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The Emergence and Development of Cognitive Behaviour Therapy in Australia: Observations from an Early Player. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
A 37-year-old male with a 13-year history of atopic dermatitis (AD) was treated with cognitive behavioural stress management. Self-rated stress and extent of AD rash decreased from baseline to the end of treatment, and gains were maintained at follow-up. A significant correlation between stress and extent of AD rash was observed. Discussion focused on the possible role of stress induced immunosuppression on exacerbations of AD, and the need for controlled trials evaluating the treatment procedures used in the current study.
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Nicol NH, Ersser SJ. The role of the nurse educator in managing atopic dermatitis. Immunol Allergy Clin North Am 2011; 30:369-83. [PMID: 20670819 DOI: 10.1016/j.iac.2010.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nursing is making a key contribution to the development and evaluation of atopic dermatitis (AD) education. Educational interventions have long been recommended and used as a critical adjunct at all levels of therapy for patients with AD to enhance therapy effectiveness. These interventions may be directed toward adult patients or the parent/caregiver or child with eczema. Education should be individualized and includes teaching about the chronic or relapsing nature of AD, exacerbating factors, and therapeutic options with benefits, risks, and realistic expectations. This important educational facet of care management is becoming increasingly difficult to accomplish in routine care visits and seems to be equally difficult to measure and evaluate. A limited number of studies to date suggest effectiveness of educational approaches to improve the management of AD. We recommend that an international priority be given to assessing the effects of patient and parental education by nurses and other care providers in AD management using research studies designed to address the common weaknesses of existing randomized studies and the relative benefits of different strategies.
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Klokk M, Stansfeld S, Overland S, Wilhelmsen I, Gotestam KG, Steinshamn S, Mykletun A. Somatization: the under-recognized factor in nonspecific eczema. The Hordaland Health Study (HUSK). Br J Dermatol 2011; 164:593-601. [PMID: 21114476 DOI: 10.1111/j.1365-2133.2010.10150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychodermatology has focused primarily on depression and anxiety in eczema. Skin symptoms are listed among many others for the ICD-10 diagnosis of somatization disorder. Somatization (unexplained somatic symptoms) is highly prevalent in the general population, but its association with eczema is yet to be empirically investigated. OBJECTIVES We therefore explored the association between somatization and eczema by examining the extent of somatization in eczema compared with allergic rhinitis, and by examining if eczema was more strongly associated with somatization than with anxiety and depression. Finally, we aimed to examine the relationship between the site of eczema and somatization for individual somatic symptoms and for somatic symptoms as a whole. METHODS For this population-based cross-sectional study we employed data from the Hordaland Health Study (HUSK) with 15,225 participants aged 41-48 years. Information on nonspecific eczema, allergic rhinitis, somatization, anxiety, depression and other covariates was obtained by self-report. RESULTS The association between nonspecific eczema and somatization was strong and followed a dose-response pattern, as did all somatic symptoms in our index of somatization when analysed separately. The association between nonspecific eczema and somatization was stronger than that between rhinitis and somatization, and also the association between nonspecific eczema and anxiety and depression. In multivariate models, somatization accounted for most of the association between nonspecific eczema and anxiety/depression. In contrast, the association between nonspecific eczema and somatization was robust for adjustment for anxiety/depression. CONCLUSIONS Somatization was strongly associated with nonspecific eczema. This applies to a whole range of somatic symptoms constituting the construct of somatization. There is hardly any mention of somatization in leading dermatological journals, in contrast to anxiety and depression which are frequently reported in eczema. We speculate that this under-recognition of somatization in the dermatological literature may correspond to under-recognition of this factor also in clinical practice.
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Affiliation(s)
- M Klokk
- Department of Physical Medicine and Rehabilitation, Aalesund Hospital, Norway.
