This episode of Psych News Special Report delves into the emerging field of psychodermatology, exploring the intricate relationship between skin conditions and mental health. Dr. Mohammad Jafferany, an expert in the field, discusses his journey into psychodermatology, the psychological impacts of various skin conditions, and the importance of understanding the NICE model. The conversation also covers the classification of psychodermatological disorders, specific conditions like alopecia areata and atopic dermatitis, and effective treatment approaches.

You can read this month's Special Report on Psychodermatology here.

"PsychNews Special Report" is a production of Psychiatric News, a media platform dedicated to serving as the primary and most trusted source of information for APA members, other psychiatrists and physicians, health professionals, and the public about developments in the field of psychiatry and mental health that impact clinical care and professional practice. Learn more at psychiatryonline.org/journal/pn.

Transcript for Audio

[00:12] Dr. Adrian Preda: Welcome to Psych News Special Report, a monthly podcast from Psychiatric News produced for the APA's Medical Minds channel. I'm Dr. Adrian Preda, Editor-in-Chief of Psychiatric News and Professor of Clinical Psychiatry and Human Behaviour at University of California Irvine School of Medicine. Each episode, we sit down with the authors of the Psychiatric News Special Report, our deep dive into relevant topics at the heart of psychiatry and mental health care.

Today, we are diving into psychodermatology, a fascinating and evolving field at the intersection of dermatology and psychiatry. Skin and mind are deeply connected, and psychodermatology explores how dermatology conditions and psychiatric disorders interact. Our guest today is Dr. Mohamed Jafferani, a recognized expert in psychodermatology and psychiatry. Dr. Jafferani is a professor at Central Michigan University College of Medicine.

And the president of the Association for Psychocoutinous Medicine of North America. His recent special report in Psychiatric News examines the psychological and psychosocial aspects of dermatologic diseases shedding light on their role in conditions like depression, anxiety, and even suicidal ideation. We'll explore key takeaways from his report, discuss clinical applications, and address the future of psychodermatology. Dr. Gioferrani, welcome to the show.

[01:37] Dr. Mohammad Jafferany: Thank you Dr. Pradall, thank you for having me. It's my pleasure to be here.

[01:41] Dr. Adrian Preda: To start, can you tell us a little about your journey into psychiatry and more specifically what led you to specialize in psychodermatology?

[01:51] Dr. Mohammad Jafferany: Yeah, so many people don't know I have a dual training in dermatology and psychiatry. So while doing my practice in dermatology, I used to come across lots of cases which were having some kind of psychological percussion. Like for example, I see many patients have acne in young teenager girls and I see the associated shame, guilt because of the affected whole face.

Anxiety, depression, avoidance behaviors and everything I was noticing. However, as a dermatologist, I was unable to help them except just treating them dermatologically. They get better, but it's still not up to the mark. So that left me wondering, you know, what could I have done better that I could help this kind of population? And it's not just for acne. Lots of people with psoriasis.

Even simple parietal, simple to come for itching without any recognized cause. And later I knew that they were having psychogenic parietal. So when these things are coming across in my practice, I was always wondering, I got to do something to help these patients. And then I started taking interest in psychiatry. So, and later on I did my training in psychiatry as well.

And after doing my psychiatry training, then I started combining the field as a psychodermatology. And then I worked in this field, you know, for some time and I used to have my own clinic, psychodermatology clinic right now at my workplace. And it is one of the few, probably six or seven clinics in the country. And so that's how I got connected to this field and, you know, doing what I'm doing now.

And my work involves a lot of teaching and mentoring medical students. And at academic level, as you mentioned in my introduction, I'm the president of the Psycho-Demontology Association of North America. So we are involved in two ways, international organizations as well, who are also involved in psychoterminology. And we do a kind of a combined work and research. And in fact...

We have the first World Psychodermatology Congress is being held next June in Istanbul. I am the Co-President of this Congress as well. yes, this is my journey started and I enrolled into from Dermatology to Psychiatry and then to Psychodermatology.

