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ABSTRACT: OBJECTIVES: To determine the extent of body image dissatisfaction (BID) in patients with self-reported systemic sclerosis (SSc)-related telangiectases and to identify the demographic, psychological and disease-related correlates of BID within a cross-sectional study. METHODS: Patients with SSc were invited to participate in a questionnaire survey. Each completed the Adjusted Satisfaction with Appearance Scale (ASWAP), the Hospital Anxiety and Depression Scale (HADS) and an open-ended telangiectases questionnaire. Thematic analysis was utilised to describe the qualitative data. RESULTS: 141 patients with SSc participated (83% female, 70% limited cutaneous SSc, median age 62 years). Telangiectases were reported by 113 (80%). ASWAP 'dissatisfaction with appearance' scores were significantly higher in those reporting telangiectases (p=0.02). Anxiety and depression scores were similar in those with and without telangiectases. Those reporting telangiectases were more likely to be anticentromere positive (40% vs. 18%, p=0.02) and to have a history of severe digital ischaemia (38% vs. 18%, p=0.04) than those not. Qualitative analysis revealed four themes: changes in behaviour as a result of telangiectases, public and private self-image, negative emotional impact of telangiectases and appreciation of life. CONCLUSIONS: BID, as measured by the ASWAP 'dissatisfaction with appearance' subscale, was significantly higher in patients with telangiectases. Telangiectases were associated with anticentromere positivity and digital ischaemia, lending further support for telangiectases as a potential marker for vascular involvement. Qualitative analysis provided new insights into the thoughts and feelings of patients with telangiectases. Our findings highlight the impact of telangiectases and the need to address and manage related concerns.
Clinical and experimental rheumatology 01/2013; · 2.15 Impact Factor
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ABSTRACT: Abnormal cutaneous sensitivity to the ultraviolet and/or visible radiation in sunlight characterizes photosensitivity disorders. Little is known regarding their impact in childhood. Our objective was to characterize childhood photosensitivity disorders presenting to a photoinvestigation unit, evaluating their impact on quality of life (QoL).
Photoinvestigation records of children attending from 2000 to 2007 were evaluated for diagnosis, clinical, demographic and phototest parameters. These children were subsequently contacted during summertime to evaluate the impact of photosensitivity on QoL, utilizing the children's dermatology life quality index (CDLQI).
83 children underwent photoinvestigation; 62 (74.7%) were diagnosed photosensitive (mean age 8.6 years, range 2-16; 33 female), with abnormal phototest findings in 35 children. 38/55 questionnaires (69.1%) were returned. Mean (± standard deviation) CDLQI score (all diagnoses) was 10.2 ± 7.3 with very high scores in xeroderma pigmentosum (20.7 ± 5.7; n = 3) and actinic prurigo (18.2 ± 7.1; n = 6) and moderate scores in photoaggravated eczema (7.9 ± 4.2; n = 8) and polymorphic light eruption (6.2 ± 4.4 n = 18). CDLQI correlated with number of months affected per year (r = 0.595, P = 0.001).
Photosensitivity disorders have a substantial impact, ranging from moderate to extremely large, on QoL in childhood, and the psychological consequences should be considered in their management.
Photodermatology Photoimmunology and Photomedicine 12/2012; 28(6):290-2. · 1.30 Impact Factor
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ABSTRACT: As the experience of stigma and its psychological dimensions require careful measurement, the purpose of this study was to
examine the psychometric properties and factor structure of the Feelings of Stigmatization Questionnaire (FSQ). A total of
170 participants with psoriasis and 124 with atopic dermatitis (AD) completed the FSQ. AD participants self-rated AD severity,
while psoriasis severity was determined by a clinician. Confirmatory (CFA) and exploratory factor analytic (EFA) techniques
were used to examine the factor structure of the FSQ. The FSQ total score was not related to age, age at onset, illness duration
or psoriasis severity but it was negatively associated with AD severity (r=−.25, p<.01). The original six-factor structure of the FSQ was not replicated in our sample. Using EFA, a fixed three-factor solution
proved the most stable, with the dimensions of feeling flawed, anticipation of rejection and secrecy, and positive attitudes
towards skin disease being identified.
Journal of Clinical Psychology in Medical Settings 04/2012; 14(3):248-257. · 1.49 Impact Factor
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Rheumatology (Oxford, England) 04/2012; 51(7):1331-3. · 4.24 Impact Factor
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ABSTRACT: This study examined how satisfaction with information about warfarin related to demographic and clinical factors including therapeutic outcome.
This study took place in the Outpatient clinic of the Mercy University Hospital, Cork, Rep. of Ireland.
