ABSTRACT
BACKGROUND: Verrucous or hypertrophic lichen planus is a chronic inflammatory skin disease characterized by extremely pruritic thick hyperkeratotic plaques and is resistant to topical treatment. PATIENTS AND METHODS: Herein, we report three clinical cases of hypertrophic lichen planus successfully treated with a combination of topical steroids daily in occlusion and trichloroacetic acid (TCA) 50% with peeling every week. DISCUSSION: TCA is involved in regulating inflammation and scarring. Through its keratolytic properties it enhances the efficacy of topical steroids, whose action is hindered by hyperkeratosis. CONCLUSION: The combination of TCA and topical steroids offers a good alternative for the treatment of hypertrophic lichen planus.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Clobetasol/therapeutic use , Keratolytic Agents/therapeutic use , Lichen Planus/drug therapy , Trichloroacetic Acid/therapeutic use , Aged, 80 and over , Anti-Inflammatory Agents/administration & dosage , Clobetasol/administration & dosage , Drug Therapy, Combination , Female , Humans , Hypertrophy , Keratolytic Agents/administration & dosage , Male , Middle Aged , Pruritus/etiology , Trichloroacetic Acid/administration & dosageABSTRACT
INTRODUCTION: Recurrent and intentional ingestion of metallic objects is a rare but important phenomenon. It has attracted great interest among mental health professionals over the last decades. However, this issue is rarely reported in the literature. A deep exploration of its clinical and specific psychopathological aspects remains limited. CASE REPORT: We report the case of a 32-year-old female patient, who was sentenced to 20 years in prison for homicide against her cousin, the daughter of an uncle who had raped her when she was 14. This affair was hushed by the patient's family and the patient was submitted to several acts of abuse by her family. Following her incarceration, she repeatedly ingested metallic objects requiring repeated admissions in a department of surgery for endoscopic extractions or surgical interventions. She impulsively ingested more than 30 times various metallic objects such as wire, razor blades, spoons, etc., under the pressure of impulsiveness and massive anxiety. Voluntary metal ingestions, associated with iterative self-mutilation behaviors, took place within the framework of a borderline personality disorder, the incarceration and the conditions of imprisonment playing a role in initiating and retaining the behavior. CONCLUSION: Through this case report, we examine the specific psychiatric aspects of intentional ingestion of metallic objects in order to better understand this behavior.
Subject(s)
Homicide/psychology , Metals , Pica/diagnosis , Pica/psychology , Prisoners/psychology , Adolescent , Adult , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/psychology , Child Abuse/diagnosis , Child Abuse/psychology , Child Abuse/therapy , Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/psychology , Child Abuse, Sexual/therapy , Endoscopy, Gastrointestinal , Female , Foreign-Body Migration/diagnosis , Foreign-Body Migration/psychology , Foreign-Body Migration/therapy , Gastrointestinal Tract , Humans , Life Change Events , Self Mutilation/diagnosis , Self Mutilation/psychology , Self Mutilation/therapy , Social Environment , Social FacilitationABSTRACT
INTRODUCTION: Liaison psychiatry is a discipline caring for psychiatric disorders in patients of general hospitals. It involves clinical, educational, and research aspects. The liaison psychiatry supports patients hospitalized for full-time in medical and surgical departments, patients admitted in day-hospital and patients treated in the emergency department. In this transversal study, we assessed the liaison psychiatry impact that is still in development stage in Morocco. This study lasted 24 months, and was conducted at the University Hospital in Fez, Morocco. OBJECTIVES: The goal of this work was to evaluate the prevalence of psychiatric disorders managed by liaison psychiatry, identify those requiring medical and surgical departments of such psychiatric support, and classify the motivations involved in their needs. METHODS: This transversal study was initiated in January 2010 and has lasted 24 months. The study recruited 180 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fes, Morocco. The psychiatric assessment was based on a psychiatric interview using the MINI. The data were collected by a certified psychiatrist using a questionnaire containing 24 items. After initial psychiatric assessment, the follow-up was proposed to the patient in the psychiatric department. RESULTS: During this study, 22 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (16%) and Nephrology (11%). The most common motivations for psychiatric consultations were respectively psychomotor agitation (17%) and an evaluation of suicide attempts (17%). Depressive and psychotic disorders were the most diagnosed disorders with 47% and 11% respectively. The psychiatric support was based on pharmacological treatment in 60% of cases. Finally, the outcome was favourable in 80% of followed cases. CONCLUSION: Hospitalized patients in different medical and surgical departments of the University Hospital of Fez have demonstrated a high prevalence of psychiatric disorders. This constitutes a very strong motivation to setup a department of liaison psychiatry. This would allow a better psychiatric support and follow-up of patients.
