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Wang N, Pei L, Zhang M, Wang G, Zheng S, Kou X, Chen H. The impact of psychological interventions on surgical site wound healing post-surgery in psoriasis patients: A meta-analysis. Int Wound J 2024; 21:e14509. [PMID: 38151959 PMCID: PMC10958094 DOI: 10.1111/iwj.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/29/2023] Open
Abstract
This meta-analysis investigates the impact of psychological interventions on the wound healing process at surgical sites in patients with psoriasis who have undergone various surgical procedures. Following the PRISMA guidelines, an extensive database search was conducted, initially identifying 679 articles, with 6 studies ultimately meeting our rigorous selection criteria. These studies, which included both Randomized Controlled Trials and observational designs, utilized a range of scales, such as the REEDA and Manchester Scar Scale (MSS), to measure the healing of surgical wounds. Statistical analyses were performed using Review Manager and SPSS, revealing that psychological interventions significantly expedited wound healing as early as 1 week post-surgery (I2 = 93%; Random: SMD = -3.01, 95% CI: [-4.35, -1.66], p < 0.01), according to the REEDA scale. At the one-month follow-up, a continued positive effect was observed on the MSS (I2 = 69%; Random: SMD = 2.31, 95% CI: [1.54, 3.08], p < 0.01). The studies demonstrated a low risk of bias, and funnel plot analysis suggested no significant publication bias. These results highlight the beneficial role of psychological support in the postoperative recovery of psoriasis patients, suggesting a need for a more integrated approach to patient care that includes psychological well-being as a component of comprehensive treatment strategies.
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Affiliation(s)
- Na Wang
- Department of DermatologyHebei University of Chinese MedicineShijiazhuangChina
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Lin Pei
- Geriatric DepartmentHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Mengqian Zhang
- Department of DermatologyHebei University of Chinese MedicineShijiazhuangChina
| | - Gang Wang
- Department of DermatologyHebei University of Chinese MedicineShijiazhuangChina
| | - Shumao Zheng
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Xiaoli Kou
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
| | - Hu Chen
- Department of DermatologyHebei Province Academy of Chinese Medicine SciencesShijiazhuangChina
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Heyne S, Haufe E, Beissert S, Schmitt J, Günther C. Determinants of Depressive Symptoms, Quality of Life, Subjective Health Status and Physical Limitation in Patients with Systemic Sclerosis. Acta Derm Venereol 2023; 103:adv6502. [PMID: 37671777 PMCID: PMC10496846 DOI: 10.2340/actadv.v103.6502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/11/2023] [Indexed: 09/07/2023] Open
Abstract
Systemic sclerosis is a progressive connective tissue disease for which there is limited knowledge about physical limitations, quality of life and depression. The aim of this study was to assess these parameters during the disease process of systemic sclerosis, in a cross- sectional study of 79 patients and a longitudinal study of 33 patients over 10 years. Medical data were collected by physicians' questionnaires and sociodemographic data, pain, physical limitation, quality of life, subjective health status, risk of depressive symptoms by patients' questionnaires. Data analysis was descriptive and exploratory. Cross-tabulations, χ2 test and Student's t-test were used for calculations, Pearson's correlation to measure dependencies, and logistic regression analyses for categorized parameters. The cross-sectional analysis of 79 patients with systemic sclerosis (81% female, mean ± standard deviation age 61.5 ± 12.6 years) demonstrated a higher rate of patients with risk of depressive symptoms (42.3%) higher physical limitations, lower quality of life, and subjective health status than reference values for the general German population. Moderate to strong correlations between disease-related physical limitation, quality of life, subjective health status, risk of depressive symptoms and pain were detected (correlation according to Pearson -0.459 to -0.638, p < 0.001). Longitudinal analysis revealed a significant increase in disease activity, pain, physical limitation and risk of depressive symptoms (p < 0.001) during the disease process. This study demonstrates that nearly half of patients with systemic sclerosis probably experience depressive symptoms. The rate of patients with risk of depressive symptoms, pain and physical limitations increased during the systemic sclerosis disease process. Health-related quality of life and state of health declined, indicating the need for better interdisciplinary care for patients with systemic sclerosis.
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Affiliation(s)
- Stefanie Heyne
- Department of Dermatology, University Hospital Dresden at Technical University Dresden, Dresden, Germany.
| | - Eva Haufe
- Institute of Evidence-Based Healthcare, Technical University Dresden, Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Dresden at Technical University Dresden, Dresden, Germany
| | - Jochen Schmitt
- Institute of Evidence-Based Healthcare, Technical University Dresden, Dresden, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Dresden at Technical University Dresden, Dresden, Germany
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McGrath RL, Verdon S, Parnell T, Pope R. Australian physiotherapists' perceived frequency of contact with clients experiencing distress: A cross-sectional survey. Physiother Theory Pract 2023:1-18. [PMID: 37128766 DOI: 10.1080/09593985.2023.2204962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Previous research suggests physiotherapists' perceived frequency of contact with clients experiencing psychological distress is common; however, there is significant variation in the frequency of such contact. OBJECTIVE The study aimed to 1) investigate Australian physiotherapists' perceived frequency of contact with clients experiencing various forms of psychological distress; 2) identify potential factors that predict perceived frequency of contact; and 3) explore physiotherapists' beliefs regarding their role and self-reported capability to identify and assess psychological distress. METHODS A nationwide online survey of 340 Australian physiotherapists was conducted, and the data were analyzed using descriptive analysis and regression analysis. RESULTS Physiotherapists' perceived frequencies of contact with psychologically distressed and severely distressed clients expressed as proportions of all clients seen each week were 36.1% and 15.6%, respectively. Factors related to the clinical setting were stronger predictors of the perceived frequency of contact (Cohen's f2 = 0.16) than factors related to the physiotherapists themselves (Cohen's f2 = 0.03). Despite believing that identifying psychological distress was within their scope of practice, the physiotherapists in the study felt that assessing and managing this distress fell outside or on the boundary of their scope of practice. CONCLUSION Australian physiotherapists frequently encounter clients they perceive to be experiencing psychological distress. Future research into physiotherapists' capability to assess and respond to client psychological distress, using non-self-reported measures, is required.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
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Brinkman N, Rajagopalan D, Ring D, Vagner G, Reichel L, Crijns TJ. Surgeons Receiving Information About Patient Language Reflecting Unhelpful Thoughts or Distress About Their Symptoms Identify Such Language More Often Than Those Who Do Not Receive This Information. Clin Orthop Relat Res 2023; 481:887-897. [PMID: 36728917 PMCID: PMC10097561 DOI: 10.1097/corr.0000000000002496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Unhelpful thoughts and feelings of distress regarding symptoms account for a large proportion of variation in a patient's symptom intensity and magnitude of capability. Clinicians vary in their awareness of this association, their ability to identify unhelpful thoughts or feelings of distress regarding symptoms, and the skills to help address them. These nontechnical skills are important because they can improve treatment outcomes, increase patient agency, and foster self-efficacy without diminishing patient experience. QUESTIONS/PURPOSES In this survey-based study, we asked: (1) Are there any factors, including exposure of surgeons to information about language reflecting unhelpful thoughts about symptoms, associated with the total number of identified instances of language rated as reflecting unhelpful thoughts or feelings of distress regarding symptoms in transcripts of patient encounters? (2) Are there any factors, including exposure of surgeons to information about language reflecting unhelpful thoughts about symptoms, associated with the interobserver reliability of a surgeon's identification of language rated as reflecting unhelpful thoughts or feelings of distress regarding symptoms in transcripts of patient encounters? METHODS Surgeons from an international collaborative consisting of mostly academic surgeons (Science of Variation Group) were invited to participate in a survey-based experiment. Among approximately 200 surgeons who participate in at least one experiment per year, 127 surgeons reviewed portions of transcripts of actual new musculoskeletal specialty encounters with English-speaking patients (who reported pain and paresthesia as primary symptoms) and were asked to identify language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms. The included transcripts were selected based on the rated presence of language reflecting unhelpful thinking as assessed by four independent researchers and confirmed by the senior author. We did not study accuracy because there is no reference standard for language reflecting unhelpful thoughts or feelings of distress regarding symptoms. Observers were randomized 1:1 to receive supportive information or not regarding definitions and examples of unhelpful thoughts or feelings of distress regarding symptoms (referred to herein as "priming") once at the beginning of the survey, and were not aware that this randomization was occurring. By priming, we mean the paragraph was intended to increase awareness of and attunement to these aspects of human illness behavior immediately before participation in the experiment. Most of the participants practiced in the United States (primed: 48% [29 of 60] versus not primed: 46% [31 of 67]) or Europe (33% [20 of 60] versus 36% [24 of 67]) and specialized in hand and wrist surgery (40% [24 of 60] versus 37% [25 of 67]) or fracture surgery (35% [21 of 60] versus 28% [19 of 67]). A multivariable negative binomial regression model was constructed to seek factors associated with the total number of identified instances of language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms. To determine the interobserver agreement, Fleiss kappa was calculated with bootstrapped 95% confidence intervals (resamples = 1000) and standard errors. RESULTS After controlling for potential confounding factors such as location of practice, years of experience, and subspecialty, we found surgeons who were primed with supportive information and surgeons who had 11 to 20 years of experience (compared with 0 to 5 years) identified slightly more instances of language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms (regression coefficient 0.15 [95% CI 0.020 to 0.28]; p = 0.02 and regression coefficient 0.19 [95% CI 0.017 to 0.37]; p = 0.03). Fracture surgeons identified slightly fewer instances than hand and wrist surgeons did (regression coefficient -0.19 [95% CI -0.35 to -0.017]; p = 0.03). There was limited agreement among surgeons in their ratings of language as indicating unhelpful thoughts or feelings of distress regarding symptoms, and priming surgeons with supportive information had no influence on reliability (kappa primed: 0.25 versus not primed: 0.22; categorically fair agreement). CONCLUSION The observation that surgeons with brief exposure to supportive information about language associated with unhelpful thoughts and feelings of distress regarding symptoms identified slightly more instances of such language demonstrates the potential of training and practice to increase attunement to these important aspects of musculoskeletal health. The finding that supportive information did not improve reliability underlines the complexity, relative subjectivity, and imprecision of these mental health concepts. