Impulse control disorders in psychiatric inpatients.

The aim of this study was to examine the prevalence of impulse control disorders (ICDs) in a European psychiatric inpatient sample. Two hundred thirty four consecutive psychiatric inpatients (62% female) were examined using a module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) that has been developed for ICDs (SCID-ICD). In addition to intermittent explosive disorder, pyromania, kleptomania, pathological gambling, and trichotillomania, the proposed ICDs not otherwise specified were assessed, including compulsive buying, nonparaphilic compulsive sexual behavior, pathological internet use, and pathological skin picking. Based on the SCID-ICD, a lifetime ICD rate of 23.5% and a current ICD rate of 18.8% were found. The most frequent ICDs were pathological skin picking (lifetime 7.3%, current 6.8%), compulsive buying (lifetime 6.8%, current 6.0%), and intermittent explosive disorder (lifetime 5.6%, current 3.4%). In contrast, referring to admission diagnoses taken from patients' charts only 3.8% of the inpatients were diagnosed with any current ICD. Individuals with comorbid ICD were significantly younger and had more admission diagnoses other than ICD. The results suggest high rates of ICDs among psychiatric inpatients that remain to be under-diagnosed in clinical routine.

Prevalence of body dysmorphic disorder in a German psychiatric inpatient sample.

Body dysmorphic disorder (BDD) is a distressing or impairing preoccupation with an imagined or slight defect in appearance. Only a few studies have examined BDD prevalence in psychiatric settings. Prevalence rates vary widely and most studies have been conducted in outpatient samples. In the current study, we examined 155 adult psychiatric inpatients. Diagnostic criteria of BDD were assessed with the BDD module of the Structured Clinical Interview for DSM-IV. The prevalence of lifetime BDD was 2.6% (95% CI=0.1-5.1%). Currently 1.9% of the patients suffered from BDD (95% CI=0.0-4.0%). None of these patients were diagnosed with BDD on admission or during hospitalization. The BDD rates found in this study are considerably lower than lifetime and current prevalence rates reported by two other studies conducted in adult psychiatric inpatient settings (Grant et al., 2001; Conroy et al., 2008). The differences may be explained by divergent sample compositions and variation in diagnostic measures. The findings of the current study underline the need for further studies examining BDD prevalence in psychiatric settings and suggest using a combination of screening questionnaire and follow-up interview to diagnose BDD.

[Three cases of erythma ab igne (EAI) in patients with eating disorders]. / Erythema ab igne (Livedo reticularis e calore) bei drei Patientinnen mit Essstörung.

Erythema ab igne (EAI) is a reticulated pigmented dermatosis, which is caused by repetative and prolonged moderate heat exposure insufficient to produce a burn. We report here three cases of EAI in female patients with eating disorders (two with anorexia nervosa and one with bulimia nervosa) who presented with EAI on the abdomen as well as on the thighs and forearms. The clinical picture was characterized by asymptomatic reticular and macular hyperpigmentation and telangiectases without sequamation. The patients admitted the frequent and sometimes over night use of hot water bottles with the aim to reduce a general feeling of cold and to alleviate an aversive feeling of fullness after food intake. It is well known that patients with eating disorders have an increased pain threshold which might have contributed to the prolonged heat exposure. The patients were advised to stop using the hot water bottles. In two patients the EAI progressively cleared over the next 8 weeks; however, without complete remission. The third patient continued to regularly use the hot water bottle and the EAI persisted. The skin changes may persist a long time or even become permanent. EAI is accepted as a precancerous lesion and monitoring of permanent skin changes is advised. While historically EAI was seen in people sitting next to a stove or fire, a modern cause of EAI is the regular and prolonged use of laptop computers on the thighs ("laptop-thighs"). Since there is no effective treatment, the most effective measure is immediate removal of the heat source.