Only limited support for a role of psychosomatic factors in psoriasis. Results from a case-control study.
ABSTRACT To investigate the role of stressful events, social support, attachment security and alexithymia in triggering or exacerbating psoriasis.
Outpatients experiencing a recent onset or exacerbation of psoriasis (n=40) were compared with outpatients with skin conditions in which psychosomatic factors are regarded as negligible (n=116). Stressful events during the last year were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and perceived social support were assessed with the ECR questionnaire, the TAS-20 and the MSPSS, respectively.
The mean number of recently experienced life events, or of undesirable, uncontrollable or major events was not different between psoriatic patients and controls. The only stress measure that showed a slight trend towards an association with psoriasis was having experienced four or more stressful events in the preceding year. There was a statistical trend towards an association between alexithymia and psoriasis, whereas there were no significant differences between patients with psoriasis and controls with respect to perceived social support and attachment security. Subgroup analysis suggested that the role of all psychosomatic factors studied might be more important in certain clinical types, such as guttate and diffuse plaque psoriasis.
Our findings provide only limited support for a role of psychosomatic factors in psoriasis. Future studies should investigate chronic and daily stressors in addition to major life events, include measures of stress appraisal and include specifically patients with a recent onset of disease.
Article: Psychosomatic factors in pruritus.[Show abstract] [Hide abstract]
ABSTRACT: Pruritus and psyche are intricately and reciprocally related, with psychophysiological evidence and psychopathological explanations helping us to understand their complex association. Their interaction may be conceptualized and classified into 3 groups: pruritic diseases with psychiatric sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Management of chronic pruritus is directed at treating the underlying causes and adopting a multidisciplinary approach to address the dermatologic, somatosensory, cognitive, and emotional aspects. Pharmcotherapeutic agents that are useful for chronic pruritus with comorbid depression and/or anxiety comprise selective serotonin reuptake inhibitors, mirtazapine, tricyclic antidepressants (amitriptyline and doxepin), and anticonvulsants (gabapentin, pregabalin); the role of neurokinin receptor-1 antagonists awaits verification. Antipsychotics are required for treating itch and formication associated with schizophrenia and delusion of parasitosis (including Morgellons disease).Clinics in dermatology 01/2013; 31(1):31-40. · 3.11 Impact Factor
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ABSTRACT: Alexithymia, the difficulty in describing or recognizing emotions, has been associated with various psychosomatic pathologies including psoriasis. The aim of this study was to examine the prevalence of alexithymia and its association with anxiety and depression in patients with psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables. One hundred and eight psoriatic patients and 100 healthy participants from the general population completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). The severity of patients' psoriasis was clinically assessed using the Psoriasis Area and Severity Index (PASI). Psoriatic patients had higher levels of alexithymia compared with healthy participants. While a rather high rate of psoriatic patients presented anxiety and depression as defined by the HADS, the differences that were found in comparison with the control group were not significant. Neither alexithymia nor its dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally oriented thinking (EOT), were associated with gender or psoriasis severity. Age was associated only with EOT, which was independent of depression and anxiety. Higher anxiety and depression were connected with higher alexithymia and DIF, while higher anxiety with higher DDF as well. The alexithymia prevalence was higher in psoriatic patients than that in healthy participants, while it was positively correlated with anxiety and depression. Difficulty in identifying feelings was connected with both anxiety and depression, whereas difficulty in describing them was only with anxiety. Finally, externally oriented thinking was predicted only from age.Annals of General Psychiatry 12/2014; 13(1):38. · 1.53 Impact Factor
Article: The epidemiology of psoriasis[Show abstract] [Hide abstract]
ABSTRACT: This review will focus on the incidence and prevalence of psoriasis, the risk factors for psoriasis and diseases that may be associated with psoriasis. Psoriasis is a heterogeneous disease and, for the purposes of this review, the focus will be plaque psoriasis. Prevalence studies indicate that psoriasis is a common disease and its frequency varies based on age, ethnicity and geography. Family history is the strongest risk factor for the development of psoriasis. Additionally, emerging evidence suggests that some potentially modifiable exposures such as smoking, alcohol, stress and obesity may increase a patient's risk of developing psoriasis. The evolving literature suggests that psoriasis is associated with multiple other diseases including cancer, cardiovascular, autoimmune and psychiatric disease. Epidemiological studies of psoriasis contribute to measuring the public health burden of this disease and guide the care of patients with psoriasis through a better understanding of its natural history.Expert Review of Dermatology 01/2006; 1(1):63-75.