[04:32] Dr. Adrian Preda: So you have a wealth of expertise in this field. So coming to the field as a dermatologist who then train in psychiatry, probably this is a best case scenario. And I'm really grateful that you decided to write this special report for us because psychodermatology is a relatively niche field. I don't think that dermatologists know as much as they should about psychiatry. And at the other hand, we psychiatrists probably could learn a lot more about these conditions. So let's discuss your special report.

You highlight actually that more than one third of dermatology patients have psychiatric morbidities and conditions like psoriasis and eczema are linked to higher rates of depression and anxiety. Let's go over the numbers. I'll tell you, I was actually surprised by seeing how high these numbers are.

[05:21] Dr. Mohammad Jafferany: Yeah, that is exactly right. Actually, in some studies, they have mentioned the number up to 40 % of dermatology outpatients have some level of psychological involvement in various chronic skin conditions. Particularly psoriasis and atopic dermatitis, they are the most common one. But any condition like acne, for example, also have level of anxiety. And if you just name it, a variety of skin conditions, have...

Some level of anxiety patients at all the time. And since a skin is a kind of open organ and the largest organ of the body and visible, you know, organ. So anything which is on the face or hands or all which are visible, they are open to general public and people see and they get involved into some level of stigma and some level of shame and guilt. They try to avoid meeting with people.

So this number is what we mentioned about the 40 % it seems to be exactly right. And we see quite often that these patients have always there's a problem with some level of psychiatric involvement.

[06:33] Dr. Adrian Preda: And one striking statistic is that almost 30 % of dermatology patients report suicidal ideation. This is a really high number, isn't it?

[06:41] Dr. Mohammad Jafferany: Yes.

That is the biggest right. As I mentioned earlier about the psoriasis, so there are lots of case reports available in the literature where a patient committed suicide because of having a generalized skin condition on their whole body. And frequently these people are having some self-forming thoughts as well. I would particularly like to mention one case which is worth mentioning because I look at this case as a kind of turning point in my career.

From dermatology to psychiatry or psychodermatology in that context. This was when I was a dermatologist. I saw one patient, he was having generalized psoriasis all over the body. were visible on the face and arms and they all opened both the body, even generalized. He had been being treated and his condition was having relapses and ramations and but he's relatively at his baseline is stable enough.

One day I got a phone call from his wife that she wanted to meet with me and thought something about that. So we had a meeting and in that meeting she asked me some questions about these arises and I tried to explain to her that this condition is not contagious. You don't have to worry about that and it is treatable. It is curable. There are lots of information happened but nothing to worry about.

But she was kind of adamant that, you know, I cannot go out with this person. I cannot go to the dinner, the party. I cannot be intimate with him. So I just, I'm just, you know, I am done. So actually she wanted to divorce him. So she came to me to get my support, my endorsement. Yes, you can go and get divorced. So I told her that obviously I'm not in position to tell you this, that you should go ahead.

But I can definitely explain to you that how this condition happens, what is the treatment, what is the prognosis, and what is the contagiousity of this disease and things like that. So she seems to be satisfied and she was with us. just made the meeting and I thought that I, you know, helped her a lot. after a few months, I just came to know that she divorced this person. So that was really a turning point in my career that how a simple skin condition can ruin the whole family. And they have very young, small children, two, three years old. they were totally, know, this whole family was broken. So that's how I got interested into psychiatry. So they all were turning career, which you asked me previously that how I got into this field. So coming back to the original question of suicide, yes, there are reports available in the literature. There are several misconceptions including psoriasis on the top of the list.

Hydrogenated separative waft is another condition, which is the inflammation of the skin glands, axillary glands, and some other conditions. They have documented evidence of patient committed suicide. So based upon that, we should not ignore any skin condition which is visible on the face or visibly, people can look at that. They have this potential for depression, self-forming thoughts, suicidal thoughts, and even people can commit suicide. We just should not take it lightly granted. We should be very careful, very cautious about these patients and we see them and treat them.

[10:20] Dr. Adrian Preda: Totally. And you're making the point here that it's not just the physical symptoms, right? It's also the emotional baggage that comes with them. And in your special report, you are talking about psychosocial burdens. What does that actually mean, the psychosocial burdens? Can you talk about that?