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Goodhand JR, Wahed M, Rampton DS. Management of stress in inflammatory bowel disease: a therapeutic option? Expert Rev Gastroenterol Hepatol 2009; 3:661-79. [PMID: 19929586 DOI: 10.1586/egh.09.55] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is increasing evidence that psychological stress and associated mood disorders are linked with, and can adversely affect the course of, inflammatory bowel disease (IBD). Unfortunately, owing to methodological difficulties inherent in undertaking appropriately targeted and blinded trials, there are limited high-quality data regarding the effects on IBD of interventions aimed to ameliorate stress and mood disorders. Nevertheless, patients want psychological intervention as well as conventional medical strategies. Emerging trial evidence supports the suggestion that psychologically orientated therapy may ameliorate IBD-associated mood disorders, but there are no strong data as of yet to indicate that stress management has a beneficial effect on the activity or course of IBD. As yet, which, when and how interventions targeted at psychological stress and mood disturbances should be offered to individual patients with IBD is not clear.
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Affiliation(s)
- James R Goodhand
- Centre for Gastroenterology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
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Abstract
Atopic dermatitis (AD) is a complex disease traditionally involving interaction of genetic, environmental, and immunologic factors. Recent studies suggest psycho-neuro-immunologic factors and emotional stress are important in its evolution. The observations that internal (bacterial infections) or external (psycho-logic) stressors may induce AD flares is explained by studies showing that stress impairs the skin barrier function and favors a shift in immunity toward a T helper type 2 cell/allergic response. Furthermore, those with AD appear to have an inherited hypothalamic deficiency that impairs normal hypothalamic-pituitary-adrenal axis function. Neuropeptides released in the skin may also mediate neurogenic inflammation, including mast cell degranulation. AD causes significant stress and impaired quality of life in patients and their family members. Psychologic and stress-reduction interventions were recently shown to improve patient well-being, and to significantly improve cutaneous manifestations.
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Affiliation(s)
- Jenna Arndt
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 697, Rochester NY 14642, USA
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Ersser SJ, Latter S, Sibley A, Satherley PA, Welbourne S. Psychological and educational interventions for atopic eczema in children. Cochrane Database Syst Rev 2007:CD004054. [PMID: 17636745 DOI: 10.1002/14651858.cd004054.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. There have been no relevant systematic reviews applicable to children. OBJECTIVES To assess the effectiveness of psychological and educational interventions in changing outcomes for children with atopic eczema. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (to September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (from 1966-2005), EMBASE (from 1980 to week 3, 2005 ), PsycINFO (from 1872 to week 1, 2005). On-line: National Research Register, Meta-register of Controlled Trials, ZETOC alerts, SIGLE (August 2005). SELECTION CRITERIA RCTs of psychological or educational interventions, or both, used to manage children with atopic eczema. DATA COLLECTION AND ANALYSIS Two authors independently applied eligibility criteria, assessed trial quality and extracted data. A lack of comparable data prevented data synthesis. MAIN RESULTS Five RCTs met the inclusion criteria. Some included studies required clearer reporting of trial procedures. Rigorous established outcome measures were not always used. Interventions described in all 5 RCTs were adjuncts to conventional therapy. Four focused on intervention directed towards the parents; data synthesis was not possible. Psychological interventions remain virtually unevaluated by studies of robust design; the only included study examined the effect of relaxation techniques (hypnotherapy and biofeedback) on severity. Three educational studies identified significant improvements in disease severity between intervention groups. A recent German trial evaluated long term outcomes and found significant improvements in both disease severity (3 months to 7 years, p=0.0002, 8 to 12 years, p=0.003, 13 to 18 years, p=0.0001) and parental quality of life (3 months to 7 years, p=0.0001, 8 to 12 years p=0.002), for children with atopic eczema. One study found video-based education more effective in improving severity than direct education and the control (discussion) (p<0.001). The single psychological study found relaxation techniques improved clinical severity as compared to the control at 20 weeks (t=2.13) but this was of borderline significance (p=0.042). AUTHORS' CONCLUSIONS A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi-professional eczema school and nurse-led clinics) require further and comparative evaluation to examine their cost-effectiveness and suitability for different health systems.
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Affiliation(s)
- S J Ersser
- Bournemouth University, Institute of Health & Community Studies, Royal London House, Christchurch Road, Bournemouth, Hampshire, UK, BH1 3LT.