Patients attending an anticoagulation clinic completed the Satisfaction with Information about Medicines (SIMS) Scale. This was examined in line with clinical and demographic information including: age, gender, diagnosis, number of weeks taking warfarin, and INR control.
The level of satisfaction with information was measured and in addition the association between anticoagulation control and satisfaction level was examined.
One hundred and nineteen patients (61.3% male), participated in the study. The majority of patients were prescribed warfarin for atrial fibrillation (53.8%). Satisfaction with information about warfarin was inversely related to age (ρ = -0.33, P < 0.01). Patient-reported satisfaction with information pertaining to the question "what is your medicine for?" was significantly associated with anticoagulation control (χ(2) = 7.27, P < 0.01).
International journal of clinical pharmacy. 03/2011; 33(3):543-8.
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ABSTRACT: there have been few studies of quality of life in childhood scleroderma and these focused predominantly on self-perception and the influence of skin lesions. Our cross-sectional study aimed to describe the influence of childhood scleroderma on physical function and quality of life in relation to clinical and demographic measures.
children with either localized scleroderma or systemic sclerosis (SSc) attending pediatric rheumatology clinics, together with their parents or guardians, were asked to complete a set of 4 validated measures. Clinical and demographic data were provided by consultant pediatric rheumatologists.
in total, 28 children and their parents/guardians participated in the study (68% female, median age 13 yrs; 86% localized scleroderma, 14% SSc). The median Child Health Assessment Questionnaire (CHAQ) score was 0.1 (range 0-3, 0 indicating no impairment), the median Child Dermatology Life Quality Index (CDLQI) score was 5 (range 0-30, 0 indicating no impairment), and the median Child Quality of Life Questionnaire (CQOL) function score was 26 (range 0-105, 0 indicating no impairment). Family activity, measured by the Child Health Questionnaire (CHQ-PF50), was also moderately impaired by scleroderma, with a median score of 83 (0-100, 100 indicating no impairment).
scleroderma had only a moderate effect on quality of life and physical function as measured by the 4 validated instruments. Although a small number of children reported greater impairment, this is an encouraging finding, given its potential disfiguring and debilitating effects.
The Journal of Rheumatology 11/2010; 38(1):167-73. · 3.69 Impact Factor
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C Elise Kleyn,
Shane McKie,
Andrew R Ross,
Daniela Montaldi,
Lloyd J Gregory,
Rebecca Elliott,
Clare L Isaacs,
Ian M Anderson, Helen L Richards,
J F William Deakin,
Donal G Fortune,
Christopher E M Griffiths
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ABSTRACT: Psoriasis produces significant psychosocial disability; however, little is understood about the neurocognitive mechanisms that mediate the adverse consequences of the social stigma associated with visible skin lesions, such as disgusted facial expressions of others. Both the feeling of disgust and the observation of disgust in others are known to activate the insula cortex. We investigated whether the social impact of psoriasis is associated with altered cognitive processing of disgust using (i) a covert recognition of faces task conducted using functional magnetic resonance imaging (fMRI) and (ii) the facial expression recognition task (FERT), a decision-making task, conducted outside the scanner to assess the ability to recognize overtly different intensities of disgust. Thirteen right-handed male patients with psoriasis and 13 age-matched male controls were included. In the fMRI study, psoriasis patients had significantly (P<0.005) smaller signal responses to disgusted faces in the bilateral insular cortex compared with healthy controls. These data were corroborated by FERT, in that patients were less able than controls to identify all intensities of disgust tested. We hypothesize that patients with psoriasis, in this case male patients, develop a coping mechanism to protect them from stressful emotional responses by blocking the processing of disgusted facial expressions.Abbreviations: BOLD, blood oxygenation level-dependent; 95% CI, 95% confidence interval; FERT, facial expression recognition task; fMRI, functional magnetic resonance imaging; HADS, Hospital Anxiety and Depression Scale; OR, odds ratio; PASI, Psoriasis Area and Severity Index; VAS, visual analog scale
Journal of Investigative Dermatology 08/2009; 129(11):2613-2619. · 6.31 Impact Factor
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ABSTRACT: The objective of this study was to examine the psychometric properties of the revised Illness Perceptions Questionnaire (IPQ-R) in adult participants with atopic dermatitis (AD). Two hundred and eighty-four participants who had a GP or dermatologist confirmed diagnosis of AD completed the IPQ-R. The factor structure of the IPQ-R was examined using confirmatory (CFA) and exploratory factor analysis (EFA). The results of the CFA did not indicate a good comparative fit with the IPQ-R subscales, while the EFA and a fixed six-factor principal components analysis largely replicated the original factor structure of the IPQ-R. The existence of the acute/chronic and cyclical timeline dimensions, and the illness coherence subscale was most strongly supported, while all items of the consequences and emotional representation subscales consistently loaded onto one factor. The EFA for causal attributions did not produce a stable solution. The findings indicate that although the factor structure of the IPQ-R was not confirmed in the sample of patients with AD using CFA, it was partly reproduced using EFA. Overall, the results suggest that in patients with AD the IPQ-R, in particular the consequences and emotional representations subscales, should be employed and interpreted with care.
