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Psoriasis is associated with significant psychosocial morbidity and a decrease in health-related quality of life. It is important to view psoriasis as a serious disease and resist the tendency to underestimate its impact on overall patient well-being. The disability experienced by psoriasis sufferers is comparable to that of patients with other chronic illnesses such as heart disease, diabetes, cancer, and depression. Aggressive intervention is warranted in order to improve patient quality of life and decrease the potential for psychosocial sequelae. Health-related quality of life measures are becoming a necessary adjunct to traditional clinical assessments in the evaluation and treatment of psoriasis patients by the individual clinician. They also provide valuable information to government agencies and third party payers in the determination of resource allocation and reimbursement.
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PMID:Quality of life issues in psoriasis. 1289 27

The need for a global assessment of the health state of patients affected by psoriatic arthritis (APs) which takes into account not only bio-clinical aspects but also other relevant results such as physical, mental and social wealth, was the main reason for the development of an original questionnaire capable of assessing the social and psychological impact of both the affections [psoriasis (Ps) and APs] considered individually and in their summing up of effects. Our study assessed 56 consecutive patients affected by APs under treatment in the Medical and Skin Disease Departments of the "Santa Maria" Perugia University Hospital of Terni, within a time span of 14 months. A questionnaire divided in five parts (a general part and four special parts, assessing, psychological, social, rheumatological and social, economic and therapeutic issues) was proposed to each patient under observation. The questionnaire can be self-filled in by the patient more than once and has been statistically validated for internal consistency, reproduciability and comparability with control groups. The patients with APs consider "bad" their diseases (50%) and develop depression (50%); the social life are troubled by Ps (49%) alone, in comparison with APs (22%); 70% of patients agrees with therapy and is willing to sustain an extra-expense of 500 euro per year.
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PMID:[A proposal of questionnaire for evaluation of the quality of life in patients with psoriatic arthritis]. 1294 99

Individuals with moderate-to-severe psoriasis perceive that the disease exerts profound emotional, social and physical effects on their lives, and a significant percentage report that they do not consider their treatment sufficiently aggressive. A survey of individuals with a variety of chronic diseases reveals that those with psoriasis have the lowest estimation of their health-related quality of life, lower than that of patients with arthritis, congestive heart failure, chronic lung disease or depression. Although psoriasis can be treated effectively, many treatments are associated with long-term risks. Toxicity-sparing treatment strategies that include combination, rotational and sequential regimens can help to control moderate-to-severe psoriasis while reducing risk. Algorithms for the treatment of moderate-to-severe psoriasis detail possible options for specific types of psoriasis and for patients with specific needs. The purpose of the algorithms is to make optimum use of phototherapy, traditional cytotoxic and immunosuppressive agents, retinoids, and newer biologic agents.
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PMID:Case studies in severe psoriasis: A clinical strategy. 1457 96

Psychiatric and psychological factors play an important role in at least 30% of dermatologic disorders. In many cases the impact of the skin disorder upon the quality of life is a stronger predictor of psychiatric morbidity than the clinical severity of the disorder as per physician ratings. Furthermore, in certain disorders such as acne and psoriasis, the psychiatric co-morbidity, which can be associated with psychiatric emergencies such as suicide, is an important measure of the overall disability experienced by the patient. The severity of depression and increased suicide risk are not always directly correlated with the clinical severity of the dermatologic disorder. Consideration of psychiatric and psychosocial factors is important both for the management, and for some aspects of secondary and tertiary prevention of a wide range of dermatologic disorders. It is useful to use a biopsychosocial model which takes into account the psychological (e.g. psychiatric comorbidity such as major depression and the impact of the skin disorder on the psychological aspects of quality of life) and social (e.g. impact upon social and occupational functioning) factors, in addition to the primary dermatologic factors, in the management of the patient. Some dermatology patients are likely to benefit from psychotherapeutic interventions and psychotropic agents for the management of the psychosocial comorbidity, in addition to the standard dermatologic therapies for their skin disorder.
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PMID:Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. 1464 Jul 76

Meditation is becoming widely popular as an adjunct to conventional medical therapies. This article reviews the literature regarding the experience of chronic illness, theories about meditation, and clinical effects of this self-care practice. Eastern theories of meditation include Buddhist psychology. The word Buddha means the awakened one, and Buddhist meditators have been called the first scientists, alluding to more than 2500 years of precise, detailed observation of inner experience. The knowledge that comprises Buddhist psychology was derived inductively from the historical figure's (Prince Siddhartha Gautama) diligent self-inquiry. Western theories of meditation include Jungian, Benson's relaxation response, and transpersonal psychology. Clinical effects of meditation impact a broad spectrum of physical and psychological symptoms and syndromes, including reduced anxiety, pain, and depression, enhanced mood and self-esteem, and decreased stress. Meditation has been studied in populations with fibromyalgia, cancer, hypertension, and psoriasis. While earlier studies were small and lacked experimental controls, the quality and quantity of valid research is growing. Meditation practice can positively influence the experience of chronic illness and can serve as a primary, secondary, and/or tertiary prevention strategy. Health professionals demonstrate commitment to holistic practice by asking patients about use of meditation, and can encourage this self-care activity. Simple techniques for mindfulness can be taught in the clinical setting. Living mindfully with chronic illness is a fruitful area for research, and it can be predicted that evidence will grow to support the role of consciousness in the human experience of disease.
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PMID:Meditation's impact on chronic illness. 1465 May 73