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Jalenques I, Bourlot F, Martinez E, Pereira B, D'Incan M, Lauron S, Rondepierre F. Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi. Acta Derm Venereol 2022; 102:adv00769. [DOI: 10.2340/actadv.v102.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The magnitude of the association between psoriasis and depression has been evaluated, but not that between psoriasis and anxiety. The aim of this systematic review and meta-analysis was to examine the prevalence and odds of anxiety disorders and symptoms in patients with psoriasis. Five medical databases (Cochrane Database, EMBASE, PubMed, PsychINFO, ScienceDirect) were searched for relevant literature. A total of 101 eligible articles were identified. Meta-analysis revealed different prevalence rates depending on the type of anxiety disorder: 15% [95% confidence interval [CI] 9–21] for social anxiety disorder, 11% [9–14] for generalized anxiety disorder, and 9% [95% CI 8–10] for unspecified anxiety disorder. There were insufficient studies assessing other anxiety disorders to be able to draw any conclusions on their true prevalence. Meta-analysis also showed a high prevalence of anxiety symptoms (34% [95% CI 32–37]). Case-control studies showed a positive association between psoriasis and unspecified anxiety disorder (odds ratio 1.48 [1.18; 1.85]) and between psoriasis and anxiety symptoms (odds ratio 2.51 [2.02; 3.12]). All meta-analyses revealed an important heterogeneity, which could be explained in each case by methodological factors. The results of this study raise the necessity of screening for the presence of anxiety disorders, as previously recommended for depressive disorders, in patients with psoriasis and, if necessary, to refer such patients for evaluation by a mental health professional and appropriate treatment.
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Cordingley L, Nelson PA, Davies L, Ashcroft D, Bundy C, Chew-Graham C, Chisholm A, Elvidge J, Hamilton M, Hilton R, Kane K, Keyworth C, Littlewood A, Lovell K, Lunt M, McAteer H, Ntais D, Parisi R, Pearce C, Rutter M, Symmons D, Young H, Griffiths CEM. Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/lvuq5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Psoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.
Objectives
To (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.
Design
Mixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.
Setting
Primary care, secondary care and online surveys.
Participants
People with psoriasis and health-care professionals who manage patients with psoriasis.
Results
Prevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.
Limitations
The duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.
Conclusions
Recognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.
Future work
Patient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Pauline A Nelson
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christine Bundy
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Anna Chisholm
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Jamie Elvidge
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rachel Hilton
- Bridgewater Community Healthcare NHS Foundation Trust, Wigan, UK
| | - Karen Kane
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Alison Littlewood
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Dionysios Ntais
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christina Pearce
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Martin Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deborah Symmons
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Helen Young
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher EM Griffiths
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
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Fabrazzo M, Romano F, Arrigo M, Puca RV, Fuschillo A, De Santis V, Sampogna G, Giordano GM, Catapano F, Lo Schiavo A. A Multivariate Analysis of Depression Prevalence in Psoriasis Patients: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042060. [PMID: 35206248 PMCID: PMC8871876 DOI: 10.3390/ijerph19042060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
The literature reported higher depression rates in psoriasis patients compared to the general population. Our study aimed to verify whether variability in depression prevalence was due to using different diagnostic tools. We also aimed to determine whether dysfunctional coping strategies might increase the depression burden. We assessed psoriasis severity by the Psoriasis Area Severity Index (PASI) and PSOdisk. We analyzed mental alterations of 120 outpatients by Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), Symptom Checklist-90-Revised (SCL-90-R), plus coping strategies and quality of life by Coping Orientation to Problems Experienced (COPE) Inventory and 36-Item Short Form Health Survey (SF-36). We divided our cohort into five subgroups from minimal to severe psoriasis using the PSOdisk total score. Depression prevalence varied according to the assessment criteria for specificity, frequency, and severity. Different mood disorders other than major depression emerged when we used DSM-IV-TR criteria. Correlation analysis of the criteria we used to diagnose depression or depressed mood indicated that a dysfunctional coping strategy was highly and positively correlated only in patients of the severe subgroup. Differently, a negative correlation emerged between the SF-36 Mental Summary Component (MSC) and behavioral disengagement, thus suggesting that psychopathological distress might induce patients with a marked/severe psoriasis to adopt dysfunctional coping strategies. Dermatologists are fundamental in detecting comorbid depression, referring psoriasis patients to mental health specialists to achieve adequate treatments, and preventing suicide risk.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
- Correspondence: ; Tel.: +39-(0)81-566-65-29
| | - Francesca Romano
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
| | - Marzia Arrigo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Rosa Valentina Puca
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
| | - Antonietta Fuschillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Valeria De Santis
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Francesco Catapano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Ada Lo Schiavo
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
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Fiocco Z, Kupf S, Patzak L, Kämmerer T, Pumnea T, French LE, Reinholz M. Quality of Life and Psychopathology in Lichen Planus: A Neglected Disease Burden. Acta Derm Venereol 2021; 101:adv00619. [PMID: 34698356 PMCID: PMC9472096 DOI: 10.2340/actadv.v101.442] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The disease burden of lichen planus and its impact on patients’ quality of life have not been well studied. The aim of this mono-centre cross-sectional study was to investigate these factors. From June to September 2020, an anonymous survey was posted to 253 patients, who were diagnosed with lichen planus in our outpatient clinic from January 2018 to June 2020. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI), the EuroQol 5-dimension 3-level score, and further quality of life indicators. Beck Depression Inventory II was used to evaluate symptoms of depression. A total of 100 patients completed and returned the survey. Lichen planus affected quality of life in 78% of cases. DLQI was higher for multiple localizations (r = 0.454, p < 0.001). Patients with genital lichen planus had a significantly higher DLQI (mean ± standard deviation (SD) 8.68 ± 6.96) than patients who were not affected in the genital area (5.01 ± 5.49; p = 0.009). DLQI was also significantly higher for ungual lichen planus (9.83 ± 7.6; not affected: 5.65 ± 5.84; p-value 0.039), and for cutaneous LP (mean 8.1, SD 6.22; not affected: 5.63 ± 6.12; p-value 0.045). Twenty-nine percent of patients had mild to moderate symptoms of depression, and 6% had severe symptoms of depression. Depression and reduced quality of life are an undetected and relevant burden affecting patients with lichen planus.
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Affiliation(s)
- Zeno Fiocco
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, DE-80337 Munich, Germany .
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Chen V, Bellodi Schmidt F. Provider perceptions and practices for appearance-related psychosocial distress caused by dermatologic disease in children. Pediatr Dermatol 2021; 38:1074-1079. [PMID: 34369607 DOI: 10.1111/pde.14679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Differences in appearance are often stigmatized in society, and dermatologic disease can lead to psychological and social sequelae that significantly impact patient quality of life. However, discrepancy between patient-reported and physician-assessed psychological distress raises a question of how clinicians are prepared in recognizing and managing the psychosocial impact of a child's skin condition. We aim to identify current practices among healthcare providers toward properly addressing appearance-related psychosocial distress in pediatric dermatology patients. METHODS Surveys assessing provider attitude and practices to appearance-related distress were distributed to members of the Society of Pediatric Dermatology via the Pediatric Dermatology Research Alliance, and Florida Chapter of American Academy of Pediatrics. RESULTS Over half of respondents report encountering appearance-related psychosocial distress on a daily basis and believe screening to be important. However, only 14% use a validated screening tool and 18% screen all patients. Major obstacles to generalized screening were limited time and staffing. Self-reported knowledge and management of appearance-related psychosocial distress includes direct counseling and referrals to local support groups, mental health providers, specialized summer camps, and school-affiliated resources. Nevertheless, 86% expressed interest in learning more about appearance-related psychosocial distress, particularly about patient education and resources. CONCLUSIONS Although clinicians frequently encounter appearance-related distress with pediatric dermatology patients, screening is selective and lacks standardization. Self-reported knowledge and management is comprehensive, but there is a need for increased training in patient education and resources.