Psychology Health and Medicine 06/2008; 13(3):346-59. · 1.18 Impact Factor
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C Elise Kleyn,
Laura Schneider,
Rosita Saraceno,
Cristina Mantovani, Helen L Richards,
Donal G Fortune,
Marie Cumberbatch,
Rebecca J Dearman,
Giorgio Terenghi,
Ian Kimber,
Christopher E M Griffiths
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ABSTRACT: Psychological stress is believed to exacerbate inflammatory skin disease but the underlying mechanisms are poorly understood. We investigated the impact of acute social stress--Trier public speaking test--on: epidermal Langerhans' cell (LC) frequency; and cutaneous nerve fiber expression of protein gene product (PGP) 9.5 and calcitonin gene-related peptide (CGRP). Thirty-six healthy volunteers each had a pair of baseline 6 mm biopsies taken from sun-protected buttock skin. A second pair of biopsies was taken from contralateral buttock 4 hours (n=5) or 24 hours (n=15) after the Trier stressor. Controls (n=16) did not perform the Trier and had biopsies 24 hours apart. One of each pair of biopsies (baseline; 4 or 24 hours) was processed for counts of epidermal CD1a(+) LC; the other examined for PGP 9.5 and CGRP expression. We observed a significant (P<0.01) 16.4% reduction in epidermal LC frequency 24 hours post-stressor as compared with baseline; there was no significant change from baseline in non-stressed controls. At 24 hours, PGP 9.5 and CGRP were increased (P=0.025) and reduced (P=0.03), respectively, from baseline in the stressed group compared with controls. These data suggest that acute social stress reduces epidermal LC frequency and modulates cutaneous neuropeptide expression thereby supporting the concept of a "brain-skin" axis.
Journal of Investigative Dermatology 05/2008; 128(5):1273-9. · 6.31 Impact Factor
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ABSTRACT: A single-case design was used to examine the benefits of cognitive behaviour therapy (CBT) in the treatment of two patients with atopic dermatitis (AD). Improvements were indicated for both cases in global outcome measures, with reductions in anxiety, depression and stigmatization beliefs and improvements in quality of life. Self-rated AD severity remained relatively stable across treatment time. For both cases, treatment gains were particularly evident in terms of reducing avoidance behaviours. The findings were discussed in relation to the need for CBT as an adjunct treatment for patients with AD and its potential role in improving psychological functioning.
Psychology Health and Medicine 09/2007; 12(4):445-9. · 1.18 Impact Factor
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ABSTRACT: Accumulating evidence suggests that in order to understand and respond to the difficulties presented by illness, patients construct their own "common sense" cognitive model of illness. This study set out to examine self-help group members, and students' beliefs about their atopic dermatitis (AD) and to investigate their relationship with symptom report and clinical and demographic variables. A total of 284 participants with AD undertook a self-assessment of their disease severity and completed the Revised Illness Perception Questionnaire. The most frequent symptoms associated with AD were itching, sleep difficulties and pain. The most commonly reported triggers of AD were stress, hereditary factors and emotional state. Over 75% of participants believed that their condition would be chronic. Self-help group members reported more significant consequences of the condition, a greater emotional impact, while the student group felt they had more personal control of their AD. Multiple regression analyses indicated that illness beliefs, in particular perceived consequences associated with AD and personal control, accounted for a significant proportion of the variance in emotional response to the condition. This study suggests that participants' beliefs and emotional response are more strongly associated with the meaning they ascribe to their condition rather than its severity.
Psychology Health and Medicine 09/2007; 12(4):433-44. · 1.18 Impact Factor
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ABSTRACT: Skin disease can cause psychologic difficulties, but information is lacking on the emotional impact of the common photosensitivity condition, polymorphous light eruption (PMLE).
We sought to examine the emotional impact of PMLE, and its relationships with patients' beliefs about their PMLE and health-related variables.
Patients with PMLE who had attended a hospital dermatology department were mailed the Illness Perception Questionnaire-Revised during the summers of 2002 to 2004.