This article describes the development of a questionnaire that assesses problems in adapting to chronic skin disorders, the Adjustment to Chronic Skin Diseases Questionnaire. Patients (N = 442) with different skin disorders completed the original item pool. Principal-components analysis suggested a 6-factor solution that was largely replicated with 2 additional samples of 192 patients with psoriasis or atopic dermatitis and 165 patients with atopic dermatitis. Four of the subscales showed very good internal consistencies, retest reliabilities, and sufficient correlations with expert ratings: Social Anxiety/Avoidance, Itch-Scratch Cycle, Helplessness, and Anxious-Depressive Mood. Two short additional subscales, Impact on Quality of Life and Deficit in Active Coping, showed moderate internal consistencies, but good retest reliabilities. Correlations of the subscales with measures of depression, anxiety, and coping, and meaningful differences between dermatological subgroups support their construct validity. A treatment study showed that changes in some of the subscales correlated with changes in the severity of the skin condition.
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PMID:Measuring adjustment to chronic skin disorders: validation of a self-report measure. 1469 48

The psychological adjustment of patients with psoriasis has been studied extensively. By comparison, no research has focused on their partners. We examined illness representations of psoriasis held by patients and their partners, and investigated whether divergent beliefs were associated with psychological distress. Fifty-eight patients with chronic plaque psoriasis and their partners completed a range of psychological assessments including beliefs about the condition, anxiety, depression, and worry. Patients also completed a self-assessment of psoriasis severity. Patients with psoriasis had significantly higher levels of anxiety, depression, and worry than their partners (t's > 2.53, p's < .05). Multiple regression analysis indicated that divergence in patients' and partners' beliefs about emotional impact of psoriasis and chronicity of timeline accounted for a statistically significant (21.3%) proportion of the variance in depression for partners. Differences in views on the consequences of having psoriasis and the cyclical nature of the condition were also significantly associated with increased levels of worry in partners. Dissimilarity in particular aspects of illness representations are associated with increased psychological distress in particular for the partners of patients with psoriasis. The results illustrate the importance of concordance between patients' and partners' models of illness in relation to adjustment, and highlight the need to consider and collaborate with both patients and their partners in managing this challenging condition.
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PMID:Divergent beliefs about psoriasis are associated with increased psychological distress. 1519 41

The aim of the investigation was to compare psychological symptoms and health-related quality of life of dermatology patients and healthy controls. The sample consisted of 333 consecutively recruited patients from four dermatology outpatient clinics, 172 hospitalized dermatological patients from two university hospitals and 293 matched healthy controls. All patients and controls completed Beck's Depression Inventory, the Brief Symptom Inventory and the Dermatology Life Quality Index. Hospitalized patients were more distressed than outpatients and healthy controls and reported greater impairment of disease-related quality of life than outpatients. More hospitalized patients had suicidal thoughts and were characterized as having severe to moderate depression compared with outpatients and controls. Female patients and younger patients were generally more distressed than male patients and older patients, and patients with atopic dermatitis and psoriasis were more distressed than patients with urticaria and eczemas. Disease-related impairment of quality of life was the main predictor of psychological symptoms, when controlling for diagnosis, age, gender, disease duration and disease severity. Although older age was associated with fewer psychological symptoms, our data suggest that skin disease affects quality of life equally in young and older patients. The findings highlight the importance of recognizing disease-related psychological problems and possible psychiatric comorbidity of dermatology patients, especially among patients with atopic dermatitis and psoriasis.
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PMID:Psychological symptoms and quality of life of dermatology outpatients and hospitalized dermatology patients. 1520 37

Psoriasis is a common condition, affecting 1.5-2% of the population of industrialized countries. It is important for clinicians to be aware that psoriasis can have a substantial emotional impact on an individual, which is not necessarily related to the extent of skin disease. This review examines current literature addressing the psychological and emotional aspects of psoriasis. A literature search of the MEDLINE (1966-2002) and PsycINFO (1984-2002) computer databases and bibliographies was carried out. Papers selected for the review included English language reviews and all original research relevant to the topic, in the form of randomized controlled trials, cohort studies, case-control studies, cross-over and uncontrolled clinical trials, patient surveys, quality-of-life studies, case series and case reports. Despite significant shortcomings, the available prevalence studies showed uniformly high rates of psychopathology among psoriasis sufferers. The few intervention studies available are summarized and critically discussed. Psoriasis is associated with a variety of psychological problems, including poor self esteem, sexual dysfunction, anxiety, depression and suicidal ideation. The clinical severity of the psoriasis may not reflect the degree of emotional impact of the disease. A number of psychological interventions have shown promise in recent trials. It is important that clinicians consider the psychosocial aspects of this illness.
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PMID:Psychiatric morbidity in psoriasis: a review. 1525 Aug 91

The author is looking to the psychological consequences of chronic hair diseases through a review of the recent literature. In general those consequences are depending on the coping skills and on the personality traits. The effect of hair loss on the quality of life is similar to that of a severe psoriasis. The most important effect is a loss of self-confidence. This is enhanced by an insecure or ambivalent attachment pattern. The coping skills will therefore be different and less flexibles. Two psychiatric syndromes are first mentioned: the body dysmorphic syndrome (very slight or imaginary defect in appearance) and trichotillomania. Androgenetic alopecia leads to an important suffering in women mostly. Alopecia induced by cancer chemotherapy has been reported to cause changes in self-concept and body image. This does not return to the previous state after regrowth of hair for a majority of patients. A cosmeto-oncologic care strategy is developed in our department to improve the quality of life of the patients during this difficult coping period. Alopecia areata has an important psychiatric comorbidity: mostly anxiety and depression. Old stressful life events are frequently reported at the onset of the disease revealing a chronic stress. Those patients have difficulties to express their feelings (what is called alexithymia). With a systemic vision this is interpreted as an unconscious task of avoiding family conflicts. This conflicts are raising the anxiety of family splitting coming from early loss or death in the previous generations. A cautious family therapy helps to change those unconscious myths.
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PMID:[Psychological consequences of chronic hair diseases]. 1551 58


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