A cognitive behavioral symptom management program as an adjunct in psoriasis therapy

Centre for Dermatology, The University of Manchester, Manchester, England, United Kingdom
British Journal of Dermatology (Impact Factor: 4.28). 02/2002; 146(3):458 - 465. DOI: 10.1046/j.1365-2133.2002.04622.x

ABSTRACT Background Patients with psoriasis may experience significant psychological and social disabilities. Stress or distress are proposed aggravators of the disease process in psoriasis. Preliminary studies to date have suggested that adjunctive psychological therapies may be effective in the clinical management of psoriasis.Objectives To examine whether a 6-week multidisciplinary management approach, the Psoriasis Symptom Management Programme (PSMP) for patients with psoriasis improves clinical severity of psoriasis and its associated psychological distress and disability.Methods In a case–control study, patients with psoriasis attending an out-patient psoriasis speciality clinic chose to receive standard psoriasis treatment alone (n = 53) or to enter the PSMP as an adjunct to standard therapy (n = 40). They were assessed at baseline, at the end of the 6-week PSMP and after 6 months follow-up.Results As compared with standard treatment alone, analysis of covariance indicated that participation in the PSMP resulted in a greater reduction in clinical severity of psoriasis (P = 0·001), anxiety (P = 0·001), depression (P = 0·001), psoriasis-related stress (P = 0·001) and disability (P = 0·04) at 6 weeks and 6 months follow-up.Conclusions The management of the physical aspects of psoriasis and its psychological effects are significantly improved for patients who opt for a 6-week integrated multidisciplinary approach. Furthermore, the techniques learnt by participation in the PSMP facilitate continued control of psoriasis for at least 6 months.

29 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Trotz der gro ßen Bedeutung, die im Allgemeinen psychischen Faktoren bei Hautkrankheiten eingeräumt wird, gibt es bisher nur wenige systematische und methodisch zufrieden stellende Studien, die genauere Anhaltspunkte liefern. Eine Schwierigkeit in Forschung und Praxis stellt die Abgrenzung von auslösenden psychologischen Faktoren und Problemen in der emotionalen Bewältigung der Krankheitsfolgen dar. Fortschritte sind jedoch in der Entwicklung von verhaltenstherapeutischen Behandlungsmethoden zu verzeichnen. Diese betreffen vor allem die Behandlung von Neurodermitis, aber auch anderer chronischer dermatologischer Krankheiten wie Psoriasis, Herpes genitalis und Malignem Melanom. Besonders effektiv sind Entspannungsverfahren sowie kombinierte Gruppenprogramme, die Entspannung, Stressbewältigung, Information und andere spezifische Komponenten mit sozialer Unterstützung, darzustellen. Angesichts der komplexen Zusammenhänge zwischen psychologischen und körperlichen Faktoren ist die Zusammenarbeit von Dermatologen und klinischen Psychologen eine wichtige Voraussetzung für eine Umsetzung der Behandlungsansätze in die Praxis.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinical audit has gained popularity nowadays. By generating criteria based on data drawn from properly done clinical trial, clinical audit acts as a balance to weigh our performance in healthcare delivery against evidence-based guideline. The basic steps in clinical audit involves choosing a topic, setting up criteria and standards, measurement of performance, implementing changes and second performance measurement after changes implemented. The basic principles in all these steps are discussed in this article and psoriasis patient care will be used to illustrate the principles in setting criteria and standards. The ultimate aim of clinical audit is improvement in quality of healthcare. It is hoped that readers can have a basic grasp of clinical audit and are stimulated to have in-depth study and subsequently carry out one in their own practice.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A link between the mind and the skin has long been hypothesized. Indeed, some studies suggested that psychosocial factors may play a role in the pathogenesis and course of several skin diseases. Conversely, other studies suggested that psychiatric disorders and psychosocial difficulties may result as a complication of a primary skin disease. Epidemiological studies indeed found a high prevalence of psychiatric disorders among dermatological patients. This is a source of concern, because psychiatric morbidity is associated with emotional suffering, disability, lower quality of life, poorer adherence to dermatological treatment, and increased risk of self-harm. Conditions such as demoralization, health anxiety, irritable mood, type A behavior, and alexithymia were also found to be frequent in dermatological patients, and to be independently associated with greater psychological distress, lower quality of life, and poorer psychosocial functioning. Several studies also raised concerns about underrecognition and undertreatment of psychiatric disorders. This large body of findings suggests that psychosocial issues deserve more attention in everyday dermatological practice, and highlights the need for a biopsychosocial approach to the management of patients with skin disease. To this purpose, the development of efficient consultation-liaison services enabling an effective collaboration between dermatologists and mental health professionals is mandatory.
    Advances in psychosomatic medicine 01/2007; 28:109-126. DOI:10.1159/000106800
Show more