[10:40] Dr. Mohammad Jafferany: Yeah, this is a very, very important point. the skin has a visible organ of the body. So any skin problem on the skin, it is obvious to everybody, having an acne in a 17-year-old girl. Now you can imagine that how she'll feel in her peers and they can compare their skins and how would she feel, the shame and guilt and low self-esteem and these kind of problems. Similarly with psoriasis also.

Being invisible on the skin, on the scalp, face, arms. These people, try to avoid gay things, try to go out, it's not possible for them. And these problems of skin disease, they're visible, have caused rifts in families, relationships. And I have seen many people, young people, have been, know, girlfriend-boyfriend relationship, the problem because of just the skin condition. Because they just cannot go out together, you know.

So these are the stigma on the top of that. People try to avoid seeing a psychiatrist because of the stigma. if they go, if they are being referred to a psychiatrist by a dermatologist, they will feel, and they always, and it's my own experience as well, they will tell me that why should I go to see a psychiatrist? I'm not crazy. So we have to try to make them understand that your condition requires some psychiatric treatment as well.

Along with the typical entomoplasmic treatment. So the social problems, the psychosocial problems of process, avoidance behaviors, and self-esteem, and depression, and all these things happen with many people. And many cases like trichotropomania is again a common example. Many young girls I see, they are having bad patches on their scalp. Now they try to come off it, with weird caps on their head.

Or they just cannot go out again in public places and cannot go to school or in the family gatherings, they try to avoid and having very low self-esteem and having self-harming thoughts, they cut themselves, avoid people. These are all examples of psychosocial issues. And in case of psoriasis, depression, anxiety, leading to even committing suicide, these are all psychosocial issues which needs to be considered in any case of chronic skin disease.

[13:05] Dr. Adrian Preda: So it sounds like it's a vicious cycle that can be very tough to break. And not surprisingly, these are situations that have a huge impact on someone's daily life. You describe how people would experience shame and guilt, probably stop going out, stop socializing. So it's a difficult situation where one thing leads to another, and I would imagine the stress that's the result of the skin disorder.

Will in turn result in increased psychological stress, which in turn will further worsen the skin condition. And it seems like there is a model, a scientific model that tries to capture this complexity, the neuroimmune cutaneous endocrine model or NICE. So what's the NICE model about? Can you break it down for us?

[13:52] Dr. Mohammad Jafferany: Yeah, it is not actually a nice powder because it causes... So as you know that there are lots of chemicals, neurohormones and chemical mediators. They are released from the nerve fibers and those cells. And in inflammatory conditions and the cascade of the inflammation, it starts with these neurochemicals. And I don't have to name every mediator.

So what happens in any chronic inflammatory condition, there is a disruption in the feedback loops and their interactions, which causes more and more inflammation. So that's how many skin conditions they are regarded nowadays as inflammatory skin condition. Atopic dermatitis, particularly on psoriasis, they are regarded as inflammatory conditions. And that's how the biologics they have now started using in these disorders.

To treat them. So this model, this NICE model, which is actually not a NICE model, it interferes with all these functions of all these neurochemicals and neurohormones and radiators to cause more more inflammation. And that is disrupted actually in those conditions.

[15:06] Dr. Adrian Preda: So it sounds like this is a case where stress induces inflammation, which in turn increases the stress so that the psychological stress feeds right back into the skin problems, which in turn will further increase the psychological distresses. Is that a way to understand this model?

[15:24] Dr. Mohammad Jafferany: That is absolutely right, exactly. Stress diaphysis model involved into these chronic inflammatory skin conditions. Yes, that's absolutely right what you mentioned.

[15:34] Dr. Adrian Preda: And you're also talking, it's an interesting connection, right? Because the skin and the brain are actually like siblings, developmentally speaking at least, right? They are originating from the same embryonic layer, the ectoderm.

[15:48] Dr. Mohammad Jafferany: That is correct, yeah.

[15:49] Dr. Adrian Preda: What's the link there? there, you know, so other than the whole sort of psychological link, does this biological relatedness play a role into how these conditions feed into one another?

