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Introduction: Dermatitis artefacta (DA) is a condition whereby self-induced skin damage is the means used to satisfy a desire to assume the sick role. Objectives: To describe clinical evaluation, diagnosis, treatment and evolution of an 15 years-old woman with DA. Methods: Retrospective review of clinical records, including dermatology, psychiatry and Pathology. Results: A 15-year-old woman, who come to the Child Psychiatry consultations derived by the Dermatology Service, which is attended by the appearance of multiple bullous lesions throughout the body. Since August, the patient has reported a worsening of her mood, with feelings of loneliness and vital emptiness, with somatic and psychic anxiety referred. In the Dermatology office, she does not recognize self-infliction and the patient is derived to psychiatry consultation and solicited a skin biopsia. In the psychiatric interview, she recognizes that burns occur with a deodorant spray. She admitted doubts about her sexuality for months, claiming to be homosexual for the first time. When she burns, feels pleasure and relief. At the exploration: She wears a gay pride flag bracelet. Expressionless attitude. Cold contact. Approachable. Slightly collaborative. Without major affective disorders. No somatic anxiety, nor psychic. Short speech, impoverished language. Personality traits Cluster B and C. •Salamanca Questionnaire: Dependent personality, and in the background anxiety and histrionic. •Plutchik Impulsivity Scale: 14. •Toronto Alexithymia Scale: 64 Conclusions: The prognosis of the condition is variable, but it has been shown that resolution of the underlying psychosocial stressor leads to improvement. Multinucleated keratinocytes, a pathognomonic lesion of cryodermatitis artefacta, are discovered in the Pathology. [ABSTRACT FROM AUTHOR]

Introduction: At present in the province of Salamanca, there is no outpatient program focused on dual pathology. There is a perceived need of attention to those patients who present a serious mental disorder and a substance use disorder. Objectives: In accordance with the recommendations of the scientific evidence of recent years, we propose the creation of a specific healthcare resource within the framework of the University of Salamanca Health Complex. Methods: The dual pathology outpatient program sits (image 1) on the second level of the assistance system and follows the indications of the IV Mental Health Plan of the Regional Ministry of Health. It is intended to be a bridge between the two usual lines of assistance (image 2): mental health network and drug dependence network. It will offer a multidisciplinary and integrated approach from a biopsychosocial perspective. It will focus on diagnosis, differential diagnosis, psychopharmacological and psychotherapeutic approach, nursing care and psychometry. In addition, the dual pathology outpatient program aims to be a training area for service professionals and the basis for promoting research activity focused on dual pathology. A previous training and coordination program has been carried out with the different resources of both networks. A pilot project is proposed, building a therapeutic team consisting of a psychiatrist, two clinical psychologists, two nurses, a social worker and two social educators. Results: The first clinical results are presented. Conclusions: This new program results from the effort to improve care for patients with dual pathology. More experience in this area is necessary. [ABSTRACT FROM AUTHOR]