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Affiliation(s)
- Vivien Chen
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fernanda Bellodi Schmidt
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Physician-patient agreement on physicians’
communication skills and visit satisfaction
in dermatology clinics: a one-with-many design. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2021.110574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lukmanji A, Basmadjian RB, Vallerand IA, Patten SB, Tang KL. Risk of Depression in Patients With Psoriatic Disease: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2020; 25:257-270. [PMID: 33263264 DOI: 10.1177/1203475420977477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous systematic reviews have assessed the prevalence and odds ratio (OR) of depression for patients with psoriatic disease. Due to probable bidirectional effects, prevalence and prevalence ORs are difficult to interpret. No prior reviews have quantified the relative risk (RR) of depression following a diagnosis of psoriatic disease. OBJECTIVE To estimate the RR of depression in individuals with psoriasis and in psoriatic arthritis (PsA), clear-to-moderate psoriasis, and moderate-to-severe psoriasis subgroups. METHODS Observational studies investigating the risk of depression in adults with psoriatic disease were systematically searched for in Medline, EMBASE, PsycINFO, and CINAHL databases; 4989 unique references were screened. Studies that reported measures of incident depression in psoriasis patients were included. Thirty-one studies were included into the systematic review, of which 17 were meta-analyzed. Random effects models were employed to synthesize relevant data. Sources of heterogeneity were explored with subgroup analysis and meta-regression. RESULTS Seventeen studies were included in meta-analyses. The pooled RR of depression in psoriasis patients compared to nonpsoriasis controls was 1.48 (95% CI: 1.16-1.89). Heterogeneity was high (I2 = 99.8%). Subgroup analysis and meta-regression did not indicate that PsA status or psoriasis severity (clear-to-mild, moderate-to-severe) were sources of heterogeneity. No evidence of publication bias was found. CONCLUSIONS This review demonstrates that the risk of depression is greater in patients with psoriasis and PsA. Future research should focus on developing strategies to address the mental health needs of this patient population for depression, including primary prevention, earlier detection, and treatment strategies.
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Affiliation(s)
- Aysha Lukmanji
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Robert B Basmadjian
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Isabelle A Vallerand
- 2129 Department of Medicine, University of Calgary, AB, Canada.,70401 Division of Dermatology, University of Calgary, AB, Canada
| | - Scott B Patten
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada.,2129 Department of Medicine, University of Calgary, AB, Canada.,2129 Mathison Centre for Mental Health Research & Education, University of Calgary, AB, Canada.,2129 Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, AB, Canada
| | - Karen L Tang
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada.,2129 Department of Medicine, University of Calgary, AB, Canada
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12
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Ismail D, McAteer H, Majeed-Ariss R, McPhee M, Griffiths CEM, Young HS. Research priorities and identification of a health-service delivery model for psoriasis from the UK Psoriasis Priority Setting Partnership. Clin Exp Dermatol 2020; 46:276-285. [PMID: 32748405 DOI: 10.1111/ced.14407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psoriasis impacts the health and psychosocial functioning of patients, conferring a significant economic burden on healthcare systems. There remain unmet needs in psoriasis care, which if addressed by research, could improve clinical outcomes. AIM To research priorities and identify a health service delivery model from the UK Psoriasis Priority Setting Partnership (PsPSP). METHODS Between July 2017 and November 2018, we invited people with lived experience of psoriasis and healthcare professionals to (i) identify unmet needs, and (ii) prioritize the order in which these should be addressed by research. We collaborated with the Psoriasis Association and used methodology established by the James Lind Alliance, which pioneers the joint setting of research priorities by patients and clinicians worldwide. RESULTS In our initial harvesting survey (Survey 1), 2133 questions were submitted by 805 individuals. Submissions that had not been answered by research (true uncertainties) were supplemented with evidence gaps from systematic reviews/guidelines published in the previous 5 years and refined to produce 55 indicative questions. Voting in Survey 2, by 1154 individuals, enabled a shortlist of questions, which were prioritized during the final workshop to produce a top 20 list of research questions. Submissions on health service delivery (5.8% of the total submissions), which were analysed separately, described a blueprint for psoriasis care. CONCLUSIONS The PsPSP will inform the translational research agenda, ensuring that future research is relevant for the needs of people with psoriasis and those who manage the disease. Submissions on health service delivery describe a model of holistic, patient-focused care providing high-quality, effective management for patients with psoriasis.
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Affiliation(s)
- D Ismail
- Department of Dermatology, Salford Royal Hospital, Stott Lane, Manchester, UK
| | - H McAteer
- Psoriasis Association, Northampton, UK
| | - R Majeed-Ariss
- Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre The University of Manchester, Manchester, UK
| | - M McPhee
- Centre of Evidence Based Dermatology, King's Meadow Campus, University of Nottingham, Nottingham, UK
| | - C E M Griffiths
- Department of Dermatology, Salford Royal Hospital, Stott Lane, Manchester, UK.,Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre The University of Manchester, Manchester, UK
| | - H S Young
- Department of Dermatology, Salford Royal Hospital, Stott Lane, Manchester, UK.,Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre The University of Manchester, Manchester, UK
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13
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Duvetorp A, Mrowietz U, Nilsson M, Seifert O. Sex and Age Influence the Associated Risk of Depression in Patients with Psoriasis: A Retrospective Population Study Based on Diagnosis and Drug-Use. Dermatology 2020; 237:595-602. [PMID: 32927456 DOI: 10.1159/000509732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The reported prevalence of depression among individuals with psoriasis varies substantially, and the effect of gender on depression distribution has revealed conflicting results. In addition, using medication to identify cases is uncommon. OBJECTIVE To study the prevalence of pharmacologically treated depression among individuals with and without psoriasis in a Swedish population using ICD-10 codes and data from the Swedish Prescribed Drug Register. METHODS A retrospective case-control population-based study was performed including all living individuals (age ≥18 years) in Region Jönköping, southern Sweden (n = 273,536). ICD-10 codes for the diagnosis of psoriasis (L40.*) and depression (F32.* and F33.*), and data on pharmacological treatment from the Swedish Prescribed Drug Register, were extracted from electronic medical records between April 9, 2008 and January 1, 2016. The extraction date was January 1, 2016. RESULTS The risk of pharmacologically treated depression was increased in individuals with psoriasis (age- and sex-adjusted OR 1.55; CI 1.43-1.68); 21.1% of women with psoriasis received pharmacological treatment for depression during the study period compared to 14.2% in the control population. Prevalence figures for depression were significantly higher in women with psoriasis compared to men. The risk of suffering from depression was highest among male and female patients with psoriasis under the age of 31 years. CONCLUSIONS Depression is common among patients with psoriasis. The results of the current study underline the need for dermatologists to adopt a holistic approach, looking beyond the skin, when handling patients with psoriasis in every-day clinical practice.
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Affiliation(s)
- Albert Duvetorp
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mats Nilsson
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Oliver Seifert
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden, .,Department of Dermatology and Venereology, Ryhov Hospital, Jönköping, Sweden,
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14
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Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms. Arch Dermatol Res 2020; 313:531-537. [PMID: 32857186 DOI: 10.1007/s00403-020-02130-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
Many dermatology patients experience social anxiety symptoms; however, few studies have investigated vulnerabilities contributing to this distress. Anxiety sensitivity (AS), or the fear of the consequences of anxiety, warrants consideration given its association with social anxiety and dermatological symptoms, respectively. The purpose of this investigation was to investigate the role of AS in social anxiety symptoms in two samples of adults with psychodermatological conditions. AS social, but not physical or cognitive, concerns were hypothesized to demonstrate unique associations with social anxiety symptoms after controlling for relevant variables. Participants completed self-report measures online (Study 1) or in-person (Study 2). Study 1 included 164 participants with active skin conditions (Mage = 31.88; 69.5% female; 83.5% White), and Study 2 included 63 dermatology outpatients (Mage = 51.49; 70.7% female; 65% White). Results revealed AS social concerns was a unique factor contributing to social anxiety symptoms in both samples. This study demonstrates replication, and the findings suggest heightened concerns about the negative consequences related to visible skin conditions may worsen social anxiety symptoms in individuals with psychodermatological conditions. Despite limitations, this study informs the conceptualization of co-occurring psychological and dermatological conditions and highlights the need to evaluate the efficacy of brief AS interventions among patients with psychodermatological conditions.