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Jafferany M. Psychodermatology: a guide to understanding common psychocutaneous disorders. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2007; 9:203-13. [PMID: 17632653 PMCID: PMC1911167 DOI: 10.4088/pcc.v09n0306] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 10/10/2006] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This review focuses on classification and description of and current treatment recommendations for psychocutaneous disorders. Medication side effects of both psychotropic and dermatologic drugs are also considered. DATA SOURCES A search of the literature from 1951 to 2004 was performed using the MEDLINE search engine. English-language articles were identified using the following search terms: skin and psyche, psychiatry and dermatology, mind and skin, psychocutaneous, and stress and skin. DATA SYNTHESIS The psychotropic agents most frequently used in patients with psychocutaneous disorders are those that target anxiety, depression, and psychosis. Psychiatric side effects of dermatologic drugs can be significant but can occur less frequently than the cutaneous side effects of psychiatric medications. In a majority of patients presenting to dermatologists, effective management of skin conditions requires consideration of associated psychosocial factors. For some dermatologic conditions, there are specific demographic and personality features that commonly associate with disease onset or exacerbation. CONCLUSIONS More than just a cosmetic disfigurement, dermatologic disorders are associated with a variety of psychopathologic problems that can affect the patient, his or her family, and society together. Increased understanding of biopsychosocial approaches and liaison among primary care physicians, psychiatrists, and dermatologists could be very useful and highly beneficial.
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Affiliation(s)
- Mohammad Jafferany
- Division of Child and Adolescent Psychiatry, University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, WA, USA.
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Dennis H, Rostill H, Reed J, Gill S. Factors promoting psychological adjustment to childhood atopic eczema. J Child Health Care 2006; 10:126-39. [PMID: 16707541 DOI: 10.1177/1367493506062552] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has found that children with atopic eczema are more likely to experience psychosocial difficulties than would be expected within the general population. This article aims to explore the relationship between child, parent and family factors in promoting positive adjustment to atopic eczema. Children aged five to 11 years with atopic eczema and their parents were identified from a specialist children's dermatology clinic. Seventy-four respondents completed questionnaires assessing child behaviour, parental well-being and family functioning. Parental psychological health, a supportive family environment and low impact of atopic eczema on family functioning were found to predict lower levels of internalizing behaviour (anxiety, depression and social withdrawal). These findings emphasize the importance of family and parental psychological processes rather than biomedical variables in promoting positive adjustment to atopic eczema.
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Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ, Schachner LA, Sidbury R, Whitmore SE, Sieck CK, Van Voorhees AS. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association "Administrative Regulations for Evidence-Based Clinical Practice Guidelines". J Am Acad Dermatol 2004; 50:391-404. [PMID: 14988682 DOI: 10.1016/j.jaad.2003.08.003] [Citation(s) in RCA: 274] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jon M Hanifin
- American Academy of Dermatology, PO Box 4014, Schaumburg, IL 60168-4014, USA
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Ersser S, Latter S, Surridge H, Buchanan P, Satherley P, Welbourne S. Psychological and educational interventions for atopic eczema in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2003. [DOI: 10.1002/14651858.cd004054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bielory L, Kanuga M. Complementary and alternative interventions in atopic dermatitis. Immunol Allergy Clin North Am 2002. [DOI: 10.1016/s0889-8561(03)00076-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Linnet J, Jemec GB. Anxiety level and severity of skin condition predicts outcome of psychotherapy in atopic dermatitis patients. Int J Dermatol 2001; 40:632-6. [PMID: 11737422 DOI: 10.1046/j.1365-4362.2001.01272.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a skin disease associated with an increased anxiety level. Psychotherapy studies of AD patients report improvement in anxiety level and skin condition after psychotherapy. METHODS This psychotherapy study investigated 32 adult AD patients with mild to severe AD. Sixteen participants received 6 months of brief dynamic psychotherapy, while 16 were controls. The participants were compared using Spielberger's State-Trait Anxiety Index (STAI) and Severity Scoring of Atopic Dermatitis Index (SCORAD) pre- and post-therapy, and at follow-up after 12 months. RESULTS Initially, no outcome differences were found between the two groups; however, a post hoc multiple regression analysis indicated that AD patients with a higher intake level of trait anxiety (TA) showed greater improvement after psychotherapy, in terms of anxiety level and skin condition, than did AD patients with a low intake level of TA. Atopic dermatitis patients with a higher anxiety level, in the no-treatment group, were more likely to discontinue the program. CONCLUSIONS The results suggest that AD patients with a higher anxiety level are more likely to improve their psychologic and dermatologic condition after psychotherapy, but are more vulnerable to nonadherence when no adequate psychologic treatment is offered. The results underscore the importance of proper psychologic assessment and treatment in addition to dermatologic treatment.
