P Malewski

Hannover Medical School, Hanover, Lower Saxony, Germany

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Publications (10)12.89 Total impact

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    ABSTRACT: This study examines the extent of stigmatization experienced by vitiligo patients considering the visibility of the lesions. 363 vitiligo patients were assessed using the Experience with Skin Complaints (QES), Adjustment to Chronic Skin Disorders (ASC), and Sense of Coherence (SOC) questionnaires. Out of the total patients group two representative samples with 52 patients each were identified comparable for age, gender, and the duration of the skin disease, the first with visible and the second with invisible lesions. Data indicate a significant negative correlation between the QES dimensions, except for 'Composure', and between coping scales with sense of coherence withstanding. The 'visible lesions' group scored higher compared to the 'invisible lesions' group on the two QES scales 'Self-Esteem' and 'Refusal', i.e., patients with visible lesions experienced a higher level of stigmatization. This study provides new information which supports the notion that the stigmatization experience of vitiligo patients is psychologically relevant.
    Journal of the European Academy of Dermatology and Venereology 05/2007; 21(4):456-61. · 2.69 Impact Factor
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    ABSTRACT: Keloid and hypertrophic scarring represent chronic disfiguring dermatoses with a high resistance to therapy. The aim of our study was to assess for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life impairment as much as patients with other chronic skin diseases. An item-pool was created modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was distributed to 100 outpatients with keloids and hypertrophic scars. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical impairment) of the questionnaire with nine and five items, respectively, were established. Test-retest reliability of the questionnaire was excellent (corr > 0.9). Good validity was suggested by the correlation of physical impairment with pain (P < or = 0.001), pruritus (P < 0.001), and the amount of restriction of mobility (P < 0.001). The psychological scale was associated with pain and restriction of mobility, although the correlations were lower. This study demonstrates for the first time an impairment of quality of life in a large group of patients with keloid and hypertrophic scarring.
    Archives for Dermatological Research 05/2006; 297(10):433-8. · 2.71 Impact Factor
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    ABSTRACT: The aim of this study was to determine the psychosocial consequences of psoriasis in a large sample in Germany. A questionnaire including the Psoriasis Disability Index (PDI) circulated by the German Psoriasis Alliance was answered by 3753 members representing a return rate of 42.3%. Psoriasis was graded-at the time of the examination-with less than 3% of the body surface affected as "mild", between 3 and 10% as "moderate," and more than 10% as "severe." The general impact of the illness on everyday life was "mild" in about 27%, "problematic" in about 45%, and "severe" in about 25% of the respondents. About 50% of the participants in the study had, concerning the skin, "mild" (PDI=9), about 35% "moderate" (PDI=14), and about 15% "severe" psoriasis (PDI=19). The differences of the PDI values are significant (ANOVA: p<0.001). This investigation confirms the enormous burden caused by the skin disease in the form of impairment and stigmatization, depending on the somatic severity, even when the current affection is rather mild. In connection with psychosocial consequences, future study should also focus on the disease burden of psoriasis.
    Der Hautarzt 06/2005; 56(5):466-72. · 0.50 Impact Factor
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    ABSTRACT: Hintergrund und FragestellungDie psychosozialen Konsequenzen der Psoriasis in Deutschland sollten anhand einer groen Stichprobe bestimmt werden.Patienten und MethodikAuf eine Befragung des Deutschen Psoriasis Bundes e.V., die unter anderem den Psoriasis Disability Index (PDI) enthielt, antworteten 3753 Mitglieder bei einer Rcklaufquote von etwa 42,3%. Die Psoriasis wurde bei einer Erkrankung von—zum Zeitpunkt der Untersuchung—weniger als 3% der Krperoberflche als leicht, zwischen 3 und 10% als mittelschwer und bei mehr als 10% als schwer eingeschtzt.ErgebnisseDie generelle Belastung im Alltag durch die Erkrankung war bei etwa 27% der Befragten geringgradig , bei etwa 45% problematisch und bei etwa 25% stark. Bei etwa 50% der Teilnehmer der Studie lag eine in Bezug auf den Hautbefall leichte (PDI=9), bei etwa 35% eine mittelschwere (PDI=14) und bei etwa 15% eine schwere Psoriasis (PDI=19) vor. Die PDI-Unterschiede sind signifikant (ANOVA: pSchlussfolgerungenDie vorliegende Untersuchung besttigt die erhebliche Belastung durch die Hauterkrankung in Form einer Behinderung bzw. psychosozialen Stigmatisierung in Abhngigkeit vom Schweregrad, aber auch bei einer eher geringen aktuellen Ausprgung. In Zukunft sollte im Zusammenhang mit den psychosozialen Konsequenzen der Psoriasis auch die Krankheitslast thematisiert werden.Background and objectiveThe aim of this study was to determine the psychosocial consequences of psoriasis in a large sample in Germany.Patients and methodsA questionnaire including the Psoriasis Disability Index (PDI) circulated by the German Psoriasis Alliance was answered by 3753 members representing a return rate of 42.3%. Psoriasis was graded—at the time of the examination—with less than 3% of the body surface affected as mild, between 3 and 10% as moderate, and more than 10% as severe.ResultsThe general impact of the illness on everyday life was mild in about 27%, problematic in about 45%, and severe in about 25% of the respondents. About 50% of the participants in the study had, concerning the skin, mild (PDI=9), about 35% moderate (PDI=14), and about 15% severe psoriasis (PDI=19). The differences of the PDI values are significant (ANOVA: pConclusionsThis investigation confirms the enormous burden caused by the skin disease in the form of impairment and stigmatization, depending on the somatic severity, even when the current affection is rather mild. In connection with psychosocial consequences, future study should also focus on the disease burden of psoriasis.
