Yeager Violet, Bogoyas Matthew, Goubran Bishoy, Gonzalez Lisandra, Ferrer Gerardo F
Psychiatry, Larkin Community Hospital, Miami, USA.
Division of Clinical and Translational Research, Larkin Community Hospital, Miami, USA.
Cureus. 2020 Jun 22;12(6):e8772. doi: 10.7759/cureus.8772.
Neurotic or psychogenic excoriation (PE) is one of the most commonly diagnosed skin disorders associated with a primary psychiatric condition. PE is characterized by excessive picking and scratching of normal-appearing skin, and is often comorbid or is an inherent manifestation of affective disturbance and psychosis itself in schizophrenia. Evidence in the literature has demonstrated the therapeutic efficacy of selective serotonin reuptake inhibitors (SSRI) in treating PE. Other pharmacological treatments that have shown therapeutic benefits in case reports include doxepin, clomipramine, naltrexone, pimozide, and olanzapine. However, using adjunct therapeutic methods or augmentation in the treatment of neurogenic excoriation in the setting of schizophrenia is still not well explored. In this study, we discuss the case of a 59-year-old medically complex paraplegic male with schizophrenia comorbid with severe refractory PE. The patient had poor adherence to psychopharmacological treatment. Consequently, the patient was repeatedly hospitalized due to acute exacerbations of schizophrenic episodes and self-mutilation due to PE. After several failed treatment approaches, olanzapine 10 mg PO BID was added as an adjunct therapy to the Haldol® Decanoate (Janssen Pharmaceutica, Beerse, Belgium) at a dosage of 100 mg/month intramuscularly to control the acute PE symptoms. This treatment modality proved successful in this case, and the patient has been free from PE relapse for over one year of close follow-up. Olanzapine along with Haldol Decanoate long-acting injectable (LAI), might, therefore, be a useful adjunct therapeutic modality for patients with refractory PE with a comorbid diagnosis of schizophrenia and warrants further research.
神经性或心因性皮肤搔抓症（PE）是最常被诊断出的与原发性精神疾病相关的皮肤疾病之一。PE的特征是对外观正常的皮肤过度搔抓，且在精神分裂症中常与情感障碍和精神病本身合并存在或为其固有表现。文献证据已证明选择性5-羟色胺再摄取抑制剂（SSRI）治疗PE的疗效。在病例报告中显示有治疗益处的其他药物治疗包括多塞平、氯米帕明、纳曲酮、匹莫齐特和奥氮平。然而，在精神分裂症背景下使用辅助治疗方法或增效治疗神经性皮肤搔抓症仍未得到充分探索。在本研究中，我们讨论了一名59岁患有多种内科疾病的截瘫男性病例，该患者患有精神分裂症并合并严重难治性PE。患者对精神药物治疗依从性差。因此，患者因精神分裂症发作急性加重以及PE导致的自残行为而反复住院。在几种治疗方法失败后，添加奥氮平10 mg口服，每日两次，作为辅助治疗，同时每月肌肉注射100 mg氟哌啶醇癸酸酯（扬森制药公司，比利时比尔瑟）以控制急性PE症状。这种治疗方式在该病例中被证明是成功的，在一年多的密切随访中患者未出现PE复发。因此，奥氮平与氟哌啶醇癸酸酯长效注射剂（LAI）联合使用，可能是难治性PE合并精神分裂症诊断患者有用的辅助治疗方式，值得进一步研究。
