Kawahara Tisha, Henry Laura, Mostaghimi Ladan
Department of Dermatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53715, USA.
Int J Dermatol. 2009 Oct;48(10):1066-70. doi: 10.1111/j.1365-4632.2009.04127.x.
Psychocutaneous medicine studies the boundaries between skin and mind, and takes the unique approach of examining the patients in their biopsychosocial context. It can help patients with chronic skin problems cope with anxiety and the social stigma of their disease. Decreased psychologic stress can contribute to better treatment outcomes and be an important key to patient care. In addition, some primary psychiatric disorders may be expressed in the skin, such as delusions of parasitosis. A psychocutaneous specialist is well placed to treat these disorders.
To assess the need for psychocutaneous medicine in dermatology, eighty-five attendees of the Wisconsin Dermatological Society (WDS) meeting were asked to complete a needs assessment survey.
Forty-two percent of respondents felt that 30% of their patients would benefit from psychiatric interventions. In addition, 43% of respondents did not routinely inquire about mental health issues. When they did recognize psychiatric needs in a patient, 83% of responders did not feel comfortable prescribing psychotropic medications.
Our data showed that about one-half of the members of WDS attending the meeting believed that a high percentage of their patients would benefit from psychocutaneous intervention. Moreover, it was found that the training during medical school and dermatology residency was insufficient for professionals to confidently prescribe psychotropic medications. Considering the fact that studies have shown psychiatric comorbidity in 30% of dermatologic diseases, and that many of the respondents who felt that their patients would not benefit from psychocutaneous intervention did not inquire about psychologic effects of skin disease in their patients, we conclude that psychocutaneous medicine is an under-recognized field in dermatology. Further evaluation of the demand for psychocutaneous clinics and their integration into daily dermatologic practices and residency training programs is needed.
心理皮肤医学研究皮肤与心理之间的界限，并采用独特的方法在生物心理社会背景下对患者进行检查。它可以帮助患有慢性皮肤问题的患者应对焦虑和疾病带来的社会耻辱感。心理压力的减轻有助于取得更好的治疗效果，是患者护理的重要关键。此外，一些原发性精神障碍可能表现在皮肤上，如寄生虫妄想症。心理皮肤专科医生很适合治疗这些疾病。
为评估皮肤科对心理皮肤医学的需求，我们邀请了威斯康星皮肤病学会（WDS）会议的85名参会者完成一项需求评估调查。
42%的受访者认为他们30%的患者将从精神科干预中受益。此外，43%的受访者没有常规询问心理健康问题。当他们确实认识到患者有精神科需求时，83%的受访者对开具精神类药物感到不自在。
我们的数据显示，参加会议的WDS成员中约有一半认为他们的很大一部分患者将从心理皮肤干预中受益。此外，研究发现医学院校和皮肤科住院医师培训期间的训练不足以让专业人员自信地开具精神类药物。鉴于研究表明30%的皮肤病存在精神科共病，而且许多认为他们的患者不会从心理皮肤干预中受益的受访者没有询问皮肤病对患者的心理影响，我们得出结论，心理皮肤医学在皮肤科是一个未得到充分认识的领域。需要进一步评估对心理皮肤诊所的需求，以及将其纳入日常皮肤科实践和住院医师培训项目。