    Der Hautarzt 04/2005; 56(5):466-472. · 0.50 Impact Factor
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    ABSTRACT: Feelings of stigmatization are an important somatopsychic consequence of psoriasis, affecting the quality of life. It is thus relevant to supplement reliable statements about the detailed changes of stigmatization experience and psoriasis over time. In this study we compared the Psoriasis Area and Severity Index (PASI), the 'self-administered PASI' (SPASI) and the 'Questionnaire on Experience with Skin Complaints' of 166 psoriasis patients (64 women, 102 men) in a 1-year follow-up to assess the relation between these factors over time. The results suggest a more pronounced feeling of discrimination in women with no significant somatic differences between gender at the first measurement. In a prospective evaluation we found a clear proportion of 'discordant' courses of these parameters, mainly in women, indicating a contradictory relation of somatic improvement or deterioration vs subjective experience with skin complaints. All in all, these results show a moderate but significant relevance of skin state for feeling of stigmatization over time only in men, thus suggesting a considerable influence of other psychic variables, probably coping skills, especially in women.
    Acta Dermato Venereologica 02/2005; 85(1):27-32. · 3.49 Impact Factor
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    ABSTRACT: How are the effects of a psychodynamic inpatient treatment on personality data of patients with anorexia nervosa and bulimia nervosa? In how many patients can a successful change in the personality area be observed? 732 patients were assessed at the beginning and the end of an inpatient treatment as well as 2 1/2 years after this treatment. Data were collected by means of the personality inventories "Freiburger Persoenlichkeitsinventar (FPI-R)" and "Narzissmusinventar". A definition of success was constructed using the clinical significance concept. It is related to the scales life satisfaction, inhibition (FPI-R), powerless self and negative body self (Narzissmusinventar). The results in both questionnaires show the clinically well known psychopathology characteristics of eating disorder patients. During the inpatient treatment and also afterwards, there are improvements in the personality data, but not to the extent of the values obtained from a healthy control group. In the outcome measure, one third of the patients experienced remarkable improvements. The success in the personality area is positively correlated to the success in the eating disorder symptoms. This success could not be predicted by initial data or by therapy data. There are marked impairments of the patients in the personality data. Changes in this domain take time and are rather small.
    Zeitschrift fur Psychosomatische Medizin und Psychotherapie 02/2001; 47(4):366-79. · 0.98 Impact Factor
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    ABSTRACT: Illness specific stress plays an important part in the daily life of psoriatic patients. Until now for the measurement of relevant aspects of daily stress only the "Psoriasis Life Stress Inventory" (PLSI) of Gupta & Gupta exists; with the "Psoriasis-Alltagsstress-Inventar" (PAI), a German version of the PLSI is presented and its psychometric properties are discussed. 385 in-patients completed the PAI. The internal validity was examined by factor analysis. Moreover, the correlations between the PAI total score and sociodemographic parameters (ANOVA) and extent of skin involvement (multiple regression) were determined. The PLSI score proves to be sufficiently independent of age, sex, age at onset, and general extent of skin involvement. However, affections of the hands, the lower abdomen and the genitals show a strong influence on the total score. We found marked interrelations with the stigmatization feeling ("Questionnaire on Experience with Skin Complaints" QES, Schmid-Ott et al. 1998). The results suggest that the PAI is a useful and psychologically relevant questionnaire for psoriatic patients.