[16:02] Dr. Mohammad Jafferany: Yeah, that's very interesting because the ectoderm causes the skin and nervous system both. So they are derived from the same germ layer. So that's how they are connected from the embryologic point. And then once, you know, the fetus is born and the child grows and adults. So when we talk about the biological factors, so this is kind of one of them. And then depending upon how the patient is brought up, what kind of stressful situations or trauma he suffered or she suffered. So that will perpetuate the problems. So these patients, they could be prone who have gone through any kind of trauma in their childhood. I mentioned one case history in my this report about a young girl who developed laminitis artefactra and she had some sexual trauma. Her mother also died. Grandma was taken care of her. So all these kind of scenarios, they are very potential, know, grounds for developing a psychocortinous disease. So in like possible cases of dermatitis or defective, we're always and always having this kind of history. So that, you know, accounts a lot. So the connection between, you know, starting from this embryology to the biological factors and in the social factors and the childhood issues, and they all collectively make the person prone to a possible psychoclerosis.

[17:38] Dr. Adrian Preda: So it seems like we are looking at a very complex set of disorders. Is there a way to classify these disorders?

[17:46] Dr. Mohammad Jafferany: Yeah, so regarding the classification of psychodermatological disorders, so there are there's no consensual single classification system available at this point. However, starting from the last probably 10-15 years, some different classification systems have been coming up. So starting from that, so this divided classification into psychophysiological, primary psychiatric, secondary psychiatric and some cutaneous sensory syndromes and the dermatological effects of psychiatric drugs and the psychiatric effects of dermatological drugs, so vice versa. So this was a pretty common classification going on for several years and then different classification came into the picture and just recently, last year or so, there's another international classification was proposed and was published in the Journal of European Academy of Dermatology.

And so this actually I put in my report as well. So they have divided into two groups. Primary mental health disorder with skin condition and skin disorder with mental health conditions. So that's how they classify it. But to just to kind of summarize or simplify rather, we should understand that some skin disorders which are aggravated by stress, they are very close and chronological relationship.

The more the stress, the more worsening of the disease. Less stress is kind of a remission of the disease. Again, atrophic dermatitis, psoriasis, acne, they very good examples for that. And the other group is primary psychiatric, is tuberous aortic factor, trigotromania, these are the good examples for that group. And the secondary psychiatric is like some conditions which are examples are like Woodley Go for example. Woodley Go are just simple, deep-ingvented patches, but they're not causing any physical harm, but they are very bad from the emotional aspects. And how the people, again, the same thing of low self-esteem, guilt going out in public places and all those, they try to avoid that. And especially in the young girls who are having on the face or on the exposed parts of the body, it becomes a problem in assimilation in the society and many...

People, I have seen that they have, especially from the cultural aspects in different cultures around the world, the girl cannot marry if she's having a virtual ego because they right away refuse and just shun that, no, we can't marry this girl. So there is a huge implication of a simple discrimination just as a de-pigmentation, no other physical harm for causing this kind of problem. There is a secondary psychiatric issue.

And the next group is Continuous Sensory Syndrome is those conditions which are having a physical problem but there's no, I'm like itching for example. There's no regular cause. Now some people will complain about my scalp is burning, my scalp is itching. I have, you know, my burning tongue. So these are all these things, the gloss of dyaneia we call it, or the scalpel stasis, yes. These kind of problems are known as Continuous Sensory Syndrome. Worldwide dyaneia, square root dyaneia.

They all come into that kind of category. And the last one is the medication related to psychiatric effects of the antipasic drugs, Acutein, which is very common medication now it is used for acne. And it is well documented that it has potential for high depression and even suicidal thoughts. And that's why the FDA put a black box warning on this medication regarding suicidal tendencies.

So that's what happens when a person who is being prescribed Acutane. So dermatologists, they send him or her for a psychiatric evaluation and auto clearance rather before being prescribed for that patient. So that is a very important aspect which we must consider. So this is what I'm do. And steroids, are commonly used in many conditions for a list of wild prednisone. And we all know that prednisone causes us to suffer many black symptoms, behavioral problems, aggression.