Questionnaires were returned by 150 of 302 patients. Emotional distress attributable to PMLE was found in more than 40% of individuals. The emotional impact of PMLE was principally predicted by patients' beliefs about their condition (>50% of the variance), particularly regarding its consequences, whereas health-related variables played a lesser role. Women associated more severe consequences with their PMLE (z = -2.27, P = .02) and were more emotionally distressed (z = -2.17, P = .03) than men.
Hospital-based patients with PMLE may not be representative of the community.
Psychologic factors should receive greater attention in PMLE management.
Journal of the American Academy of Dermatology 03/2007; 56(3):426-31. · 3.99 Impact Factor
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Tsui C Ling, Helen L Richards,
Artiena S Janssens,
Lina Anastassopoulou,
Christina Antoniou,
Francois Aubin,
Thomas L Diepgen,
Rosemary Fazakerley,
Frank R de Gruijl,
Christer T Jansen,
Stan Pavel,
Andrew Smedley,
Alexander J Stratigos,
Ann R Webb,
Neil K Gibbs,
Lesley E Rhodes
Journal of Investigative Dermatology 04/2006; 126(7):1648-1651. · 6.31 Impact Factor
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ABSTRACT: Intestinal failure (IF) is likely to be the source of significant emotional distress for patients; however, little is known about the system of beliefs held by patients on home parenteral nutrition (HPN) that may underpin such distress. The present study aimed to: (1) examine the 'common-sense' representation of IF in patients on HPN; (2) investigate whether there were any differences in such representations with regard to primary diagnosis, clinical history or aspects of treatment; and (3) test the relative importance of psychological, disease and treatment factors in accounting for IF-specific emotional outcome (feelings of anger, upset, anxiety, low mood, and fear).
Sixty-one patients with IF on HPN completed an assessment of their beliefs about causes of their condition, consequences, symptoms experienced, personal and treatment control, chronicity and recurrence, and emotional representations (feelings of anger, upset, anxiety, low mood, and fear). Standard clinical information was also gathered from patients.
Neither primary diagnosis, age, duration since start of HPN, number of nights on HPN, gender, presence of a stoma, or age at onset of HPN showed any significant differential effect on emotional representations. The principal predictors of emotional representations were: (1) poorer appraisals of patients' ability to exert personal control over aspects of their condition and treatment; and (2) the perception that the condition and treatment makes little sense to the patient (illness coherence).
The current study demonstrates that the illness and their treatments per se are insufficient to account for patients' emotional distress. Rather, cognitive variables, chiefly beliefs about personal control and illness coherence account for more of the variance in emotional outcome than any other clinical or health-related variable assessed in the current study.
Clinical Nutrition 01/2006; 24(6):896-903. · 3.73 Impact Factor
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ABSTRACT: The article examines the English-language research literature concerning psychologic aspects of psoriasis published since 1995. The literature is concerned with (1) the consequences of psoriasis in terms of quality of life, disability, depression, anxiety, and stigmatization and factors that may predict such outcomes; (2) potential mechanisms of the interaction between psychologic factors, stress, and the pathophysiology of psoriasis; and (3) examination of the clinical utility of psychologic interventions on extent of psoriasis and psychologic distress. The implications of the findings are discussed with reference to future directions for research and practice.
Dermatologic Clinics 11/2005; 23(4):681-94. · 2.16 Impact Factor
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ABSTRACT: The objective of this study was to examine the psychometric properties and clinical correlates of the 20-item Toronto Alexithymia Scale (TAS-20) in patients with psoriasis.
Three hundred patients with psoriasis completed the TAS-20 and had the severity of their psoriasis clinically assessed. Test-retest reliability was assessed over 10 weeks in a subset of 71 patients receiving standard medical treatment for their psoriasis. Examination of the factor structure employed both exploratory (EFA) and confirmatory (CFA) factor analysis techniques.
The overall prevalence of alexithymia in this population of psoriasis patients, as indicated by the TAS-20, was 33%. The TAS-20 total score was not related to clinical severity, age, age at onset or duration of psoriasis. The 10-week test-retest reliability on a sample of 71 psoriasis patients, pre- and posttreatment with photochemotherapy, was found to be acceptable (r=.69; P<.001). EFA produced no stable solutions. The three-factor structure of the TAS-20 using CFA was also not replicable in this sample.
The findings of this study support the contention that alexithymia is not significantly influenced by either disease severity or chronicity in patients with psoriasis. It is recommended that when employing the TAS-20 in patients with psoriasis, caution is exercised in the interpretation of the scale scores and that further psychometric evaluation of the scale is undertaken as appropriate.
