CHOICE OF PSYCHOTHERAPY - would depend upon - (a) Factors related to the patient

psychotherapy - Unlike reconstructive psychotherapy, no insights are offered and therapy is directed towards correction of patient's maladaptive behavioural patterns. Behaviour therapy is a form of re-educative psychotherapy. 3. Supportive psychotherapy - Here attempts are made to strengthen a patient's existing defences by simple guidance and reassurance CHOICE OF PSYCHOTHERAPY - would depend upon - (a) Factors related to the patient - Age, intelligence, motivation for treatment, ability to express emotions, willingness to establish a relationship with the therapist, etc. (b) Factors related to the therapist - Training and skill of therapist to administer a particular type of therapy. (c) Psychiatric diagnosis - Circumscribed or stress-related psychiatric problems would require re-educative or supportive therapies, while neurotic disorders especially when associated with personality difficulties may benefit from re-constructive psychotherapy. ADDENDUM Chronic fatigue syndrome (CFS) Definition A condition of severe fatigue as a principal complaint associated with other somatic symptoms and considerable disability, but with no clear-cut biomedical diagnosis .Etiology; Uncertain. Some patients show immunological abnormalities. CFS can occur after infection. Risk factors are - (a) Previous psychiatric illness. (b) Encephalitis or other causes of nervous damage. (c) Lack of physical fitness. Cl. Fs. - Excessive physical and mental fatigue brought on by physical or mental effort, and with associated functional disability, for which a conventional biochemical cannot be found Symptoms may overlap with some psychiatric disorders such as depression .Tr. - None specific. Ant i depress ants in depressive illness .Rehabilitation is the mainstay of treatment. Cautious increases in physical activity. Factitious disorders These are characterised by physical or psychological complaints symptoms that are intentionally produced or feigned in order to assume the role of the sick patient Munchausen's syndrome is an uncommon, extreme and dangerous subtype of factitious disease, characterised by pathological lying, the deliberate use of self-induced symptoms to gain hospitalization, and wandering from hospital to hospital, even to the extent of undergoing numerous laparotomies for abdominal pain. Other more common factitious disorders are dermatitis artefacta, self-induced fevers and infections, haemorrhage and bleeding disorders, factitious diarrhoea and hypoglycemia 12.SKIN DISEASES A INFECTIONS. Ectoparasite Infections Scabies Definition: A contagious disease caused by a mite, Sarcoptes scabiei, disease is spread through contact with infected individuals, or rarely through contact with infected clothes, bed linen or towels. LIFE CYCLE -The fertilized female excavates a sloping tunnel (burrow) in the stratum corneum, depositing eggs and then dying in the burrow. The larvae emerge from the eggs after 3-7 days, wander to the skin surface and form shallow pockets in the horn of the original or a new host, and reach maturity 14-17 days after the eggs were laid. Copulation occurs in the pocket and the female excavates her burrow, while the male soon dies. Clinical features: Pruritus - The sole complaint is severe itching worse at night.The nocturnal pruritus may be regarded as suggestive of scabies but not pathognomonic Itching starts two to four weeks after the contagion, this time lag being required for the development of lesions other than the burrow. Scabies is suspected by the fact that several members of the family are itching at night. The burrow - is the diagnostic sign of scabies It is a slightly elevated grayish tortuous or dotted line in the skin. It represents a tunnel made by the female mite in the horny layer of the skin in which to lay her eggs.Burrows are best seen in the soft parts of the skin.Scratching destroys the roofs of the burrows.Other lesions such as follicular papules, papulopustules, and excoriation marks are more commonly seen.The sites of predilection for the lesions are the interdigital folds, flexor aspect of the wrists, the elbows, anterior axillary folds, around the nipples, umbilicus, lower abdomen, genitalia, buttocks, medial aspects of the thighs, legs and feet.The face and neck are spared except in children. If scabies is untreated for some period of time, various complications may arise Complications:1 Eczematization.2. Secondary infection.3. Id eruption. 4. Urticaria. 5. Contact dermatitis to antiscabetic drugs. Variants of Scabies: (a) Scabies in clean individuals. (b) Scabies incognito - occurs in persons treated with steroids. (c) Nodular scabies. (d) Animal scabies. (e) Norwegian scabies - Crusted form of severe scabies in persons with low immunological status Differential Diagnosis - Similar signs are found with papular rashes from fleas, including papular urticaria, also atopic skin lesions in young children with maximal lesions on extremities, generalised pruritus, delusions of parasitosis (parasitophobia), dermatitis herpetiformis, sarcoptic mange from pets Management : 1 All the family members should be treated at the same time.2.The clothes, bed linen andtowels should be boiled and ironed. 3. Secondary infection should be treated first. 4. Specific therapy - The patient must bathe and scrub the body with a brush to lay open the burrows. After the bath, the skin is dried and the scabicide applied from neck to toes. Avoid in