Influence of disease phase on embitterment and emotional dysregulation in psoriatic patients

Embitterment and metacognition in obsessive-compulsive disorder

OBJECTIVE

Embitterment is a persistent emotion that is known to everybody in reaction to injustice and being let down, associated with feelings of helplessness and hopelessness. People with psychiatric disorders can develop bitterness, which is to be understood as a form of reactive embitterment to the illness. The aim of this explorative study was to investigate the occurrence of embitterment in obsessive-compulsive patients compared to healthy volunteers and in the context of their metacognitions and other biographical and clinical characteristics.

METHOD

Following a semi-structured diagnostic interview, a number of measures were administered to 31 patients with obsessive-compulsive disorder (OCD) [ICD-10 F42.X: mean age 35.2 (SD = 10.7) years] and 31 healthy volunteers [mean age 39.1 (SD = 15.0) years]. These measures included the Post-Traumatic Embitterment Disorder questionaire (PTEDq) for measuring embitterment, the Yale-Brown Obsessive-Compulsive Scale, the Metacognition Questionnaire and other psychometric questionnaires such as the Beck Depression Inventory and the State-Trait Anxiety Inventory.

RESULTS

Patients with OCD scored more than three times higher (mean = 2.0, SD = 1.1) than the healthy participants in the PTEDq (mean = 0.6, SD = 0.8; p < 0.001), but the cut-off of < 2.5 for a clinically relevant embitterment disorder was not reached. Dysfunctionally distorted metacognition (MCQ-30), which is a consistent finding in OCD, as well as a generally high degree of clinical impairment were significantly cor related to the degree of embitterment.

CONCLUSION

Our findings suggest that embitterment as measured by PTEDq is important in patients with OCD, who are characterized by metacognitive distortions with an injustice of fate as well as a mortification of their self-image. In future, it would be necessary to screen patients with OCD not only for depressive symptoms but also specifically for feelings of embitterment in order to be able to initiate appropriate psychotherapeutic measures at an early stage.

Does the Vehicle Matter? Real-World Evidence on Adherence to Topical Treatment in Psoriasis

The influence of the vehicle in topical treatment adherence remains to be elucidated. The aim of this study is to analyze the influence of the pharmaceutical dosage form on adherence to topical treatment in psoriasis patients, taking into consideration the mechanical features. The adherence was evaluated in a sample of 102 psoriasis patients, followed for approximately 45 days. Adherence was calculated with a new combined methodology using a log and medication weights. The effect of the group formulation was evaluated using logistic regression models. A complex effect of the vehicle on adherence was found, mediated by the affected area. The adherence was significantly higher for patients applying gels and creams than for those using ointments, whenever the body area affected was extensive. The opposite was found when the affected area was small. Mechanical properties can partially explain the findings since gels and creams may be easier to apply. Patient beliefs and preferences regarding vehicles and their sensory attributes might also explain the results. It is noteworthy that adherence was strikingly low, with more than 75% non-adherent patients. This real-world evidence provides an insight for pharmaceutical industries and guidance for treatment prescription by physicians aiming to address the public health emergency of treatment non-adherence.

The 12-Item Pruritus Severity Scale - Determining the Severity Bands

Introduction: Assessment of pruritus still remains a challenge due to its subjective character. Various itch questionnaires are widely used to evaluate the severity of pruritus. The aim of the current study was to define the cut off values for the 12-Item Pruritus Severity Scale (12-PSS). Methods: A total of 240 patients (86 males and 154 females) in the age between 19 and 87 years (mean 52.9 ± 20.7 years) suffering from pruritic dermatological conditions were asked to assess their maximal pruritus with the 12-PSS, the Verbal Rating Scale (VRS) and the Numerical Rating Scale (NRS). All subjects also completed the Dermatology Life Quality Index (DLQI). VRS, NRS, and DLQI scorings were used as anchor measures to define cut-offs of 12-PSS. Results: According to VRS, 43 (17.9%) patients suffered from mild, 96 (40%) from moderate, 65 (27.1%) from severe and 36 (15%) from very severe pruritus. Mean 12-PSS scoring for each VRS category was 7.6 ± 3.9, 10.4 ± 3.9, 13.0 ± 3.8, and 13.9 ± 3.8 points, respectively (p < 0.001). Each VRS category significantly differed from the others regarding the mean 12-PSS scoring, except the mean scoring of severe and very severe pruritus (p = 0.72). Thus, three pruritus severity categories of 12-PSS were defined with following score ranges: mild pruritus-3-6 points of 12-PSS, moderate pruritus-7-11 points of 12-PSS and severe pruritus-12-22 points of 12-PSS based on calculation of weighted κ coefficient against VRS, NRS, and DLQI as anchor measures. Conclusions: The 12-PSS is able to differentiate between patients suffering from mild, moderate, and severe pruritus.