ABSTRACT
Excoriation disorder (skin picking disorder, SPD) is an illness that is included in the classification of mental disorders since DSM-5. Despite a prevalence of 1.4-5.7% in the general population, this is a not well-known condition among dermatologists and psychiatrists. We describe a case of a man who lost all upper incisors and canines as a result of a severe form of SPD. We provide an overview of the treatment options and call for increased attention for this condition.
Subject(s)
Mental Disorders , Self-Injurious Behavior , Diagnostic and Statistical Manual of Mental Disorders , Humans , Male , Prevalence , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/epidemiologyABSTRACT
Catatonia is a psychomotor syndrome characterised by multiple symptoms like stereotypies - repetitive, abnormally frequent, non-goal-directed movements. A problem is the lack of unanimity regarding the number of symptoms needed for diagnosis. We describe repetitive inappropriate sexual behaviour in a patient with bipolar depression and excited catatonia with Bush-Francis Catatonia Rating Scale score of 12. Electroconvulsive therapy resulted in disappearance of catatonia and inappropriate sexual behaviour and remission of depression. A recurrent episode with similar inappropriate sexual behaviour was successfully treated with electroconvulsive therapy. We interpreted the repetitive inappropriate sexual behaviour as a catatonic stereotypy. Similar stereotypies are reported in children with autism. Tics and self-injury in patients with autism are described as a stereotypy within catatonia. The agitated depression is another possible diagnosis with the repetitive inappropriate sexual behaviour as an example of psychomotor agitation. More research is needed towards repetitive inappropriate sexual behaviour as a possible stereotypy within catatonia.
Subject(s)
Catatonia/therapy , Depression/therapy , Electroconvulsive Therapy , Psychomotor Agitation/therapy , Sexual Behavior , Catatonia/diagnosis , Depression/diagnosis , HumansABSTRACT
BACKGROUND: There is considerable controversy about the possible link between suicidal behaviour and antidepressants. Since ethical and methodological problems prevent direct research, discussion has to draw largely on indirect evidence. AIM: To review randomised controlled trials (rcts), observational studies, ecological studies and recommendations of the Food and Drug Administration (fda) regarding the risk of suicidality linked to the use of ssris. METHOD: We summarised and reviewed critically the literature on suicidality and ssris via the PubMed database up till March 2008. RESULTS: Various analyses, most of which were meta-analyses, showed that in adults ssris increase the risk of suicidal ideation and suicide attempts. However, neither observational studies nor the findings of the fda gave any indication of an increased risk of suicide in adults being treated with ssris. On the other hand, if patients were on antidepressants, the younger they were, the greater was the risk of suicidal thoughts or suicide attempts. Children, adolescents and young adults who were on ssris ran an increased risk of suicidal ideation and suicide attempts. One observational study did not show this association. CONCLUSION: Treatment with ssris does not increase the risk of suicide in adults, but it is difficult to make a firm pronouncement about the effect of ssris on suicidal behaviour (ideation and suicide attempts). However, in children, adolescents and young adults being treated with ssris, there is an increased risk of attempted suicide.