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15
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Korman NJ, Malatestinic W, Goldblum OM, Murage MJ, Renda L, Lin CY, Lucas J, Middleton C, Lobosco S. Assessment of the benefit of achieving complete versus almost complete skin clearance in psoriasis: a patient's perspective. J DERMATOL TREAT 2020; 33:733-739. [PMID: 32432957 DOI: 10.1080/09546634.2020.1772454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Psoriasis is characterized by thick and scaly plaques. The Dermatology Life Quality Index (DLQI) and Physician Global Assessment (PGA) can be used to define its severity.Objective: To assess the impact of complete clearance of skin versus almost clear skin across various disease measures.Methods: Data were collected in a survey of US dermatologists and patients with psoriasis from November 2016-January 2017. Dermatologists completed a 6-point PGA (0 = clear skin, 1 = almost clear skin). Patients completed the DLQI and Work Productivity and Activity Impairment questionnaire (WPAI). Patients with clear and almost clear skin were compared using analysis of covariance for continuous variables, and multivariate logistic regression analysis for categorical variables.Results: Data for 99 and 160 patients with clear and almost clear skin, respectively, were included in the analyses. Patients with clear skin reported less frequent and lower intensity itching, lower total DLQI score (indicating better health-related quality of life), and less impairment of overall work productivity than patients with almost clear skin (all: p < 0.05).Limitations: Limitations relating to general survey methodology.Conclusion: Patients perceived a meaningful difference between clear and almost clear skin. Clear skin is now a realistic treatment target with newer biologics approved in psoriasis.
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Affiliation(s)
- Neil J Korman
- University Hospitals Case Medical Center, Cleveland, OH, USA
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16
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Kalashnikova NG, Lotti T, Urakova DS, Jafferany M. Treatment of psoriatic skin lesions with a new Er:Yag laser technology: A case series study. Dermatol Ther 2020; 33:e13264. [DOI: 10.1111/dth.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/02/2020] [Accepted: 02/07/2020] [Indexed: 12/28/2022]
Affiliation(s)
| | - Torello Lotti
- Dermatology and Venereology Guglielmo Marconi University Rome Italy
| | - Diana S. Urakova
- Department of Dermatology Institute of Medical and Social Technologies Moscow Russia
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17
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Liang SE, Cohen JM, Ho RS. Screening for depression and suicidality in psoriasis patients: A survey of US dermatologists. J Am Acad Dermatol 2019; 80:1460-1462. [PMID: 30682396 DOI: 10.1016/j.jaad.2019.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/10/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Sydney E Liang
- New York University School of Medicine, New York, New York
| | - Jeffrey M Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Roger S Ho
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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18
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Hassanin AM, Ismail NN, El Guindi A, Sowailam HA. The emotional burden of chronic skin disease dominates physical factors among women, adversely affecting quality of life and sexual function. J Psychosom Res 2018; 115:53-57. [PMID: 30470317 DOI: 10.1016/j.jpsychores.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/21/2018] [Accepted: 10/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Both physical and emotional effects are linked with the natural history of chronic skin diseases (CSD). Skin lesions can be confined to covered areas or involve emotionally charged regions (genitalia/exposed areas). OBJECTIVE To investigate the contribution of the physical effects of CSD and their emotional burden in adversely affecting the quality of life (QOL) and sexual function. METHODS Two groups were included: A group of women suffering from CSD and a control group. All participants answered the 19-item Female Sexual Function Index (FSFI) questionnaire. Women suffering from CSD answered the 10-item Dermatology Life Quality Index (DLQI) questionnaire; this group was divided into various subgroups according to the type of disease and regional involvement. RESULTS Neither the DLQI score (P = .06) nor the FSFI scores were significantly affected by the type of disease. The DLQI score was significantly higher in the subgroups with involvement of genitalia or exposed areas (P: < 0.001and 0.01, respectively). Moreover, genital involvement was associated with pervasive and significantly lower FSFI scores, and the arousal, satisfaction, and total scores were significantly lower among women with the involvement of exposed areas. The DLQI score was significantly negatively correlated with the FSFI scores. CONCLUSION The emotional burden of CSD should not be overlooked as it dominates the physical effects of disease by adversely affecting QOL and sexual function among women. It is necessary to provide this information to dermatologists and patients, especially in light of effective cognitive-behavior therapy that can be undertaken to ameliorate the emotional stresses.
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Affiliation(s)
- Ahmed Mohamed Hassanin
- Department of Andrology and Sexology, Faculty of Medicine, Cairo University, 1 Al-Saraya street, EL Manial, Cairo, 11559, Egypt.
| | - Nashaat Nabil Ismail
- Department of Andrology and Sexology, Faculty of Medicine, Beni-Suef University, 1 Latin America Street - Second Floor - Flat No. 10, Garden City, Egypt
| | - Ahmed El Guindi
- Department of Andrology and Sexology, Faculty of Medicine, Cairo University, 1 Al-Saraya street, EL Manial, Cairo, 11559, Egypt
| | - Hanan Amin Sowailam
- El-Houd El-Marsood Dermatology Hospital, Ministry of Health, Egypt; Department Of Dermatology, Faculty of Medicine, Beni-Suef University, Egypt
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19
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Kim SJ, Park MY, Pak K, Han J, Kim GW, Kim HS, Ko HC, Kim MB, Kim BS. Improvement of depressive symptoms in patients with moderate-to-severe psoriasis treated with ustekinumab: an open label trial validated using beck depression inventory, Hamilton depression rating scale measures and 18fluorodeoxyglucose (FDG) positron emission tomography (PET). J DERMATOL TREAT 2018; 29:761-768. [PMID: 29658378 DOI: 10.1080/09546634.2018.1466021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin disease associated with psychiatric co-morbidities, especially depression. Early detection of psychological vulnerability in patients with psoriasis seems to be of great clinical importance and significantly impacts the quality of life of the patients. OBJECTIVES We sought to clarify the association between psoriasis and depressive symptoms in patients with moderate-to-severe psoriasis, and to determine the risk factors for depressive symptoms and analyze the effect of ustekinumab on the symptoms. We also aimed to evaluate the changes in glucose metabolism using 18fluorodeoxyglucose (FDG) positron emission tomography (FDG-PET). METHODS Fifteen patients with moderate-to-severe psoriasis scheduled to be treated with ustekinumab were enrolled. At baseline and after achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI) score (PASI75), all patients underwent a psychiatric interview and FDG-PET. Fifteen healthy volunteers were enrolled for comparison. RESULTS Patients with moderate-to-severe psoriasis were more depressed than those in the control group were (p < .05). The severity of psoriasis at baseline did not correlate with the depression symptoms. Treatment with ustekinumab significantly reduced the depressive symptoms, as verified using Beck Depression Inventory and Hamilton Depression Rating Scale psychiatric interviews (p < .05). However, FDG-PET of the brain showed no significant difference before and after PASI75 achievement using ustekinumab injection. CONCLUSIONS Patients with moderate-to-severe psoriasis are at an increased risk for depressive symptoms, and treatment with ustekinumab may be beneficial. FDG-PET does not reflect the changes in depressive symptoms in such patients.
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Affiliation(s)
- Seong-Jang Kim
- a Department of Nuclear Medicine, School of Medicine , Pusan National University , Busan , Korea
| | - Min-Young Park
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Kyoungjune Pak
- a Department of Nuclear Medicine, School of Medicine , Pusan National University , Busan , Korea
| | - Junhee Han
- c Department of Statistics and Institute of Statistics , Hallym University , Chuncheon , Korea
| | - Gun-Wook Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Hoon-Soo Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Hyun-Chang Ko
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Moon-Bum Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea.,d Biomedical Research Institute, Pusan National University Hospital , Busan , Korea
| | - Byung-Soo Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea.,d Biomedical Research Institute, Pusan National University Hospital , Busan , Korea
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20
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Nelson PA, Kane K, Pearce CJ, Bundy C, Chisholm A, Hilton R, Thorneloe R, Young H, Griffiths CEM, Cordingley L. 'New to me': changing patient understanding of psoriasis and identifying mechanisms of change. The Pso Well ® patient materials mixed-methods feasibility study. Br J Dermatol 2017; 177:758-770. [PMID: 28403510 PMCID: PMC5637913 DOI: 10.1111/bjd.15574] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/27/2022]
Abstract
Background Psoriasis is an inflammatory long‐term condition involving comorbidities, unhealthy lifestyle and significant life impact. Patients’ understanding of psoriasis is limited and support lacking. The Common‐Sense Model of Self‐Regulation of Health and Illness emphasizes the role of illness and treatment beliefs on coping and self‐management. New ‘Pso Well®’ patient materials informed by the model, addressed psoriasis as a long‐term condition, medication management and lifestyle behaviours. Objectives To investigate whether Pso Well® materials (i) broaden understanding of psoriasis without increasing anxiety; (ii) are acceptable; and (iii) comprise features that appear to effect change. Methods The Revised Illness Perceptions Questionnaire (IPQ‐R modified) and the Hospital Anxiety and Depression Scale (HADS) were administered in patients before and after intervention. Numerical rating scales assessed perceptions of change in understanding and anxiety resulting from engagement with the materials. Qualitative interviews explored acceptability and perceived ‘active ingredients’. Results Fifty‐five patients completed pre‐ and postintervention questionnaires (56% female; median age 59 years). Postintervention, a large effect size was indicated in two IPQ‐R domains – illness coherence [t(55) = −3·48, P = 0·001 (two‐tailed), η2 = 0·19] and personal control [t(55) = −2·98, P = 0·004 (two‐tailed), η2 = 0·14] – and a medium effect in one, treatment control [t(55) = −2·08, P = 0·042 (two‐tailed), η2 = 0·08]. HADS scores did not change. For numerical rating scales, 80% of participants reported increased understanding of psoriasis and none reported increased anxiety. Interviews with 19 patients indicated the materials were acceptable and usable. Factors reported to broaden understanding and promote engagement with self‐management included linking of related disease aspects, personally relevant content and high‐quality design. Conclusions High‐quality, theory‐based psoriasis materials are acceptable to patients and can improve understanding and sense of control without increasing anxiety. What's already known about this topic? Psoriasis is associated with comorbidities, unhealthy lifestyle and significant life impact. Patients’ understanding of psoriasis is limited, self‐management support is lacking and disengagement from healthcare services is common.
