ABSTRACT
The evaluation of such patients is problematic. It seems appropriate to use a structured assessment scale when considering referring a patient for a psychiatric consultation. However, a difficulty does exist in assessing the role of primary and secondary psychiatric conditions in cases of long-term dermatological itching. There is further difficulty in assessing the degree of severity of the itching, as itching is a subjective phenomenon. For the most part, the psychological assessment of the patient may be carried out by the dermatologist with a special emphasis on emotional aspects. Because direct psychiatric consultations of patients with itching are not common, the dermatologist may consult with the psychiatrist to clarify the primary cause of the condition. Often, the history itself will reveal information about tension and anxiety which shows up in various aspects of the everyday life of the patient: altered moods, decline in level of activity, interest and desire (expressions of depression), and delusional thoughts (expression of psychosis). A structured history focusing on significant periods in the patient's life, such as school performance, marital functioning, employment record, may act as a guide because failure in these specific areas of functioning could lead to a diagnosis of an underlying psychiatric illness. Listening, paying attention, and calming the patient constitute a nonspecific treatment of various mental problems and, as such, can be of great help. It is also possible to treat the problem in an integrated way through a team approach where the dermatologist and the psychiatrist treat the patient together, and where treatment will combine primary drug treatment with psychotherapeutic intervention.
