Download Psychogenic, somatoform and functional itch: heterogeneity or

ArchivEuromedica
1st & 2nd Edition 2011
screening for congenital hypothyroidism: how much and at what level?
Arch Dis Child. 2011 Apr;96(4):374-9.
5. Demartini B, Masu A, Scarone S, Pontiroli AE, Gambini O. Prevalence
of depression in patients affected by subclinical hypothyroidism.
Panminerva Med. 2010 Dec;52(4):277-82.
6. Duntas LH, Biondi B. New insights into subclinical hypothyroidism
and cardiovascular risk. Semin Thromb Hemost. 2011 Feb;37(1):27-34.
7. Hercbergs AH, Ashur-Fabian O, Garfield D. Thyroid hormones and
cancer: clinical studies of hypothyroidism in oncology. Curr Opin
Endocrinol Diabetes Obes. 2010 Oct;17(5):432-6.
8. Krassas GE, Poppe K, Glinoer D. Thyroid function and human
reproductive health. Endocr Rev. 2010 Oct;31(5):702-55.
9. Atis G, Dalkilinc A, Altuntas Y, Atis A, Caskurlu T, Ergenekon E. Sexual
dysfunction in women with clinical hypothyroidism and subclinical
hypothyroidism. J Sex Med. 2010 Jul;7(7):2583-90.
10. Kvetny J, Wilms L, Pedersen PL, Larsen J. Subclinical hypothyroidism
affects mitochondrial function. Horm Metab Res. 2010 May;42(5):324-7.
11. Todd CH. Management of thyroid disorders in primary care:
challenges and controversies. Postgrad Med J. 2009 Dec;85(1010):655-9.
12. Chen HP, He JS, Hu GS. [Analysis on the traditional Chinese medicine
syndromes of the patients with autoimmune thyroid diseases. Changes
in the thyroid and immune functions in 109 cases] // Zhong Xi Yi Jie He Za
Zhi. 1990 Sep;10(9):538-9, 517.
13. Silva JE, Bianco SD. Thyroid-adrenergic interactions: physiological
and clinical implications. Thyroid. 2008 Feb;18(2):157-65.
14. Vasilenko A., Luzina- J-L, Sokolova T. Modern NeuroEndocrinImmunological Conception of Acupuntcture International Council of
Medical Acupuncture and Related Techniques (ICMART) May, 2005.
Psychogenic, somatoform and functional itch: heterogeneity or overlap
of the phenomenon?
Andrey Lvov, Dmitry Romanov, Svetlana Bobko
Introduction
Itch or pruritus is one of the most common symptoms in
dermatology. About 35% outpatients of the dermatological
clinic suffer from itch (Alexander H., 2005). In general
population it occurs within prevalence from 8.8% to 13.9%
(Wolkenstein P., 2003, Dalgard F., 2005, Halvorsen J.A.,
2009). Itch accompanies skin diseases (atopic dermatitis
and urticaria) in 100% of cases (Weisshaar E. et al., 2009),
psoriasis in 87% of cases (Yosipovich G., 2000; Krueger G.,
2001), herpetic infection in 58% cases (Oaklander A.L. et
al., 2003) as well as systemic diseases (chronic renal or liver
failure, lymphoproliferative diseases, oncological process)
and psychiatric disorders.
Itch unexplained by any dermatological or somatic cause is
considered as psychogenic or functional and equivalent to
somatoform one (Harth W. et al., 2006; Misery L., Alexandre
S., 2007). Somatoform pruritus is usually attributed to
undifferentiated somatoform disorder (DSM-IV-TR; 300.81),
that could include not just «sine materia» symptoms, but
also cases when physical complaints are in excess of what
would be expected from the existing medical condition, i.e.
«cum materia». Psychogenic itch is diagnosed in 6.5 % of
outpatients of dermatological clinics (Stangier U., Gieler U.,
1997) and implicates relation of pruritus exacerbation with
psychosocial stress exposure.
Objective
of the study was to evaluate complex clinical structure of
somatoform itch in order to distinguish its psychosomatic
variants.
Methods.
Psychopathological and dermatological observation by
100
Dr. Svetlana Bobko
M.D., dermatovenerologist, Ph.D.-student of dermatological department of I.M. Sechenov
Moscow State Medical University, studied in clinic for Dermatology and Allergology
Philipps-University in Marburg in 2007-2008. PhD thesis Theme”Psychogenic itch:
aspects of clinical systematics, complex therapy and prophylaxis” under supervision
of professor of dermatological department A.N. Lvov in collaboration with research
worker of department for psychiatry and psychosomatics, psychiatrist Phd Romanov
D.V.), the co-author of 22 research papers and repeated laureate of competitions for
best scientific work among young scientists, was awarded with the medal of the Russian
Academy of Medical Scientists for the best scientific work in 2008, member of Moscow
society of dermatovenerologists, european academy of dermatology and venerology and
international society of dermatology
dermatologist and psychiatrist of 40 patients with itch (24
women, mean age - 34,6±11,3 years) in the dermatologic
department. Hospital Anxiety and Depression Scale (HADS)
was used to evaluate anxious and depressive symptoms.