What does this study add? The new, theory‐informed Pso Well® patient materials address psoriasis as a long‐term condition; medications management and lifestyle behaviour. The Pso Well® patient materials can increase understanding of psoriasis, promote feelings of self‐worth and encourage a desire to engage in self‐management and behaviour change, without increasing anxiety or depression.
What are the clinical implications of this work? The Pso Well® patient materials could support clinical consultations by helping patients recognize the remitting–relapsing nature of psoriasis. This will help to improve understanding of the disease, as well as providing a clearer rationale for treatment adherence and lifestyle behaviour change.
Linked Comment: Prinsen. Br J Dermatol 2017; 177:616–617
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Affiliation(s)
- P A Nelson
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K
| | - K Kane
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K
| | - C J Pearce
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - C Bundy
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - A Chisholm
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - R Hilton
- Bridgewater Community Healthcare Trust, Wigan, U.K
| | - R Thorneloe
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K
| | - H Young
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Greater Manchester, U.K
| | - C E M Griffiths
- Dermatology Centre, Division of Musculoskeletal and Dermatological Research, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, U.K.,Manchester Academic Health Science Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Greater Manchester, U.K
| | - L Cordingley
- Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.,Division of Musculoskeletal and Dermatological Research, University of Manchester, Manchester, U.K
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21
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Thorneloe RJ, Griffiths CEM, Cordingley L. Medication non-adherence: the hidden problem in clinical practice. J Eur Acad Dermatol Venereol 2017. [PMID: 28621501 DOI: 10.1111/jdv.14324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R J Thorneloe
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Centre for Dermatology Research, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - C E M Griffiths
- Centre for Dermatology Research, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.,Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - L Cordingley
- Centre for Dermatology Research, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.,Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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22
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Young H. Psychological effects of skin disease: the psoriasis exemplar. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:590-591. [PMID: 28594616 DOI: 10.12968/bjon.2017.26.11.590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Helen Young
- Clinical Senior Lecturer and Honorary Consultant in Dermatology, University of Manchester
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23
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Simpson J, Wilson M, Ahmed A, Mizara A, Clarke A, McBride S. An exploratory study using framework analysis to investigate health‐seeking behaviour in patients with psoriasis. Br J Dermatol 2017; 177:742-750. [DOI: 10.1111/bjd.15307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/20/2022]
Affiliation(s)
- J.K. Simpson
- Department of Dermatology Royal Free London NHS Foundation Trust London U.K
| | - M. Wilson
- Department of Clinical Psychology Royal Free London NHS Foundation Trust London U.K
| | - A.A. Ahmed
- Department of Clinical Psychology Royal Free London NHS Foundation Trust London U.K
| | - A. Mizara
- Department of Dermatology Royal Free London NHS Foundation Trust London U.K
| | - A. Clarke
- Department of Clinical Psychology Royal Free London NHS Foundation Trust London U.K
| | - S.R. McBride
- Department of Dermatology Royal Free London NHS Foundation Trust London U.K
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24
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Connor CJ. Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines. Clin Cosmet Investig Dermatol 2017; 10:117-132. [PMID: 28458571 PMCID: PMC5404497 DOI: 10.2147/ccid.s111041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dermatological disease can be devastating for patients, and although dermatologists are focused on remedying the cutaneous manifestations of these conditions, it is easy to miss the psychological suffering lurking below. Studies reveal that psychiatric comorbidity in dermatology is highly prevalent. Undetected psychopathology can greatly decrease a patient's quality of life and even contribute significantly to the clinical severity of their skin disease. For these reasons, it is vital that practitioners learn to detect psychological distress when it is present, and it is equally essential that they understand the treatment options available for effective intervention. Without training in psychiatric diagnosis and psychopharmacology, dermatologists can easily feel overwhelmed or out of their comfort zone when faced with the need to manage such conditions, but with the negative stigma associated with psychiatric disease in general, a psychiatric referral is often refused by patients, and the dermatologist is thus left with the responsibility. Uncertainty abounds in such situations, but this review seeks to alleviate the discomfort with psychodermatological disease and share practical and impactful recommendations to assist in diagnosis and treatment. In a busy dermatology clinic, the key is effective and efficient screening, combined with a repertoire of pharmacological and non-pharmacological treatment options that can be dispersed through an algorithmic approach according to the specific findings of that screening. By implementing these recommendations into practice, dermatologists may begin to gain comfort with the management of psychocutaneous disease and, as a specialty, may expand to fill a hole in patient care that is truly significant for patients, their families, and our communities as a whole.
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Affiliation(s)
- Cody J Connor
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Nelson PA, Kane K, Chisholm A, Pearce CJ, Keyworth C, Rutter MK, Chew-Graham CA, Griffiths CEM, Cordingley L. 'I should have taken that further' - missed opportunities during cardiovascular risk assessment in patients with psoriasis in UK primary care settings: a mixed-methods study. Health Expect 2016; 19:1121-37. [PMID: 26340682 PMCID: PMC5053232 DOI: 10.1111/hex.12404] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle is common in psoriasis, contributing to worsening disease and increased cardiovascular disease (CVD) risk. CVD risk communication should improve patients' understanding of risk and risk-reducing behaviours; however, the effectiveness of risk screening is debated and evaluation currently limited. OBJECTIVE To examine the process of assessing for and communicating about CVD risk in the context of psoriasis. DESIGN Mixed-methods study in English general practices to (i) determine proportions of CVD risk factors among patients with psoriasis at risk assessment and (ii) examine patient and practitioner experiences of risk communication to identify salient 'process' issues. Audio recordings of consultations informed in-depth interviews with patients and practitioners using tape-assisted recall, analysed with framework analysis. PARTICIPANTS Patients with psoriasis (n = 287) undergoing CVD risk assessment; 29 patients and 12 practitioners interviewed. RESULTS A high proportion of patients had risk factor levels apparent at risk assessment above NICE recommendations: very high waist circumference (52%), obesity (35%), raised blood pressure (29%), smoking (18%) and excess alcohol consumption (18%). There was little evidence of personalized discussion about CVD risk and behaviour change support in consultations. Professionals reported a lack of training in behaviour change, while patients wanted to discuss CVD risk/risk reduction and believed practitioners to be influential in supporting lifestyle management. CONCLUSIONS Despite high levels of risk factors identified, opportunities may be missed in consultations to support patients with psoriasis to understand CVD risk/risk reduction. Practitioners need training in behaviour change techniques to capitalize on 'teachable moments' and increase the effectiveness of risk screening.
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Affiliation(s)
- Pauline A Nelson
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK.
| | - Karen Kane
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Anna Chisholm
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Dermatology and Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Christina J Pearce
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher Keyworth
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Martin K Rutter
- The Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- West Midlands CLAHRC, Keele, UK
| | - Christopher E M Griffiths
- Manchester Centre for Dermatology Research, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Lis Cordingley
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
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The Discrepancy between Patient and Clinician Reported Function in Extremity Bone Metastases. Sarcoma 2016; 2016:1014248. [PMID: 27725792 PMCID: PMC5048023 DOI: 10.1155/2016/1014248] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The Musculoskeletal Tumor Society (MSTS) scoring system measures function and is commonly used but criticized because it was developed to be completed by the clinician and not by the patient. We therefore evaluated if there is a difference between patient and clinician reported function using the MSTS score. Methods. 128 patients with bone metastasis of the lower (n = 100) and upper (n = 28) extremity completed the MSTS score. The MSTS score consists of six domains, scored on a 0 to 5 scale and transformed into an overall score ranging from 0 to 100% with a higher score indicating better function. The MSTS score was also derived from clinicians' reports in the medical record. Results. The median age was 63 years (interquartile range [IQR]: 55–71) and the study included 74 (58%) women. We found that the clinicians' MSTS score (median: 65, IQR: 49–83) overestimated the function as compared to the patient perceived score (median: 57, IQR: 40–70) by 8 points (p < 0.001). Conclusion. Clinician reports overestimate function as compared to the patient perceived score. This is important for acknowledging when informing patients about the expected outcome of treatment and for understanding patients' perceptions.
