Medication backup: attitudes and practices of psychiatrists and residents.

Twelve residents and 12 attending psychiatrists in the adult division of a university-based department of psychiatry responded to a 20-item questionnaire about medication backup, or the provision of psychotropic medications for a patient treated in psychotherapy by another clinician. The attending psychiatrists and residents did not differ significantly in their attitudes about and practices of medication backup. Results of this preliminary study indicated that about half of both groups saw between one and five patients a month for this purpose. All except one respondent believed that medication backup may have a detrimental effect on treatment.

Pruritus associated with nocturnal wakenings: organic or psychogenic?

Pruritus that interferes with sleep is generally diagnosed as having an organic rather than a psychogenic basis. We compared the dermatologic and psychosocial parameters of 79 inpatients with psoriasis with moderate to severe pururitus with (W group; n = 46) and without (NW group; n = 33) wakenings from sleep in association with pruritus. At the time of the patients' admission, compared with the NW group the W group had more severe depressive psychopathologic features (p less than 0.05); were possibly alcoholic, according to behavioral criteria for alcoholism (p less than 0.005); reported a higher daily alcohol consumption (p less than 0.05); and had symptoms suggestive of periodic movements in sleep, or nocturnal myoclonus (p less than 0.05), a sleep physiologic disorder. The two groups did not differ with respect to pruritus severity or other dermatologic parameters at the time of admission or during inpatient treatment. Contrary to the generally accepted criterion for the organicity of pruritus, psychiatric and possibly sleep pathologic factors rather than primary dermatologic factors determined the wakenings from sleep as a result of pruritus.

Pruritus in psoriasis. A prospective study of some psychiatric and dermatologic correlates.

Among 82 inpatients with psoriasis, 67% (55 patients) reported moderate or severe pruritus. The degree of depressive psychopathology discriminated between the mild, moderate, and severe pruritus groups at admission. Prospectively, the change in depression scores correlated with the change in pruritus pretreatment to posttreatment. Pruritus severity did not correlate significantly with stress due to life events, age at onset, ethyl duration of psoriasis, age, sex, marital status, and average reported daily alcohol (ethanol) consumption. Among the objective dermatologic measures, including extent and severity of lesions, only the degree of perilesional irritation discriminated between the mild, moderate, and severe pruritus groups at admission, and prospectively, change in this measure correlated with the change in pruritus pretreatment to posttreatment. This finding was most likely related to the self-excoriation associated with pruritus. Intrapsychic factors (eg, the severity of depression) rather than external psychosocial or well-defined dermatologic factors, were the most significant correlates of pruritus in psoriasis.