Psychodermatology

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RaaMD

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Hi, I'm a naive 1st year med student who is wondering if it is possible to go into this field through a residency in psychiatry and some type of dermatology training afterward. I was a dermatology patient as a child and this contributed to my entering medicine. I do not feel that I will have the scores that will be competitive enough to enter a dermatology residency and am more interested in psychiatry anyways.
 
Hi, I'm a naive 1st year med student who is wondering if it is possible to go into this field through a residency in psychiatry and some type of dermatology training afterward. I was a dermatology patient as a child and this contributed to my entering medicine. I do not feel that I will have the scores that will be competitive enough to enter a dermatology residency and am more interested in psychiatry anyways.

It is possible to complete a psychiatry residency and complete a subsequent dermatology residency. There are no dermatology fellowships within the field of psychiatry.

-AT.
 
It is possible to complete a psychiatry residency and complete a subsequent dermatology residency. There are no dermatology fellowships within the field of psychiatry.

-AT.
It is possible to do this but very rare.Dont plan on completeing a residency in one field with the idea that you will switch.If you like derm then do a psych residency at at hospital which has a large derm residency program,you might be able to arrange electives and research focusing on skin problems in psych patients.
 
More psychiatrically, it may hearten you to know that the field of psychodermatology ("psychocutaneous medicine") is not a new one, and one that psychiatrists been fostering in terms of research and treatment for some time.

This has been discussed in a thread before, but we know that many dermatological conditions have a strong psychosomatic basis...psoriasis, rosacia, eczema, etc. Of course, there are the more obtuse disorders such as trichotillomania, and secondary debilitating disorders such as post-streptococcal OCD spectrum disorders in rheumatic fever patients.

The following is from the American College of Family Physicians:
Classification

Psychodermatologic disorders can be broadly classified into three categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders.1 The term "psychophysiologic disorder" refers to a skin disorder, such as eczema or psoriasis, that is worsened by emotional stress (Figure 1). "Primary psychiatric disorder" refers to a skin disorder such as trichotillomania, in which the primary problem is psychologic; the skin manifestations are self-induced. "Secondary psychiatric disorders" affect patients with significant psychologic problems that have a profoundly negative impact on their self-esteem and body image. Depression, humiliation, frustration and social phobia may develop as a consequence of a disfiguring skin disorder.2 Table 1 lists common diagnoses associated with the different categories of psychodermatologic disorders.

As a physician and psychiatrist, you will be evaluating and treating a fair number of dermatological conditions, including simple drug rashes to more secondary dermatologic manifestations of psychiatric disorders.

TABLE 1
Diagnoses Associated with Psychodermatologic Disorders

--------------------------------------------------------------------------------

Major categories
Examples
Psychophysiologic disorders Acne
Alopecia areata
Atopic dermatitis
Psoriasis
Psychogenic purpura
Rosacea
Seborrheic dermatitis
Urticaria (hives)
Primary psychiatric disorders Bromosiderophobia
Delusions of parasitosis
Dysmorphophobia
Factitial dermatitis
Neurotic excoriations
Trichotillomania
Secondary psychiatric disorders Alopecia areata
Cystic acne
Hemangiomas
Ichthyosis
Kaposi's sarcoma
Psoriasis
Vitiligo

New research is making strides in pinpointing the genes that may be responsible for these types of behaviors. Psychiatrists will help with the pharmacogenomic treatment of such disorders in the future.

It's way early, but you can look for residency programs that have some exposure to research dealing with the interface between psychiatry and derm. I remember that there was one such researcher at the Univ. of Florida when I interviewed there.

It's a cool field, one that I've been interested in also since I started residency.
 
Can Botox Cure Depression?

May 25, 2006 — There may be more than just cosmetic benefits to using the drug best-known for smoothing wrinkles.

A new study has found that Botox may cure severe depression, and other studies have found the toxin can be used to fight Parkinson's disease, control bladder problems, and treat prostate cancer.