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27
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Bundy C. Is education enough to improve quality of life in people with chronic inflammatory skin conditions? Br J Dermatol 2016; 174:1179. [PMID: 27317274 DOI: 10.1111/bjd.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Bundy
- Centre for Dermatology Research, University of Manchester, Oxford Road, Manchester, M13 7PT, U.K.
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28
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Hoffman MB, Hill D, Feldman SR. Current challenges and emerging drug delivery strategies for the treatment of psoriasis. Expert Opin Drug Deliv 2016; 13:1461-73. [PMID: 27164301 DOI: 10.1080/17425247.2016.1188801] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Psoriasis is a common skin disorder associated with physical, social, psychological and financial burden. Over the past two decades, advances in our understanding of pathogenesis and increased appreciation for the multifaceted burden of psoriasis has led to new treatment development and better patient outcomes. Yet, surveys demonstrate that many psoriasis patients are either undertreated or are dissatisfied with treatment. There are many barriers that need be overcome to optimize patient outcomes and satisfaction. AREAS COVERED This review covers the current challenges associated with each major psoriasis treatment strategy (topical, phototherapy, oral medications and biologics). It also reviews the challenges associated with the psychosocial aspects of the disease and how they affect treatment outcomes. Patient adherence, inconvenience, high costs, and drug toxicities are all discussed. Then, we review the emerging drug delivery strategies in topical, oral, and biologic therapy. EXPERT OPINION By outlining current treatment challenges and emerging drug delivery strategies, we hope to highlight the deficits in psoriasis treatment and strategies for how to overcome them. Regardless of disease severity, clinicians should use a patient-centered approach. In all cases, we need to balance patients' psychosocial needs, treatment costs, convenience, and effectiveness with patients' preferences in order to optimize treatment outcomes.
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Affiliation(s)
- Melissa B Hoffman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Dane Hill
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
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29
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Tee S, Lim Z, Theng C, Chan K, Giam Y. A prospective cross‐sectional study of anxiety and depression in patients with psoriasis in Singapore. J Eur Acad Dermatol Venereol 2016; 30:1159-64. [DOI: 10.1111/jdv.13615] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/14/2016] [Indexed: 11/28/2022]
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30
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Korman AM, Hill D, Alikhan A, Feldman SR. Impact and management of depression in psoriasis patients. Expert Opin Pharmacother 2016; 17:147-52. [PMID: 26641936 DOI: 10.1517/14656566.2016.1128894] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Abraham M Korman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Dermatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Dane Hill
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Ali Alikhan
- b Department of Dermatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,d Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
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Chisholm A, Nelson PA, Pearce CJ, Keyworth C, Griffiths CEM, Cordingley L, Bundy C. The role of personal models in clinical management: Exploring health care providers' beliefs about psoriasis. Br J Health Psychol 2015. [PMID: 26223822 DOI: 10.1111/bjhp.12148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Individuals' illness representations, including beliefs about psoriasis (a complex immune-mediated condition), and their emotional responses to the condition guide self-management behaviour. It is also plausible that health care providers' illness representations guide their own management of psoriasis. Patients commonly report poor health care experiences related to psoriasis, and the role of health care providers' beliefs, emotions, as well as their knowledge, experiences and behaviours ('personal models') in this is unexplored. This study aimed explore health care providers' personal models of psoriasis. DESIGN AND METHODS Qualitative analysis of 23 semi-structured interviews with health care professionals providing care for psoriasis patients was performed. Purposive sampling achieved maximum variation regarding participant discipline, level of experience, gender and age. The self-regulatory/common sense model informed data collection and initial data analysis. Principles of framework analysis were used to generate predetermined and emergent key issues related to practitioners' personal models. RESULTS Three types of personal model emerged. Sophisticated-Linear Model: 70% of practitioners recognized psoriasis as a complex condition but managed it as a skin condition. Mixed Model: 17% of practitioners recognized/managed some elements of psoriasis as complex and some as a skin condition. Sophisticated-Sophisticated Model: 13% recognized and managed psoriasis as a complex condition. Across the data set, five themes emerged illustrating key patterns underpinning these different models including (1) Recognising complexity, (2) Putting skin first, (3) Taking on the complexities of psoriasis with the patient, (4) Aiming for clearance, and (5) Affective experiences within psoriasis consultations. CONCLUSIONS Health care providers recognized psoriasis as a complex condition but commonly reported managing psoriasis as a simple skin condition. Providers' beliefs and management approaches varied in the extent to which they were consistent with one another; and their emotional experiences during consultations may vary depending upon their personal model. Findings could inform future dermatology training programmes by highlighting the role of health care providers' illness representations in clinical management of the condition. STATEMENT OF CONTRIBUTION What is already known on this subject? Health behaviour is predicted by underlying beliefs and emotions associated with an illness and its treatment. Few studies have examined health care providers' beliefs and emotions about the illnesses they manage in clinical practice. Many patients are dissatisfied with dermatology consultations and wish to be treated holistically. What does this study add? Qualitative exploration of health care providers' beliefs/emotions revealed their personal models of psoriasis. Providers' personal models of psoriasis vary in coherence and are often skin rather than whole person focused. Further investigation of health care providers' models of psoriasis and their impact on health outcomes is needed.
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Affiliation(s)
- Anna Chisholm
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Manchester Centre for Health Psychology, University of Manchester, UK
| | - Pauline A Nelson
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK
| | - Christina J Pearce
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK
| | - Chris Keyworth
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK
| | - Christopher E M Griffiths
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Salford Royal NHS Foundation Trust, Manchester, UK
| | - Lis Cordingley
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Manchester Centre for Health Psychology, University of Manchester, UK
| | - Christine Bundy
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Manchester Centre for Health Psychology, University of Manchester, UK
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32
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Kincse G, Bhattoa PH, Herédi E, Varga J, Szegedi A, Kéri J, Gaál J. Vitamin D3 levels and bone mineral density in patients with psoriasis and/or psoriatic arthritis. J Dermatol 2015; 42:679-84. [PMID: 25959376 DOI: 10.1111/1346-8138.12876] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/26/2015] [Indexed: 12/19/2022]
Abstract
Limited data are available on the vitamin D3 status and bone mineral density (BMD) of patients with psoriasis or with psoriatic arthritis. Our study intended to explore possible correlations between vitamin D status and BMD, as well as among these parameters and the features of the underlying disorder. Seventy-two patients with psoriasis/or psoriatic arthritis (female : male ratio, 40:32; mean age, 58.5 ± 11.6 years; mean duration of follow up, 142.7 ± 147.7 months) participated in the study. We evaluated the characteristic clinical features of the underlying disease, performed bone densitometry of the lumbar spine and the hip region, measured the serum vitamin 25(OH)D3 levels of the patients, and undertook the statistical analysis of the relationships between the clinical and the laboratory parameters. The proportion of patients with a low BMD value did not exceed that seen in the general population. We found an inverse correlation between the serum level of vitamin 25(OH)D3 and body mass index, as well as between the former and the severity of skin involvement. Furthermore, the activity of psoriatic arthritis was significantly higher in patients with inadequate vitamin D3 status. In patients with psoriatic arthritis, BMD significantly exceeded the values measured in patients suffering from psoriatic skin lesions only. Our findings suggest the importance of evaluating the vitamin D3 status and screening for comorbid conditions in patients with psoriasis or psoriatic arthritis. This appears justified, in particular, due to the possible role of hypovitaminosis D3 in provoking the development of skin lesions and joint symptoms.
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Affiliation(s)
- Gyöngyvér Kincse
- Department of Rheumatology, "Kenézy Gyula" Hospital, Debrecen, Hungary
| | - Pál Harjit Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Emese Herédi
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - József Varga
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Szegedi
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Kéri
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Gaál
- Department of Rheumatology, "Kenézy Gyula" Hospital, Debrecen, Hungary.,Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Nelson P, Keyworth C, Chisholm A, Pearce C, Griffiths C, Cordingley L, Bundy C. ‘In someone's clinic but not in
mine
’ – clinicians’ views of supporting lifestyle behaviour change in patients with psoriasis: a qualitative interview study. Br J Dermatol 2014; 171:1116-22. [DOI: 10.1111/bjd.13231] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 02/04/2023]
Affiliation(s)
- P.A. Nelson
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C. Keyworth
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - A. Chisholm
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C.J. Pearce
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C.E.M. Griffiths
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
- Salford Royal NHS Foundation Trust University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - L. Cordingley
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
- Manchester Centre for Health Psychology University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C. Bundy
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
- Manchester Centre for Health Psychology University of Manchester Manchester Academic Health Science Centre Manchester U.K
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Keyworth C, Nelson PA, Chisholm A, Griffiths CEM, Cordingley L, Bundy C. Providing lifestyle behaviour change support for patients with psoriasis: an assessment of the existing training competencies across medical and nursing health professionals. Br J Dermatol 2014; 171:602-8. [PMID: 24749866 DOI: 10.1111/bjd.13067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Psoriasis is associated with unhealthy lifestyle behaviours which contribute to psoriasis onset and severity. Health professionals who manage patients with psoriasis are well placed to support lifestyle change but few feel confident to do so. Little is known about the extent to which health promotion and lifestyle behaviour change (LBC) skills are included within post-qualification training curricula. OBJECTIVES This study aimed to systematically examine the content of post-qualification U.K. training curricula for health professionals across General Practice and Dermatology for evidence of behaviour change skills relating to the promotion of healthy lifestyles. METHODS Core curricula documents from professional organizations were analysed for content to examine the extent to which curricula: (1) mentioned health promotion and LBC as part of the professional role; and/or (2) included health promotion and LBC as explicit training competencies or requirements for qualification. RESULTS Of the 11 core curricula documents analysed, we found 67 occurrences of terms related to LBC and health promotion. Most were in the General Practitioner curriculum (n = 42; 62·7%), followed by the Dermatology Specialist Nurse curriculum (n = 14; 20·9%) and Dermatologist curriculum (n = 11; 16·4%). No occurrences were found in the General Practitioner with a Special Interest in Dermatology curriculum. LBC knowledge, skills and attitudes were not clearly specified and only basic level LBC competencies were included. CONCLUSIONS Development of post-qualification curricula would ensure health professionals are equipped with the necessary knowledge, skills and attitudes to support LBC for patients with psoriasis. This is of particular relevance, given the evidence linking unhealthy lifestyles with psoriasis outcomes.