Results
Examined subjects were divided into 2 groups: somatoform
itch «sine materia» or functional (n=26) and somatoform
itch «cum materia» (amplifying and mimicking existing
dermatological diseases). (n=14).
In the first group without dermatological diseases subjects
itch descriptions varied greatly in quality (burning, tingling,
stabbing, biting, crawling), localization (generalized, localized) and intensity (up to itch paroxysms). In the second group
(atopic dermatitis in 8 cases - SCORAD = 36,7±11,2; psoriasis
in 6 cases - PASI = 16,9±4,8) itch was monomorphous and described as just «sensation causing desire to scratch» or burning. The following registered itch characteristics allowed to
attribute this variant of somatoform pruritus to «cum mateI.M. Sechenov Moscow State Medical University (Dermatologic department,
Department of psychiatry and psychosomatic disorders) Moscow, Russia
ArchivEuromedica
1st & 2nd Edition 2011
istered in about a half of patients
in both groups (46,1% and 50%
respectively). Patients of both
groups also had other somatoform complains according to life
history and/or at the time point
of examination: pathological sensations and vegetative dysfunctions. The functional non-skin
symptoms could be single and recurrent (pseudosomatic episodes)
or manifest in a form of cardiac or
gastric neurosis, hyperventilation
or irritable bowel syndrome. Also
patients of the sample reveled a
kind of constitutional somatopsychic predisposition (neuropatic
constitution) with symptomatic lability and multiple somatosensory
disturbances, which could be conFigure 1 and 2. Self induced skin lesions caused by itch of the first group of patients.
sidered as a predisposing factor to
ria» phenomenon and distinguish from typical dermatologimultiple somatoform complains
cal itch and «pure» psychogenic pruritus: 1) itch localization including somatoform pruritus.
greatly exceeding the atopic or psoriatic eruptions areas; 2)
Discussion.
itch emerged as a prodromal symptom of psychogenically
provoked relapses of dermatoses with typical eruptions only Somatoform itch is a heterogeneous group that includes
in several days; 3) itch persisted after eruptions totally dis- 2 variants: functional and amplified itch [6]. Nevertheless,
appeared; 4) there were psychogenically provoked transient diagnose of dermatoses doesn’t exclude the possibility of
itch flares on somatoform itch: minimal skin lesions could be accompanied
a spare skin in by over-intensive itch in case of psychosomatic disturbances.
dermatoses re- Psychogenic itch is provoked by stress and can occur in
two variants. On the one hand, it could be told about
missions.
In spite of the heterogeneity of somatoform itch phenomena, on the other
differences ob- hand – about overlap due to psychogenic provocation,
served patients general constitutional features and comorbid somatoform
with
these phenomena.
two types of Conclusion. Somatoform itch is a heterogenous phenomenon
s o m a t o f o r m developing as in a form of «pure» functional condition («sine
itch had much materia»), as in dermatological itching diseases («cum
in
common. materia»). Described two variants have common psychiatric
There was a comorbidity and constitutional predisposition.
high level of References.
comorbid anx- 1. «Pruritus» (Chapter Psychogenic itch) L. Misery, S. Ständer, Springer,
ious symptoms 2010
in both groups 2. «Pruritus» S. Ständer 1. Auflage – Bremen: Uni-Med, 2008
with
promi- 3. «Pruritus Diagnostic und Therapie von chronisch-systemischem
nent «health Hautjucken».
anxiety» (HADS Z. Zylicz, R. Twycross, E. Anthony Jones (Teil Somatoformer pruritus),
2004
anxiety sub4. «Treatment of chronic pruritus with the selective Serotonin Rescale score – uptake Inhibitors Paroxetine and Fluvoxamin. Two-arm Proof-of15,4±3,2), but concept study» S. Ständer, B. Böckenholt, F. Schürmezer-Horst et al.
no signs of 2009; 89 (1): 45-51
clinically rel- 5. «Functional Itch Disorders or Psychogenic Pruritus: Suggested
evant depres- Diagnosis Criteria from the French Psychodermatology Group» L.
sion or other Misery, S. Alexandre «Acta Dermatovenerologica», 2007, V. 87: 341severe psychi- 344.
atric disorders. 6. «Clinical pictures and classification of somatoform disorders in
dermatology» Harth W., Hermes B., Niemier V., Gieler U. European
Ps y c h o g e n i c
Journal of Dermatology 2006 Nov-Dec 16 (6) 607-14
exacerbations
Figure 3 and 4. Amplified itch in patients with Atopic of functional
dermatitis (clinical picture of a patient from second itch were reggroup)
101