Journal of Psychosomatic Research 02/2005; 58(1):89-96. · 3.30 Impact Factor
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ABSTRACT: The purpose of the present study was to examine the psychometric properties of the Penn state Worry Questionnaire (PSWQ) in patients with psoriasis. A series of cross-sectional and longitudinal studies were undertaken to assess the reliability, stability and validity of the measure. Patients with psoriasis from four samples (consecutive attendees, anxious patients, depressed patients, and 6-month follow-up of consecutive attendees) completed the PSWQ and measures assessing related constructs of anxiety and depression (HADS) and coping (COPE). The clinical severity of patients psoriasis was also assessed by dermatologists using the Psoriasis Area and Severity Index (PASI). Exploratory factor analysis was undertaken and receiver operator characteristic (ROC) analyses were used to examine the clinical utility of the PSWQ cut-off score for normal and pathological worry. Exploratory factor analysis suggested that the PSWQ is essentially unidimensional in patients with psoriasis. Intraclass correlation demonstrated that, over a 6-month period, the reproducibility of the PSWQ total scale was good in patients with anxiety and moderate in patients with depression. ROC analysis suggested that the optimum cutoff differentiating pathological worry was > 60, which is commensurate with findings in adult mental health more generally. The PSWQ cutoff for pathological worry showed a lower specificity for depression than anxiety. The PSWQ is an appropriate measure of pathological worry in patients with psoriasis. The cutoff on the scale for pathological worry demonstrates appropriate conceptual overlap with subordinate distress categories of anxiety and depression.
Journal of Clinical Psychology in Medical Settings 01/2005; 12(2):143-152. · 1.49 Impact Factor
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ABSTRACT: Macrophage migration inhibitory factor (MIF), an important pro-inflammatory cytokine, is over-expressed in plaques of psoriasis and increased levels are found in the sera of patients with psoriasis. Promoter polymorphisms of the MIF gene are associated with increased production of MIF and have been found to confer increased risk of susceptibility to chronic inflammatory diseases. We investigated whether there is an association between promoter polymorphisms of the MIF gene and chronic plaque psoriasis. Two hundred and twenty-eight UK caucasian patients with chronic plaque psoriasis, and a control panel of 401 UK caucasian normal volunteers were studied. MIF promoter polymorphisms were genotyped by allelic discrimination, or by a fluorescently labeled primer method, and capillary gel electrophoresis. Carriage of either the MIF-173*C polymorphism or the MIF CATT(7) polymorphism was positively correlated with psoriasis (odds ratios (OR) 1.52 95% confidence intervals (CI) 1.05-2.19 (p=0.024) and OR 1.67 95% CI 1.1-2.5 (p=0.013), respectively. The OR for presence of the CATT(7)-MIF-173(*)C haplotype versus all other haplotypes combined was 1.69 95% CI 1.2-2.5 (p=0.008). The results provide evidence for polymorphisms in the MIF gene, and in particular the CATT(7)-MIF-173(*)C haplotype, being of importance in susceptibility to psoriasis.
Journal of Investigative Dermatology 10/2004; 123(3):484-7. · 6.31 Impact Factor
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ABSTRACT: The aim of the study was to assess the influence of general and dermatitis-specific psychological and clinical factors on quality of life in adults with atopic dermatitis (AD).
A total of 125 adults recruited through the National Eczema Society of U.K. (NES) completed a number of psychological and dermatological questionnaires, including the Dermatology Life Quality Index (DLQI), the Stigmatisation and Eczema Questionnaire (SEQ), the Hospital Anxiety and Depression Scale (HADS), the Fear of Negative Evaluation Scale (FNE) and the Rosenberg Self-Esteem Scale (RSE).
Pearson's correlational analyses suggested that perceptions of stigma were significantly associated with psychological factors as well as quality of life (Ps<.01). An association was also found between perceived stigma and disease severity (-.28, P<.01). Almost 46% of participants were identified as having probable mood disorder. Regression analysis indicated that perceptions of stigma and depression accounted for 44.5% of the variance in quality of life in this sample [F(3,121)=34.18, P<.001], when disease severity was controlled for.
Psychological factors and disease severity were strong predictors of quality of life in adults with AD. AD-related perceptions of stigma were of particular importance in predicting AD-related quality of life over and above more general psychological factors, such as depression. These findings have important implications for the psychological and clinical management of AD.
Journal of Psychosomatic Research 08/2004; 57(2):195-200. · 3.30 Impact Factor
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ABSTRACT: 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.
Journal of Investigative Dermatology 08/2004; 123(1):49-56. · 6.31 Impact Factor
