Treatment of Severe Excoriation Disorder With Mirtazapine: A Case Report.

OBJECTIVE: Excoriation disorder is a disabling behavioral disorder characterized by compulsive and repetitive picking of the skin. Excoriation disorder has a lifetime prevalence of 3% to 5% in the general population, and it is most common in females. Its course is chronic, and it is characterized by fluctuating and frequent periods of exacerbation. Excoriation disorder is commonly comorbid with several psychiatric disorders. The treatment of this disorder is challenging and requires a multidisciplinary approach. Current literature has described an improvement in skin picking when patients are treated with fluoxetine or escitalopram; other studies have involved augmentation strategies using antipsychotics, such as olanzapine and aripiprazole; serotonin norepinephrine reuptake inhibitors; and N-acetyl-cysteine. Other pharmacological therapies include lamotrigine and opioid antagonists. Psychotherapies are additional nonpharmacological treatment modalities to consider in this condition. METHODS: We report the case of a 60-year-old Hispanic woman with severe excoriation disorder and several psychiatric comorbidities who responded remarkably to augmentation treatment with mirtazapine. CONCLUSION: Mirtazapine is a noradrenergic and specific serotonergic antidepressant, and its antihistaminergic effect can relieve skin itching and pain.

Teaching Psychiatric Emergencies Using Simulation: an Experience During the Boot Camp.

OBJECTIVE: The purpose of this study is to prepare fourth-year medical students to recognize psychiatric emergencies using simulation technology. The learning experience is accomplished during the boot camp activity designed to train fourth-year medical students in different competencies before transitioning to residency. METHODS: Ninety-eight fourth-year medical students at Paul L. Foster School of Medicine participated in the boot camp during the 2018-2019 academic year. The participation of the Department of Psychiatry was for a total of four full days divided into 3-h morning and 3-h afternoon sessions with the average of four students per hour per session. The use of high-fidelity simulation and standardized patients to recreate two different clinical scenarios representing acute psychiatric emergencies, followed by structured debriefing, was implemented. Pre- and post-qualitative surveys, which were electronically available via Qualtrics, intended to assess the effectiveness of the curriculum and course teaching modalities during the boot camp. RESULTS: All participants reported improvement on levels of confidence in diagnosis and management of psychiatric emergencies compared with baseline. Overall a statistically significant increase in the Likert score was noted in the post-survey analysis. CONCLUSIONS: Teaching psychiatric emergencies utilizing high-fidelity simulation and standardized patient encounters improved student confidence in several competencies. The increase in student confidence can potentially help the learner in transitioning better to residency.