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Affiliation(s)
- C Keyworth
- Dermatology Research Centre, The University of Manchester, Manchester, U.K
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Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The Prevalence and Odds of Depressive Symptoms and Clinical Depression in Psoriasis Patients: A Systematic Review and Meta-Analysis. J Invest Dermatol 2014; 134:1542-1551. [DOI: 10.1038/jid.2013.508] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/09/2022]
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Abstract
Patient-reported outcomes are major components of decision making in clinical research, reimbursement, health policy and health care for psoriasis. The most important construct in patient-reported outcomes is health-related quality of life (HRQoL) which encompasses the individual's well-being with respect to health. HRQoL cannot directly be measured but is assessed in single dimensions, especially physical, emotional, social and functional aspects. For this, disease- and condition-specific instruments are used. Psoriasis is a chronic inflammatory disease affecting the skin as well as other tissues and organ systems. Patients suffer from a large scale of impairments, for example, physical symptoms, stigmatization and embarrassment, psychological strain and disabilities in profession. Improvement of HRQoL is a major objective of disease management. Current knowledge on determinants of HRQoL and the treatments available increase QoL in clinical care.
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing - IVDP, University Medical Center Hamburg-Eppendorf, Hamburg, Martinistrasse 52, D - 20246 Hamburg, Germany
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Milčić D, Janković S, Vesić S, Milinković M, Janković J. Assessment of quality of life in patients with psoriasis: a study from Serbia. Int J Dermatol 2014; 54:523-8. [PMID: 24738764 DOI: 10.1111/ijd.12391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis has a substantial impact on patients' quality of life. OBJECTIVES The aims of this study were to assess the impact of the clinical severity of psoriasis on patients' quality of life and to determine the effects of psoriasis-related stress on patients' everyday life. METHODS The cross-sectional study was conducted at the Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade. The study included 201 patients (124 men and 77 women), aged 18-70 with a diagnosis of psoriasis, hospitalized or treated as outpatients during 2009. For the assessment of patients' quality of life, the psoriasis disability index (PDI) was used. The stress related to psoriasis was measured with the psoriasis life stress inventory (PLSI) and disease severity with the psoriasis area and severity index (PASI). RESULTS We found moderate correlation between PLSI and all PDI subscales and overall score (correlation coefficients ranged from 0.334 to 0.521). The correlation between PASI and PDI subscales was weak, while we failed to find any significant correlation between PASI and the PLSI. The results of multiple regression analysis indicated that stress, more severe disease, and lower educational level are significant determining factors of a poorer quality of life in patients with psoriasis. CONCLUSION Our results support the importance of assessing the quality of life in psoriasis and effects of stress in patients' adjustment to their condition and may have important implications for a psychological stress management approach in the clinical management of psoriasis.
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Affiliation(s)
- Danijela Milčić
- Institute of Dermatovenereology, Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Wilk I, Kurpas D, Andrzejewski W, Okręglicka-Forysiak E, Gworys B, Kassolik K. The Application of Tensegrity Massage in a Professionally Active Musician - Case Report. Rehabil Nurs 2014; 41:179-92. [PMID: 24711091 DOI: 10.1002/rnj.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of our study was to present options for the application of tensegrity massage to manage pain caused by the overload of soft tissues in musicians. DESIGN Tensegrity massage was applied to a 34-year-old male violinist. METHODS The methodology included a correct positioning and tensegrity massage with individually designed procedure. FINDINGS After therapy, the patient achieved complete pain relief, and relaxation of muscles in the shoulder girdle and free part of the upper arm. The analgesic effect lasted for 6 months after the end of therapy. CONCLUSIONS Massage is an effective method in eliminating pain caused by the overload of soft tissues. If used regularly before physical effort, it can prevent muscle overload. CLINICAL RELEVANCE The presented massage procedure is an effective therapy in pain caused by the overload of soft tissues in musicians and it can be one of the elements of complex physiotherapy in active musicians.
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Affiliation(s)
- Iwona Wilk
- Department of Physiotherapy, Faculty of Physiotherapy, University of Physical Education in Wrocław, Wrocław, Poland
| | - Donata Kurpas
- Department of Family Medicine, Wrocław Medical University, Wrocław, Poland.,Public Higher Medical Professional School in Opole, Opole, Poland
| | - Waldemar Andrzejewski
- Department of Physiotherapy, Faculty of Physiotherapy, University of Physical Education in Wrocław, Wrocław, Poland.,Public Higher Medical Professional School in Opole, Opole, Poland
| | - Ewa Okręglicka-Forysiak
- Department of Psychology, Faculty of Pedagogical and Historical Sciences, University of Wrocław, Wrocław, Poland
| | - Bohdan Gworys
- Department of Anatomy, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Kassolik
- Department of Physiotherapy, Faculty of Physiotherapy, University of Physical Education in Wrocław, Wrocław, Poland.,Public Higher Medical Professional School in Opole, Opole, Poland
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39
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40
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Psoriasis Comprehensive Care. Comput Inform Nurs 2014; 32:30-6. [DOI: 10.1097/cin.0000000000000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Nelson PA, Barker Z, Griffiths CEM, Cordingley L, Chew-Graham CA. 'On the surface': a qualitative study of GPs' and patients' perspectives on psoriasis. BMC FAMILY PRACTICE 2013; 14:158. [PMID: 24138455 PMCID: PMC3828399 DOI: 10.1186/1471-2296-14-158] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/11/2013] [Indexed: 11/14/2022]
Abstract
Background Psoriasis is a chronic, inflammatory skin disease affecting approximately 2% of the UK population and is currently incurable. It produces profound effects on psychological wellbeing and social functioning and has significant associated co-morbidities. The majority of patients with psoriasis are managed in primary care, however in-depth patient and GP perspectives about psoriasis management in this setting are absent from the literature. This article reports an in-depth study which compares and contrasts the perspectives of people with psoriasis and of GPs on the challenges of managing psoriasis in primary care. Methods In-depth, qualitative semi-structured interviews were conducted with a diverse sample of 29 people with psoriasis and 14 GPs. Interviews were coded using principles of Framework Analysis to enable a comparison of patient and practitioner perspectives on key issues and concepts arising from the data. Results Patients perceived GPs to be lacking in confidence in the assessment and management of psoriasis and both groups felt lacking in knowledge and understanding about the condition. While practitioners recognised that psoriasis has physical, emotional and social impact, they assumed patients had expertise in the condition and may not address these issues in consultations. This resulted in patient dissatisfaction and sub-optimal assessment of severity and impact of psoriasis by GPs. Patients and GPs recognised that psoriasis was not being managed as a complex long-term condition, however this appeared less problematic for GPs than for patients who desired a shared management with their GP incorporating appropriate monitoring and timely reviews. Conclusions The research suggests that current routine practice for psoriasis management in primary care is mismatched with the expressed needs of patients. To address these needs, psoriasis must be recognised as a complex long-term condition involving exacting physical, psychological and social demands, co-morbidity and the development of new treatments. General practitioners need to improve both their knowledge and skills in the assessment and management of psoriasis. This in turn will facilitate management of the condition in partnership with patients. Commissioning multi-disciplinary services, which focus on long-term impacts on wellbeing and quality of life, might address current deficits in care.
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Affiliation(s)
- Pauline A Nelson
- Dermatology Research Centre, Institute of Inflammation and Repair, The University of Manchester and Manchester Academic Health Science Centre, Suite 14, 5th Floor, Williamson Building, University of Manchester, Oxford Rd, Manchester M13 9PL, UK.