According to a paper published last week in the Journal of Dermatologic Surgery, a small pilot study conducted by Dr. Eric Finzi found 9 out of 10 depressed patients recovered from their depressive symptoms after getting Botox injections between the eyebrows — nearly twice the success rate of anti-depressants. Finzi has since expanded his study to 15 patients.

"The 14 of 15 actually went from being depressed to no longer being depressed," said Finzi, a medical director and president of Chevy Chase Cosmetic Center in Chevy Chase, Md., and Dermatology and Cosmetic Surgery Associates in Greenbelt, Md.

Finzi said he was testing the theory that Botox makes you stop scowling, which directly relieves your depression as feedback from facial muscles regulates the brain.

"There are a series of patients who have paralyzed facial muscles, and they have problems feeling sad," Finzi said. "So, they may be able to think sad, but they can't feel sad."

Not a 'Miracle Drug'

Finzi originally recruited 10 women between the ages of 36 and 63, with a medical history of depression. The average period of depression in Finzi's subjects was 3.5 years, but one patient had been ill for 17 years and had not responded well to conventional treatments. Seven of the 10 had had little success while on anti-depressants, and none of the subjects had previously taken Botox.

All but one improved after Botox treatments.

"I'm not depressed," said Kathleen Delano, one of the trial subjects. "I have my days, but I would not consider myself a depressed person. I'm happy."

Finzi said one woman in the study felt the depression coming back about two months after the end of the study. After another round of injections, she improved. Therefore, Finzi said, it would be important to get injections about every three months, even before there were signs that the Botox was wearing off.

Still, experts warn Botox is not a cure for depression.

"Botox is not a miracle drug," said "Good Morning America" medical contributor Dr. David Katz said. "People should know this is a maintenance therapy, not a cure."

Other Medical Uses

Botox has a wide range of medical applications and is used to alleviate the symptoms of an enlarged prostate, treat stroke victims' muscle spasms, to ease migraine, help people with Parkinson's disease control their movements, improve bladder function, and give relief for tennis elbow.

It may even help fight cancer. Researchers recently discovered Botox significantly boosted the effects of chemotherapy treatments, speeding up the destruction of tumor cells by increasing blood flow to the tumor.

Botox has only been approved by the Food and Drug Administration for a handful of medical uses, although several other uses show promise.

Both Katz and Finzi said more studies were necessary to test the effect of Botox on depression.
 
Can Botox Cure Depression?

May 25, 2006 — There may be more than just cosmetic benefits to using the drug best-known for smoothing wrinkles.

A new study has found that Botox may cure severe depression, and other studies have found the toxin can be used to fight Parkinson's disease, control bladder problems, and treat prostate cancer.

According to a paper published last week in the Journal of Dermatologic Surgery, a small pilot study conducted by Dr. Eric Finzi found 9 out of 10 depressed patients recovered from their depressive symptoms after getting Botox injections between the eyebrows — nearly twice the success rate of anti-depressants. Finzi has since expanded his study to 15 patients.

"The 14 of 15 actually went from being depressed to no longer being depressed," said Finzi, a medical director and president of Chevy Chase Cosmetic Center in Chevy Chase, Md., and Dermatology and Cosmetic Surgery Associates in Greenbelt, Md.

Finzi said he was testing the theory that Botox makes you stop scowling, which directly relieves your depression as feedback from facial muscles regulates the brain.

"There are a series of patients who have paralyzed facial muscles, and they have problems feeling sad," Finzi said. "So, they may be able to think sad, but they can't feel sad."

Not a 'Miracle Drug'

Finzi originally recruited 10 women between the ages of 36 and 63, with a medical history of depression. The average period of depression in Finzi's subjects was 3.5 years, but one patient had been ill for 17 years and had not responded well to conventional treatments. Seven of the 10 had had little success while on anti-depressants, and none of the subjects had previously taken Botox.

All but one improved after Botox treatments.

"I'm not depressed," said Kathleen Delano, one of the trial subjects. "I have my days, but I would not consider myself a depressed person. I'm happy."

