Journal Article Annotations
2023, 4th Quarter
Annotations by J. Jewel Shim, MD
The study found a significant association between subjects with either skin picking disorder, trichotillomania, or both and at least one disorder with impulsive behaviors of which the most commonly associated included compulsive buying, problematic use of the internet, and compulsive sexual behavior. Subjects with at least one comorbid disorder with impulsive behavior had more severe body-focused repetitive behaviors (BFRB), more dissociative symptoms, and were more likely to have alcohol use problems.
Strength and weaknesses:
This is the first study to specifically examine the association of disorders of impulsivity with BFRBs. The assessments used for the study were well validated and had good internal consistency. The main weakness was that the disorders with impulse control symptoms were screened by self-report, using a tool that the authors were not clear whether potentially over- or under-estimated positive findings. Similarly, psychiatric comorbidity was also determined via self-report, raising the question whether there was an over-estimation of psychiatric disorders.
The findings suggest that diagnostic categories of Impulse control disorders and obsessive compulsive and related disorders may be more fluid and as such clinicians should be careful to screen for comorbid disorders with overlapping symptomatology. This study is of interest as it can potentially improve the recognition and treatment of comorbid disorders with impulsive behaviors in this specific population of patients with BFRBs, thus improving treatment outcomes.
Psychogenic purpura (PP) is a very rare condition and thus lacks systematic diagnostic criteria. This study strove to systematically review the research on this disease with the aim of establishing a diagnostic algorithm. The investigators examined a total of 134 cases. A majority of patients reported psychological symptoms or a physiological or psychological stressor prior to the onset of the purpura. About 40% patients received a new psychiatric diagnosis, most commonly depression.
Resolution of the purpura was seen in both patients with and without psychiatric diagnoses when treated with counseling, psychotherapy, and antidepressants
Strength and weaknesses:
The authors highlighted the “gold standard” of testing for PP, the washed autoerythrocyte sensitization test, having high sensitivity (98%) and include it as a key part of their proposed diagnostic algorithm for PP. One major weakness was the quality of included studies, which were almost exclusively case reports. These reports were heterogeneous and not all included the test for autoerythrocyte sensitization, which limited the study authors’ ability to perform a meta-analysis on the data. In addition, the authors point out that their data may not include cases that were misdiagnosed, undiagnosed, or unreported and may not include those individuals with the disorder who did not have equitable access to care. Due to the overall limited number of cases and the exclusion of studies prior to May 2013, external validity could be limited. As a result, though this study found high sensitivity for the erythrocyte sensitization test in diagnosing PP, the level of evidence fell short of supporting a clear recommendation to systematically include it in the work-up of patients presenting with purpura.
Although a rare condition, this study provides a guide to the diagnostic process as well as a potential template for treatment.
This is a good review of the potential differential diagnoses and work-up for delusional infestation (DI) and a practical, multi-pronged guide to patient-centered DI treatment. It also includes recommendations for long-term management.