And these things happen with air. And on the other hand, there's psychiatric drugs which cause dermatological problems. Lithium is the most important medication which psychiatrists prescribe quite frequently. And there must be over the common dermatological problem associated with lithium. Such as psoriasis form eruptions. Pictures like psoriasis exactly. Echniform eruption. Allopecia. Thinning of hair. And these kind of things happen quite commonly.

So lithium is one medication we use for bipolar. It has a huge implication in dermatology. So we all should be aware of this kind of problem. So that's how these psychodermatological conditions are generally classified.

[22:43] Dr. Adrian Preda: It sounds like all these classifications and the way to understand it is that aiming to answer this very important question when we see one of these conditions, what's the primary cause? Are we looking at primary mental health issues that impact the skin or are we looking at the skin condition that could then have mental health consequences? Figuring out the original problem is whatever is primarily in the mind or the physical skin itself. That's the way to understand.

There are number of disorders that you focus in your special report. Maybe we can just do a bit of a deeper dive into some of these conditions. I've been always fascinated by alopecia areata. I know it's head loss. What are the mental health aspects of it?

[23:31] Dr. Mohammad Jafferany: Yeah, alopecia areata, has a, first of all, we need to find out the different types of alopecia areata. It is just a simple localized batch, or it is a generalized analysis, sorry, alopecia, or it is a alopecia universalis, no hair on the body. So there are three different celerities of alopecia. So obviously it is quite understandable, like in any psychoclinic condition, which is visible on the public.

And if a person who's having a page of loss of hair, and how would he or she feel? Obviously, they will try to cover it or try to avoid going out. And then the problems of same stigma, social isolation, avoidance behavior, all these things start coming up. And they feel more down and depressed, highly anxious. So those are the most common psychosocial implications for the adipose area.

[24:27] Dr. Adrian Preda: And I can imagine then for the childhood have alopecia areata that's going to be so much more complicated and stressful.

[24:36] Dr. Mohammad Jafferany: Perfectly, exactly. Yeah. So the more, you're right, the more problem in children because of being, going to the school and their peers make fun of them, they bully them. And these kids then because of lots of bad things in the form of having self-harm thoughts, even suicidal tendencies, they have been quite commonly depending upon the severity of the problem.

[25:00] Dr. Adrian Preda: What about atopic dermatitis?

[25:03] Dr. Mohammad Jafferany: Yeah, atopic dermatitis again, it starts from the very young childhood. So this has, I have seen many people who are having this problem where the families get frustrated. Now what happens in this problem, it is not only the child or patient who is being treated, but the family, the parents, they are also affected because of the lack of sleep at night when the child is crying or having lots of...

Treatment modalities are very expensive nowadays. Nowadays, they are using biologics and other things. And many people, you know, they can't afford and in same way, they take, you know, off from the work. So that kind of issue, taking the patient to the provider for the treatment quite regularly, taking off from the work, these are all consequences of the treatment approach. I see many patients who

The mom gets so angry or frustrated that he just gives up. That, know, I'm done. And then, hey, why you didn't take care of this child, our child? I am done. So these problems cause an issue of frustration and relationship problems between two parents just because of the skin disease. So this definitely has a huge implication of atopic dermatitis. And obviously, once the...

Child who is older, adolescent or adult, then there is a constant itch. It is kind of, again, embarrassing in situations like sitting with a group of people in the school, in the college, in the meetings, at workplaces, again, taking off on the work or the treatment and itching and scratching all over the body. It's got a huge psychosomal burden on the patient as well.

[26:56] Dr. Adrian Preda: Which goes back to what you're talking about before, this seems to be another case of a round go around type of a stress effect.

[27:04] Dr. Mohammad Jafferany: Thank you.

[27:07] Dr. Adrian Preda: Yes. Are there any other conditions that you want to make sure that we discuss?