Finzi said one woman in the study felt the depression coming back about two months after the end of the study. After another round of injections, she improved. Therefore, Finzi said, it would be important to get injections about every three months, even before there were signs that the Botox was wearing off.

Still, experts warn Botox is not a cure for depression.

"Botox is not a miracle drug," said "Good Morning America" medical contributor Dr. David Katz said. "People should know this is a maintenance therapy, not a cure."

Other Medical Uses

Botox has a wide range of medical applications and is used to alleviate the symptoms of an enlarged prostate, treat stroke victims' muscle spasms, to ease migraine, help people with Parkinson's disease control their movements, improve bladder function, and give relief for tennis elbow.

It may even help fight cancer. Researchers recently discovered Botox significantly boosted the effects of chemotherapy treatments, speeding up the destruction of tumor cells by increasing blood flow to the tumor.

Botox has only been approved by the Food and Drug Administration for a handful of medical uses, although several other uses show promise.

Both Katz and Finzi said more studies were necessary to test the effect of Botox on depression.

Yes, we talked about this study at a journal club. Despite its very small number of study participants, it was interesting to think about the role that facial expression and muscle contraction may play in a feedback role to the limbic system or other areas of the brain involved in depression.
 
Yes, we talked about this study at a journal club. Despite its very small number of study participants, it was interesting to think about the role that facial expression and muscle contraction may play in a feedback role to the limbic system or other areas of the brain involved in depression.

This study should have been titled: "Dermatologists discover what psychologists have known for 100 years."
 
This study should have been titled: "Dermatologists discover what psychologists have known for 100 years."

Psychologists knew for 100 years that the acetylcholine release that causes brow muscle contraction can contribute, through complex limbic pathways, to the lowering of mood, and that the purified bacterium Clostridium botulinum can block the release of acetylcholine, thus having a positive effect on treatment-resistent (failure of multiple selective serotonin reuptake inhibitor trials) depression?

Nah...
:laugh:
 
Thanks for the reply guys. The botox study was an interesting read.
 
I believe he was referring to radical behaviorism. I smile therefore I'm happy.
 
...Also known as affect attunement, where you subjects simulate facial expressions of photos and then report feeling emotions similar to those of the individual in the photo.
 
Hi, I'm a naive 1st year med student who is wondering if it is possible to go into this field through a residency in psychiatry and some type of dermatology training afterward. I was a dermatology patient as a child and this contributed to my entering medicine. I do not feel that I will have the scores that will be competitive enough to enter a dermatology residency and am more interested in psychiatry anyways.

u know i heard of this as a medstudent, but wasn't really sure if it was true or not. i guess you could be any combination of things if u so desired and put the time in. lol. that leaves for some interesting combinations i suppose. known of which i will venture to put forth. lol but you can imagine.
 
Psychologists knew for 100 years that the acetylcholine release that causes brow muscle contraction can contribute, through complex limbic pathways, to the lowering of mood, and that the purified bacterium Clostridium botulinum can block the release of acetylcholine, thus having a positive effect on treatment-resistent (failure of multiple selective serotonin reuptake inhibitor trials) depression?

Nah...
:laugh:

When you smile, do you feel happy?

Subtext is that you do not need to know the proximate biochemical mechanisms of smiling to realize that the mere behavioral act of smiling may induce a positive mood.

As you well know, Sazi, psychiatrists are increasingly recognizing the importance of mind/body interactions. Whether you like it or not, psychologists are leading several lines of research in psychosomatic medicine. Do you have some sort of deep-seated animosity toward psychology because this profession delayed your purchase of a yacht by two years?
 
The fact that you reply to a month old thread dealing with this subject matter only solidifies your blatent need and bizarre obsession to promote a non-medical profession that is bent on marginalizing or eliminating your future profession.

I've lived on both sides of the fence. You haven't. I formulated an informed opinion based on experience. Do I have a problem with psychologists performing research? The answer is obviously no. That is how that profession started, what it is supposed to do, and where it should be in the future.
 
i heard there is a book called "skin deep" or something about this topic.
 
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