ABSTRACT
@#Objective: This case on psycho cutaneous disorder is not only reported for its rarity, but to describe the frequently seen yet inaccurately diagnosed complex clinical disorder. It was estimated approximately as many as 25-30% of the out-patients attending dermatology clinics suffering from this condition. Patients are often reluctant for referral to the psychiatrist and pose a difficulty for the management for dermatologists. Methods: We report a case of psycho cutaneous disorder, which was referred by dermatologist. She had multiple dermatological and psychiatric morbidities, which were difficult to diagnose and treat, but managed successfully by good liaison and thorough assessment by the treating team. Result: A middle aged, separated lady was referred for psychiatrist’s opinion with complaints of itchy lesions over upper and lower limbs. She was diagnosed to have excoriation and later developed furunculosis. She also simultaneously had tinea corporis with severe xerosis, i.e. fungal infection with dryness of skin. Patient had nursed her uncle who had suffered from psoriasis. She had fears of acquiring the same illness as the illness may be contagious. On the same time, she had plantar psoriasis, which make felt anxious with depressive symptoms and contemplated suicide. The liaison teams successfully treated her medical and psychiatric problems. Conclusion: This case report highlights how concomitant dermatological and psychiatric co-morbidity was successfully managed by liaison team, which consisted of dermatologist and psychiatrist for speedy recovery.
ABSTRACT
Objective: Clinicians are less familiar with clinical presentation of rare disorder like mucopolysaccharidosis (MPS), especially as presentation is complex and varied with different subtypes of this disorder. This case report highlights severe behavioural problems and non-recognition of MPS by clinicians. Though behavioural problems, hyperactivity and aggression are common in children suffering from mental disability, they are also seen in rare metabolic disorders like MPS. Methods: We have reported a seven year old girl who presented with severe episodes of hyperactivity, poor social interaction, impaired understanding of speech and delay as well as regression in developmental milestones is presented along with the investigations and treatment given. Results: Initially, the child was thought to be suffering from intellectual subnormality and/or pervasive developmental disorder. However, radiological studies showed x-ray findings suggestive of MPS. Her developmental history, physical findings, hearing loss as noted on BERA further supported this diagnosis. Due to financial constraints of the family detailed investigations (enzyme assays) to know the exact type of MPS could not be done. Behavioural problems had to be managed with low dose clonazepam and carbamazepine. Conclusion: It is worth considering metabolic disorders as one of the important differential diagnosis in any child presenting with developmental problems, dysmorphic facies along with behavioural problems.
ABSTRACT
Objective: Medically unexplained pain is a common manifestation of psychological distress in children, though establishing this diagnosis is seldom an easy task. This study aimed to enhance and share clinical insights in the complex interplay of medical and/ or psychological factors in these children as revealed by multidimensional assessment, to help in their effective management. Methods: Researchers assessed 65 consecutive children with unexplained pain for more than a month, referred by pediatrician. Of these, 59 consented and completed the interview. Clinical interview by psychiatrist generated psychiatric diagnosis as per ICD – 10 research criteria. Global functioning of the child (CGAS) and relational functioning of the family (GARF) were assessed before and after treatment. Psychosocial stresses were assessed clinically and treatments given to child and/or parent were recorded. Psychologist assessed intelligence of the child using Raven’s Coloured Progressive Matrices and administered Children’s Apperception Test (CAT). Results: A total of 38 (64.4%) children fulfilled criteria for Persistent Somatoform Pain Disorder. Most of them (89.8 %) were undergoing personal, familial and social stresses, many of which were revealed only after detailed clinical assessment. Major depression (28.8%), intellectual subnormality (11.9%), non-organic enuresis (8.5%) and ADHD (8.5%) were common co-morbid psychiatric diagnoses. Children with varying intellectual levels were proportionately represented, and colored the clinical complexity. Repression and reaction formation were common defenses and fear of loss of love of parent, injury, being overpowered were common fears as revealed on CAT. Conclusion: Unexplained pain was often a somatic expression of emotional needs in these children. Psychosocial adversities were common and often causative. However being subtle, these were routinely unidentified. Precise assessment is the key to effective management of these cases.