[27:15] Dr. Mohammad Jafferany: Yeah, think trichotropomania is a very common problem, more than alopecia. So this happens from childhood, adulthood and a little bit more. But this is having more implications because of, again, the exposed parts of the body, mainly on the scalp, particularly in women. For some reason, it's more common in women. And so they have to cover their hair, they camouflage and the same issues of psychosocial problems, avoidance behaviors. So this must be, you know, considered and treated. And besides that, dermatitis artifacta, we briefly talked about in the context of this case report. These people have a lot of history of trauma at a young age and that manifests later on into this kind of problem or any kind of stress or trigger in the form of death in the family.

Parental divorce or something like that in the school problems and academic failures, they also push this condition to come up on the surface. Another interesting condition which I specifically like to mention is delusion of parasitosis. So this is a condition where patient is convinced that my body is infected with parasites and they are crawling under my skin and I just can't get rid of it. So they just keep on scratching.

And making ulcers and erosions on the body. And when they come to the provider, they bring a whole box or a ziplock or something like that, where there's skin debris and dead skin and things like that, or hair, they are there. And they come and bring to the doctor to show that, these are the parasites which are causing this problem to me. Now, in the old times, we used to hear about matchbox signs.

So they used to bring this thing in the mailbox. But nowadays we have ziplocs and containers and things like that. Bring the containers and ziplocs. So this condition is really hard to treat comparatively because first of all, the patient comes, he will say, or she will say that, I'm not crazy, why should I go to see a psychiatrist? When they come to a dermatologist. So now the problem with the dermatologist is that they, many dermatologists, are afraid of prescribing antipsychotics and antipsychotics is the first type of treatment in this case. So that's why when we talk about education awareness about psychotermatology and we try to educate dermatologists as well about the use of psychotropic medications to treat those patients. So the treatment of this patient is the building rapport and a bond between a provider and patient is very, very important because once they develop a bond.

Then if you advise them to seek psychiatric treatment for this disorder, they will probably oblige your recommendation. But initially for the first few visits, it is very hard for this patient to convince that they need psychiatric treatment. So this case is also very important when you talk about it. I thought I should make it there.

[30:36] Dr. Adrian Preda: That's all fascinating. I think we've laid a really solid foundation in understanding the extent of the problems here. And you started to actually discuss some of the practical implications. So how do we actually treat and manage these conditions?

[30:52] Dr. Mohammad Jafferany: So the first and foremost thing I would advise is developing a bond, a rapport with the patient. So you should be very empathetic, listening to the patient. I always advise when I start teaching or, know, talking in some lectures or somewhere, I always advise that whenever you schedule this patient, particularly for a dermatologist, that when you schedule this kind of patient, put it at the end of the day so that you have...

Enough time and you are not worried about what about the next patient. There is one thing. The other thing is that you give maximum time. If you are seeing one patient in half an hour, you can give them one hour. So more and more time. So try to just be patient and just keep listening to the patient to express themselves out as much as possible. This will create a ground for building a rapport and bond with the patient doctor.

So once this thing is important, being as an empathetic listener, then you can start to the next step. And then you can advise the patient like in many cases, but particularly for the delusion of parasitosis, which is a kind of a little bit challenging case where the only treatment is antipsychotic treatment because therapy doesn't work for these people because they are so delusional that no therapy can work for them.

So if you have developed a bond with them and then they will listen to you and then whatever you advise, they will follow you. So there's one thing. Now regarding the other cases, it varies upon the treatment approach. So many patients, they require some kind of therapy, particularly cognitive behavioral therapy. And in cases of trichotropomania or skin picking, hyperdiversal therapy is the first line treatment, is evidence-based. It works very well. So for some conditions like simple anxiety and depression associated with psoriasis for example or atopic dermatitis or acne. So wherever you have more kind of a strong evidence and element of anxiety or depression, we always advise SSRIs. They are pretty safe and they help a lot with this condition and anxiety and depression get reduced which indirectly help with this condition as well.

So bottom line the first and foremost approach is empathetic listening and building a bond and rapport with the patient. That is very important in psychocompetitive conditions.

[33:25] Dr. Adrian Preda: Are there any emerging treatments or research areas that hold promise for psychodermatology?

[33:31] Dr. Mohammad Jafferany: No, there are no imaging treatment as such. from the research and academic standpoint, they have done some studies with like tricot pneumonia, for example. But practically, they are not of any benefit to any practicing doctor. So we do not advise any x-ray or any imaging CT, MRI for any self-hypertensive condition. No.