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Abstract
Introduction Psoriasis is a common, long-term skin condition associated with high levels of psychological distress and considerable life impact. The impact of psoriasis, beyond the skin, is often not recognised and under-treated. Methods This paper explores the relationship between psychological distress and psoriasis including reference to the ‘brain–skin access’. The life impact of psoriasis is discussed and pharmacological interventions which affect distress associated with psoriasis and psychological interventions are reviewed. Evidence from peer-reviewed journals and controlled trials inform the text. Results Psoriasis has a profound impact on mental health and well-being which is under-recognised by clinicians. The sympathetic adrenal medullary axis and hypothalamic pituitary adrenal axis are likely to be involved in the onset of psoriasis and there may also be an effect from inflammation in the skin on the central release of corticotrophin-releasing hormone. Psoriasis can be stigmatising and may affect all aspects of life including relationships, employment, social life and leisure activities. There is some evidence for psychological interventions being effective in the management of distress associated with psoriasis and psoriasis itself. Studies, however, have used disparate outcomes and methods and largely involve low numbers of patients. There is very limited access to psychological support for the patients with psoriasis despite evidence of high levels of psychological distress and considerable life impact. Conclusions Psoriasis is a long-term skin condition associated with high levels of distress and considerable life impact, both of which are under-recognised. Routine screening for distress with access to effective treatment is required. There is a need for high-quality studies to assess the effect of psychological intervention in patients with psoriasis both to inform guidance and facilitate the provision of effective psychological support services.
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Affiliation(s)
- Hee-Sun Moon
- Department of Dermatology, Royal Free NHS Foundation Trust, London, NW3 2QG, UK
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Rizwan M, Reddick CL, Bundy C, Unsworth R, Richards HL, Rhodes LE. Photodermatoses: environmentally induced conditions with high psychological impact. Photochem Photobiol Sci 2013; 12:182-9. [PMID: 22961505 DOI: 10.1039/c2pp25177a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Photodermatoses are a group of skin disorders caused or exacerbated by ultraviolet and/or visible radiation, which collectively affect a high proportion of the population and substantially affect quality of life (QoL). Our objective was to assess the psychological impact of these conditions. Patients with a range of photodermatoses diagnosed at a specialist investigation centre in the UK completed questionnaires evaluating (i) anxiety and (ii) depression, using the Hospital Anxiety and Depression Scale (HADS), (iii) social anxiety, using the Fear of Negative Evaluation measure (FNE), (iv) coping strategies (brief COPE) and (v) QoL, using the Dermatology Life Quality Index (DLQI). Questionnaires were returned by 185 of 260 patients (71.1% response rate). Mean age was 50.2 years (SD 14.5, range 20-85), 80.3% female. Polymorphic light eruption was the most common diagnosis, followed by photoaggravated eczema, other photoaggravated dermatological conditions and solar urticaria. Across the sample, high percentages, i.e. 23% and 7.9% of individuals, showed scores indicating clinical levels of anxiety and depression, respectively. Facial involvement was a strong indicator for depression (t = 2.7, p < 0.01). In regression analyses psychological factors (particularly depression and adaptive coping) were the principle predictors of QoL, accounting for 17.7% of the variance (F = 7.61, p < 0.01), while clinical variables accounted for an additional 10.1% (F = 8.96, p < 0.01), with number of months/year affected exerting a significant effect (p < 0.01). This study demonstrates the high psychological comorbidity of these conditions; more awareness of this is required, with adoption of a biopsychosocial approach to their management.
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Affiliation(s)
- Muneeza Rizwan
- Photobiology Unit, Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal Foundation Hospital, Manchester M6 8HD, UK
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Orfanos CE. How to manage “difficult” patients: the primacy of trust. J Dtsch Dermatol Ges 2013; 11:455-8. [DOI: 10.1111/ddg.12077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nguyen TV, Hong J, Prose NS. Compassionate care: Enhancing physician–patient communication and education in dermatology. J Am Acad Dermatol 2013; 68:353.e1-8. [DOI: 10.1016/j.jaad.2012.10.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
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Ghosh S, Behere RV, Sharma P, Sreejayan K. Psychiatric evaluation in dermatology: an overview. Indian J Dermatol 2013; 58:39-43. [PMID: 23372211 PMCID: PMC3555371 DOI: 10.4103/0019-5154.105286] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Psychodermatology is an exciting field which deals with the close relationship that exists between dermatological and psychiatric disorders. A combined bio-psycho-social approach is essential for effective evaluation and treatment of these conditions. This review aims to give the practicing clinician an overview of psychiatric evaluation in patients with dermatological conditions.
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Affiliation(s)
- Sreyoshi Ghosh
- Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Rehberger P, Müller H, Günther C, Schmitt J. Treatment satisfaction and health status in patients with systemic sclerosis. J Dtsch Dermatol Ges 2012; 10:905-12. [PMID: 22835070 DOI: 10.1111/j.1610-0387.2012.07995.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a rare connective tissue disease. Few data are available on treatment satisfaction, determinants of quality of life, and the health status of dermatology patients with SSc. PATIENTS AND METHODS Cross-sectional study based on 72 consecutive dermatological patients with SSc. Objective clinical data were collected with a physician's questionnaire and subjective data were collected with a patients' questionnaire on disease characteristics, treatment satisfaction, quality of life, depressive symptoms, and Antonovsky's sense of coherence (SOC). We also tested the significance of possible determinants of treatment satisfaction. RESULTS Treatment satisfaction was 72.0 (± 22.2; VAS 1-100). The assessment of professional competence of the treating physician was the most important determinant of treatment satisfaction and was independent of the patient's age and sex. The assessment of physician empathy, information about the disease, and the patient's own evaluation of the severity of disease were also associated with treatment satisfaction. The mean health-related quality of life (QoL; EQ-5D) was 0.74 (± 0.28) and the mean SOC was 72.6 (± 10.6). 58 % of patients reported moderate to severe pain and 13 % were treated for pain symptoms. In 69 % there was evidence of probable depression (CES-D $ 22); 8 % were on antidepressants. CONCLUSIONS Treatment satisfaction was average and correlated especially with the sense of professional competence of the treating physician. In SSc patients, a diminished health-related quality of life as well as pain and evidence of depression are common and seem to be inadequately treated. However, the SOC indicates a lower general vulnerability. In the future, screening for pain and symptoms of depression should part of routine practice in SSc patients and, if necessary, interdisciplinary care should be initiated.
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Affiliation(s)
- Philipp Rehberger
- Clinic and Polyclinic for Dermatology, Medical School of the Technical University of Dresden, Germany.
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Nelson PA, Chew-Graham CA, Griffiths CEM, Cordingley L. Recognition of need in health care consultations: a qualitative study of people with psoriasis. Br J Dermatol 2012; 168:354-61. [PMID: 22880951 DOI: 10.1111/j.1365-2133.2012.11217.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psoriasis is a life-long inflammatory condition that can impact on quality of life, psychological and social functioning. Previous literature suggests patient dissatisfaction with psoriasis management; however, little is known about people's specific experiences of health care consultations. OBJECTIVES The study aimed to explore in depth the perspectives of people living with psoriasis including coping responses, self-care strategies and how consultations with health care professionals in both primary and secondary care are experienced. METHODS Qualitative semistructured interviews were carried out with a diverse sample of 29 people with psoriasis generated purposively and recruited from community sources in North West England. Interviews were coded using Framework Analysis to produce a thematic framework incorporating key emerging issues and concepts. RESULTS Participants experienced psoriasis as a complex condition involving physical, psychological and social challenges, as well as issues of control, but perceived that these were largely unacknowledged by practitioners in health care consultations. Practitioners were perceived as lacking knowledge and expertise in the management of psoriasis, lacking empathy with the effects of psoriasis and failing to manage it as a long-term condition. This perceived lack of support resulted in some participants withdrawing from conventional health service providers and seeking alternative sources of help. CONCLUSIONS Psoriasis needs to be recognized and managed as a complex long-term condition with emotional and social needs that are addressed alongside appropriate diagnosis and regular reviews of treatments which may involve referrals to specialist care.
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Affiliation(s)
- P A Nelson
- Dermatology Research Centre, Institute Inflammation and Repair, The University of Manchester, Manchester, Academic Health Science Centre, Manchester, UK.
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Cordingley L, Nelson PA, Griffiths CEM, Chew-Graham CA. Beyond skin: the need for a new approach to the management of psoriasis in primary care. Br J Gen Pract 2012; 62:568-9. [PMID: 23211152 PMCID: PMC3481489 DOI: 10.3399/bjgp12x658133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Barbara AM, Loeb M, Dolovich L, Brazil K, Russell M. Agreement between self-report and medical records on signs and symptoms of respiratory illness. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:145-52. [PMID: 22273629 DOI: 10.4104/pcrj.2011.00098] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations. AIMS To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills). METHODS Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records. RESULTS Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa = 0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged >5 years) and adults. CONCLUSIONS Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients.
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Affiliation(s)
- Angela M Barbara
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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