A cognitive‐behavioural symptom management programme as an adjunct in psoriasis therapy
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.
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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.
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ABSTRACT: Background and Aim: Psoriasis is a chronic disease that causes deformity and disability in patients. There is little information about the impact of psychological interventions upon this disease. The purpose of this study was to evaluate the impact of group cognitive behavioral therapy upon physical factors such as severity and level of disease and extent of itching, and mental health of psoriasis patients. Methods: This research was conducted as a semi-experimental study using pre-test and post-test with a control group and the follow-up period. Twenty Psoriasis patients were allocated into experimental and control groups. The group cognitive behavioral therapy was administered to 10 psoriasis patients allocated into the experimental group for 12 sessions. The members of both groups filled in the Psoriasis Area Severity Index (PASI) for the assessment of severity of psoriasis, general health questionnaire (GHQ), and the Quality of life in patients with pruritus (ItchyQoL) questionnaires. Results: The results indicated that the group cognitivebehavioral therapy did not have any impact upon the improvement of physical symptoms (severity and level of disease and extent of itching), but it was effective on improving the patients' psychological status. Cognitive behavioral therapy has improved the patients' general health. There is a significant difference between the two groups in terms of multiple covariance analysis for different aspects of general health, including anxiety and insomnia (effect size 0.45 and P=0.004), depression (effect size: 0.25 and P=0.044), physical symptoms (effect size 0.28 and P=0.033), and social functioning (effect size 0.41 and P=0.003). Conclusion: Although, based on the results, the group cognitive behavioral therapy does not directly affect reduction of physical symptoms of psoriasis; the effectiveness of this method on patients' psychological symptoms is considerable as a mediator in the onset, exacerbation, and relapse of the disease.
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ABSTRACT: The aim of the present study was to review the effectiveness of psychological and/or educational interventions for reducing psoriasis severity and improving psychological and quality of life (QOL) outcomes in psoriasis. Sixteen papers met the inclusion criteria. Overall, the effectiveness of the existing interventions from this narrative synthesis is positive, especially in psychological and QOL outcomes. Of the 16 included studies, only five were randomized controlled trials (RCTs). The strength of the evidence to support the effectiveness of the existing interventions was limited due to methodological weakness in the included studies. The review concludes that further research is needed to examine the effectiveness of psychological and/or educational interventions for individuals with psoriasis, including a greater number of RCTs in order to increase the methodological validity of intervention studies. Also, future research needs to be conducted to establish which interventions are most effective for specific sub-populations who may best profit from psycho-educational interventions.The Journal of Dermatology 08/2014; 41(9). DOI:10.1111/1346-8138.12583 · 2.35 Impact Factor