Like in psychiatry what we do, so there's a we don't do that and there's no evidence available that they could help. However, one condition I would like to mention, recently few reports have published regarding the use of TMS in trichotropamina. Again being trichotropamina as you know it is an OCD spectrum disorder. So some reports have mentioned positive effects.

But it is still in infancy and there is no robust evidence available, no randomized controlled trials available. They're just the case reports. So that thing I thought I should mention that. And similarly, there's another condition I would like to mention is a lopecia areata. From the medication standpoint, FDA has recently approved three biologics. So that has been used for this condition and has been kind of a treatment of our OPCI area.

[35:03] Dr. Adrian Preda: What do you see as the future of psychodermatology? Are we moving towards more integrated models of care, you think?

[35:11] Dr. Mohammad Jafferany: Oh yes, first of all I'm very optimistic and hopeful and happy about the future. I see all the time people's interest. I get emails from all around the world all the time. They're wanting to know how can I go ahead, how can I get more and more training, how can I get involved into this area. And another fascinating thing is a lot of young position and medical students actually.

They are involved into this. And again, right now, currently, I've got probably eight or nine students from different states. So they found me and they contacted me and we are working together on different projects of psychodermatology. So that's also very encouraging. And in fact, actually, last week, we had our annual psychodermatology meeting in Orlando, Florida. So we have around, I would say, 20 students, many students.

They were in attendance and they presented posters and oral presentations. So there is a, because this whole, this meeting every year, so I can see the difference. They have a number of students increasing and increasing and that shows the kind of bright future for this fascinating field.

[36:31] Dr. Adrian Preda: As we wrap up, what's one actionable recommendation our listeners can implement in their practice starting today?

[36:41] Dr. Mohammad Jafferany: I think I would say two things that are kind of connected. One is be patient and develop a rapport and bond with the patient. Because that is the basis of your future appointments and connection with the patient. So in the initial phase, on the very first day, say, no, there's nothing wrong with you. It's all in your head. Then it is not a good thing. So you have to be very patient, compassionate, and then...

Where they were born with the patient. There is one. In the same context, there is a collaboration with dermatology and psychiatry or a multidisciplinary clinic. the psychiatrist should make use of that. And same way, I always advise the dermatologists as well. The collaboration of dermatology and psychiatry is very important. Just an example, if you are a dermatologist and you want to send a patient to a psychiatrist, he would definitely say, I'm not crazy, I just came here for this, why are you sending me the psychiatrist? So that is a huge problem and then patient just run away and never come back to you. And he will not get treated as well. If this, the same building, for example, if there's a psychiatrist sitting in the next room and is your kind of joint clinic, you can tell them that, know, hey, why don't you go to this next room to see your psychologist or psychiatrist? It is a kind of combined clinic.

And your condition also needs some kind of psychological evaluation as well. So going from one room to other room in the same building is more easier. Rather than going from one building to other building, you know, five miles away, it won't work. So this model is now working in various places in Europe particularly. And here also in the USA, we are working on that. And that collaboration between dermatologists and psychiatrists.

Psychologists should be encouraged. actually there's a good paper I published in JAMA, the holistic model of multidisciplinary clinic. somebody has the time, they can read and it gives a lot of information about this area.

[38:56] Dr. Adrian Preda: Dr. Giaferrani, this has been a truly insightful conversation. Thank you for sharing your expertise with us.

[39:03] Dr. Mohammad Jafferany: That's my deepest pleasure and thanks for having me. And I hope that we had a product to type off this podcast and to help with the psychiatrist in practice.

Dr. Adrian Preda (39:16) This concludes this episode of the Psychiatric News Special Report podcast. If you enjoyed this discussion, please subscribe, rate and review the show. You can also share this episode on social media to spread awareness about the critical intersection of dermatology and psychiatry. You can read Dr. Giaferranis full Psychiatric News Special Report at psychnews.org. We posted a link to the article in the episode description. We'll be back soon with more expert conversations. Until then, stay informed, stay compassionate, and take care.