Skin Psychosomatics: First Steps — Where to Begin

When the skin reacts to inner tension, it is tempting to look straight for a "pill." But in psychosomatics the key is not to rush into medication. First you need to understand what actually lies behind the symptoms and follow a sensible sequence of steps. Dr. Saulitis stresses: in psychosomatics the first step is not treatment, but proper examination and separating one thing from another.

Don't start with medication

The first principle is not to grab for drugs straight away. Often you can "set the brain and rhythm working" without hasty pharmacological intervention. Medication is not a starting point but a possible outcome of an inquiry that begins with understanding the cause.

"In psychosomatics, the main thing is — you must not start with medication straight away; perhaps you can set the brain and rhythm working."

The confusion around the word "depression"

Here lies an important trap. The word "depression" means different things in everyday speech and to a psychiatrist. For an ordinary person, depression is fatigue, low mood, a feeling of being down — a symptom, a "basket" into which people toss various bad states. For a psychiatrist, depression is already a psychiatric disorder of a specific register, endogenous, genetically determined, treated in a completely different way. This breeds confusion: people pour their experiences into the word, but clinically it is something else.

"Depression is like a basket into which people toss their various bad states."

First step: rule out the psychiatric register

In psychosomatics, we first separate whether a psychiatric disorder actually lies behind the picture — depression, the schizophrenic spectrum and similar registers. If so, the approach is entirely different: psychotic states are not treated by talking. So the first step is to set this possibility aside deliberately, understanding that it requires different treatment.

Second step: rule out bodily pathology

Second, rule out the somatic side. Many bodily disorders on their own can secondarily produce the experiences. The doctor names the thyroid, the liver, the pancreas — various pathologies that affect the state independently. So you need to be examined: blood test, urine test, biochemistry — especially liver panels (ALT, AST and other enzymes). This helps clarify whether other disorders are influencing the psychosomatics.

On brain investigation

The doctor advises doing an electroencephalogram. If you want to study the brain more deeply, it only makes sense to do an MRI on a 3-tesla machine. In his words, CT scans and the rest carry no informative basis here.

Why this sequence

Once the basic results are in hand, it makes sense to go to a specialist — the conversation will be substantive. Without this, the doctor says, you can "throw away money and time" on endless visits to no effect. Facts first — interpretation later.

Practice: a first-steps checklist

1. Don't rush to pills — first understand the cause, try to set the rhythm working.
2. Separate the psychiatric register — honestly assess whether a depressive or other psychiatric disorder lies behind the picture (it is treated differently).
3. Rule out bodily pathology — get blood, urine and biochemistry tests, especially liver panels; remember the thyroid, liver, pancreas.
4. Do an EEG; if deeper brain investigation is needed — a 3-tesla MRI.
5. Come to the specialist with results in hand — then the consultation will be meaningful, not a waste of time.