Joint Consultation by a Psychiatrist and a Dermatologist

Abstract

Background: For one year now, there has been a joint psychodermatologic consultation service in the department of dermatology at the University Hospital of Brest, France. A dermatologist and a psychiatrist have associated to meet outpatients with psychiatric or psychological and dermatological disorders: dermatoses modulated by psychologic factors, psychologic disorders induced by skin disorders or psychiatric disorders with a cutaneous manifestation. The consultation is not only multidisciplinary but really a joint consultation implying constant close cooperation of and exchange between the two therapists. Objective: The aim of this study was to evaluate the psychiatric and dermatological diagnoses which were observed in these patients. Patients: 50 new patients were seen within one year. Only 23 underwent two or more consultations. 58% of outpatients were women and 42% men. 50% were 30–50 years old and 25% were children or teenagers. There was a large diversity in the dermatological and psychiatric diseases found as well as in the pattern of association between psychologic and skin disorders. Discussion: The number of patients was too small to draw epidemiological conclusions. Nonetheless, the aims of such a consultation seem to be reached. It allows diagnoses and treatments of psychiatric disorders in patients who otherwise would only have been treated for their somatic disorders but who are also suffering from a psychic disorder. The concomitant presence of a dermatologist and a psychiatrist appears important to symbolize the association of body and psyche and is comforting for the patients.

Joint Consultation by a Neurogeneticist of Movement Disorders and a Psychodynamic Psychotherapist: An Occasion for Subjectivization

“…Our approach to the joint consultation thus differs from Ullnik (2007): his patients explicitly seek joint consultations, and he follows a semi-structured interview to gather material for subsequent psychotherapeutic interventions. Misery and Chastaing (2003) seem closer to our perspective even though they explicitly offer a joint consultation (while we propose OP's presence on the spot, as an open possibility); also, they mostly focus on diagnosis. Moreover, they do not detail intervention techniques and psychical processes.…”

“…In this light, physicians and psychodynamically oriented psychotherapists have devised diverse outpatient clinical settings in various medical contexts and specialties, in order to address the transferential dimension of patient complaint. These include dedicated liaison psychiatry consultations associated with somatic healthcare pathways ( Consoli, 2010 ), psychoanalytic consultations within hospital services ( Del Volgo, 1997 ), bifocal patient-tailored follow-ups (e.g., Missonnier and Boige, 1998 ), and joint consultations (e.g., Misery and Chastaing, 2003 ; Ullnik, 2007 ).…”

Multidisciplinary and Holistic Models of Care for Patients With Dermatologic Disease and Psychosocial Comorbidity

“…Twenty of the included studies (87%) reported overall benefits and/or improved patient outcomes as a result of offering multidisciplinary care. Fifteen of the incorporated studies (65%) [19][20][21][22][23][24][25][26]29,[32][33][34]37,38,40 acknowledged increased need for the availability of services and/or a lack in efficacy of existing management approaches. Thirteen of included studies (57%) [19][20][21][22]24,25,32,33,[35][36][37][38]40 calledforincreasedresearchand/orgreater implementation within an educational or training context.…”

Psychogenic itch

“…Psycho-dermatological classifications (associated skin and psychological disorders) have included pruritus sine materia among “psychological disorders responsible for skin sensations 29 ,” “functional cutaneous and mucous disorders 30 ” or “conditions in which strong psychogenic factors are imputed 31 .”…”