U, Consoli SG, Tomas-Arag L et al. Self-inflicted lesions in dermatology: terminology and classification – a position paper from the European Society for Dermatology and Psychiatry (ESDaP). Acta Derm Venereol 2013; 93: 4–12.
16. Wong JW, Nguyen TV, Koo JYM. Primary psychiatric conditions: dermatitis artefacta, trichotillomania and neurotic excoriations. Indian J Dermatol 2013; 58 (1): 44–8. doi: 10.4103/0019-5154.105287
17. Shavlovskaia O.A. Trevozhnye rasstroistva v dermatologicheskoi praktike. Consilium Medicum. Dermatology (Suppl.). 2014; 3: 33–5. [in Russian]
18. Arbabi M, Farnia V, Balighi K et al. Psychiatric characteristics and Quality of Life in patients with pathologic skin picking. Iran J Psychiatry 2008; 3: 16–9.
19. Jafferany M, Vander Stoep A, Dumitrescu A et al. The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol 2010; 49 (7): 784–9. doi: 10.1111/j.1365-4632.2009.04372.x
20. Ocek T, Kani AS, Baş A et al. Psychodermatology: Knowledge, Awareness, Practicing Patterns, and Attitudes of Dermatologists in Turkey. Prim Care Companion CNS Disord. 2015; 17 (2). doi: 10.4088/PCC.14m01628. eCollection 2015.
21. Jafferany M, Stoep AV, Dumitrescu A et al. Psychocutaneous disorders: a survey study of psychiatrists' awareness and treatment patterns. South Med J 2010; 103 (12): 1199–203. doi: 10.1097/SMJ.0b013e3181fa73ef
22. Park KK, Koo J. Use of psychotropic drugs in dermatology: unique perspectives of a dermatologist and a psychiatrist. Clin Dermatol 2013; 31 (1): 92–100. doi: 10.1016/j.clindermatol.2011.11.013
23. Orion E, Wolf R. Psychological factors in skin diseases: stress and skin: facts and controversies. Clin Dermatol 2013; 31 (6): 707–11. doi: 10.1016/j.clindermatol.2013.05.006
24. Gee SN, Zakhary L, Keuthen N et al. A survey assessment of the recognition and treatment of psychocutaneous disorders in the outpatient dermatology setting: how prepared are we? J Am Acad Dermatol 2013; 68 (1): 47–52. doi: 10.1016/j.jaad.2012.04.007
25. Poulos GA, Alghothani L, Bendo S et al. Neurotic excoriations. A diagnosis of exclusion. J Clin Aesthet Dermatol 2012; 5 (2): 63–4.

Авторы

О.А.Шавловская*
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва,
ул. Трубецкая, д. 8, стр. 2
*shavlovskaya@mma.ru

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O.A.Shavlovskaya*
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow,
ul. Trubetskaia, d. 8, str. 2
*shavlovskaya@mma.ru

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