    Der Hautarzt 07/2000; 51(7):496-501. · 0.50 Impact Factor
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    ABSTRACT: Zusammenfassung Hintergrund und Fragestellung. Der krankheitsspezifische Alltagsstress stellt einen wichtigen Ausschnitt im Leben von Psoriasispatientinnen und -patienten dar. Bisher existierte für seine Messung lediglich das “Psoriasis Life Stress Inventory” (PLSI) von Gupta und Gupta; mit dem “Psoriasis-Alltagsstress-Inventar” (PAI) wird eine deutsche Fassung des PLSI vorgestellt, und seine psychometrischen Eigenschaften werden diskutiert. Patienten/Methodik. Insgesamt 385 stationäre Patientinnen und Patienten füllten den PAI aus, dessen interne Validität durch eine Faktorenanalyse überprüft wurde. Außerdem wurden die Zusammenhänge zwischen dem PAI-Gesamtwert und soziodemographischen Variablen (Varianzanalyse) sowie dem Hautbefall (multiple Regression) bestimmt. Ergebnisse. Der Alltagsstress (PAI) zeigt sich relativ unabhängig von Alter, Geschlecht und Zeitpunkt des Beginns der Erkrankung sowie dem generellen Hautbefall, wird jedoch stark von dem Befall der Hände, des Unterleibs und des Genitalbereichs beeinflusst. Ebenso finden sich ausgeprägte Zusammenhänge mit dem Stigmatisierungserleben (“Fragebogen zum Erleben von Hautbeschwerden”, FEH, [13]). Schlussfolgerungen. Bei dem PAI handelt es sich hinsichtlich psychometrischer Qualität und praktischer Einsetzbarkeit um ein praktikables und relevantes psychologisches Untersuchungsinstrument für Psoriasispatientinnen und -patienten.
    Der Hautarzt 01/2000; 51(7):496-501. · 0.50 Impact Factor
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    ABSTRACT: We analyzed how psoriasis patients sought professional help and correlated it to their illness attitudes and feeling of stigmatization. Semi-structured interviews of 400 patients were reanalyzed to identify homogeneous groups concerning initial reactions at first manifestations of the disease. Four groups ("isolated", "stigmatized", "socially supported" and "non-stigmatized" patients) were found and cross-tabulated with five resulting groups of a second cluster-analysis concerning the "style" of the seeking behaviour of professional and paraprofessional help and medical measures against the psoriasis ("multi-users", "arranged mini-users", "waiting-room patients", "optimists" and "self-therapists"). We were able to describe typical courses of illness behaviour depending on the initial reaction. The results are discussed with regard to the desirable identification of problematic patients within professional care units.
    Der Hautarzt 09/1997; 48(8):547-55. · 0.50 Impact Factor
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    ABSTRACT: Ziel der vorliegenden Untersuchung war die Vorhersage der Inanspruchnahme medizinischer Leistungen im Zusammenhang mit dem Krankheitserleben und der empfundenen Stigmatisierung bei Patienten mit Psoriasis vulgaris. Es wurde eine Reanalyse der Daten eines von einem Marktforschungsinstitut an 400 Psoriasispatienten erhobenen teilstrukturierten Interviews durchgeführt. Untersucht wurde die Bedeutung des Krankheitserlebens bei Diagnosestellung für das Inanspruchnahmeverhalten von und die Einstellung gegenüber der medizinischen Versorgung. Eine Clusteranalyse zum Krankheitserleben bei Diagnosestellung ergab 4 homogene Gruppen typischer initialer Erlebnisweisen (die „Isolierten”, die „Stigmatisierten”, die „Unterstützten” und die „Nicht-Stigmatisierten”). Eine zweite Clusteranalyse zum späteren Therapieinanspruchnahmeverhalten ergab 5 homogene Gruppen (die „Multi-User”, die „Arrangierten Mini-User”, die „Wartezimmerpatienten”, die „Hoffnungsvollen” sowie die Gruppe der „Eigentherapeuten”). Um mögliche Verlaufstypen zu identifizieren, wurden in dem folgenden Analyseschritt diese beiden Taxonomien zueinander in Beziehung gesetzt (Chi2-Analyse). Die Ergebnisse werden vor dem Hintergrund der wünschenswerten frühzeitigen Identifikation von „Problempatienten” diskutiert. We analyzed how psoriasis patients sought professional help and correlated it to their illness attitudes and feelings of stigmatization. Semi-structured interviews of 400 patients were reanalyzed to identify homogeneous groups concerning initial reactions at first manifestations of the disease. Four groups (”isolated”, ”stigmatized”, ”socially supported” and ”non-stigmatized” patients) were found and cross-tabulated with five resulting groups of a second cluster-analysis concerning the ”style” of the seeking behaviour of professional and paraprofessional help and medical measures against the psoriasis (”multi-users”, ”arranged mini-users”, ”waiting-room patients”, ”optimists” and ”self- therapists”). We were able to describe typical courses of illness behaviour depending on the initial reaction. The results are discussed with regard to the desirable identification of problematic patients within professional care units.
    Der Hautarzt 07/1997; 48(8):547-555. · 0.50 Impact Factor