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Affiliation(s)
- J Linnet
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark.
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Abstract
The role of psychological factors in certain dermatological conditions is not disputed; however, these processes have been much more thoroughly explored in adult populations than in pediatric populations. Therefore, this article reviews relevant adult and child studies. This article explores three aspects of psychological functioning as they relate to dermatological conditions and their treatment, specifically stress and emotional regulation, behavioral and environmental issues, and compliance. The goal of this article is to give the practicing dermatologist a working overview of psychological factors in pediatric skin disease which will facilitate good communication with families around these issues and referral for adjunctive psychological treatment as needed.
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Affiliation(s)
- D I Czyzewski
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
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Leung DY, Hanifin JM, Charlesworth EN, Li JT, Bernstein IL, Berger WE, Blessing-Moore J, Fineman S, Lee FE, Nicklas RA, Spector SL. Disease management of atopic dermatitis: a practice parameter. Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Work Group on Atopic Dermatitis. Ann Allergy Asthma Immunol 1997; 79:197-211. [PMID: 9305225 DOI: 10.1016/s1081-1206(10)63003-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
It has been estimated that in at least one third of dermatology patients, effective management of the skin disorder involves consideration of associated emotional factors. This article provides an overview of psychodermatology with a focus on the more recent literature and an emphasis on the clinical aspects and psychologic therapies for (1) cutaneous associations of psychiatric disorders and (2) psychiatric associations of certain cutaneous disorders that are known to be influenced by psychosomatic factors. This article also provides an update on the use of psychotropic drugs (i.e., the antianxiety, antidepressant, and antipsychotic agents) for the treatment of mental disorders that occur in conjunction with cutaneous conditions. Some of their other pharmacologic properties, such as the antihistaminic and analgesic effects of some antidepressant agents are also reviewed.
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Affiliation(s)
- M A Gupta
- Department of Psychiatry, University of Western Ontario, London, Canada
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Abstract
Research is reviewed on habit reversal treatment of tics and other nervous habits, and on the components of such treatment. Awareness training and the use of a competing response are found to be its essential components. Studies which evaluate the habit reversal procedure and its variations in the treatment of stuttering are also reviewed.
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Affiliation(s)
- D W Woods
- North Dakota State University, Fargo 58105, USA
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Abstract
Eighteen adults with extensive atopic dermatitis, resistant to conventional treatment, were treated by hypnotherapy, with statistically significant benefit (P < 0.01) measured both subjectively and objectively, which was maintained at up to 2 years where results were available. Twenty children with severe, resistant atopic dermatitis were treated by hypnosis. All but one showed immediate improvement, which was maintained at the following two clinic appointments. In 12 children, replies to a questionnaire at up to 18 months after treatment, showed that 10 had maintained improvement in itching and scratching, nine in sleep disturbance, and seven maintained improvement in itching and scratching, nine in sleep disturbance, and seven maintained improvement in mood.
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Affiliation(s)
- A C Stewart
- Department of Dermatology, Barnsley District General Hospital, U.K
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Dermatology. Health Psychol 1995. [DOI: 10.1007/978-1-4899-3226-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- A D Watkins
- Department of University Medicine, Southampton General Hospital, UK
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Abstract
BACKGROUND The role of anger in the onset or perpetuation of episodes of atopic dermatitis in adults has long been considered an important factor. The objective was to investigate whether atopic patients feel ineffective in dealing with anger and assertiveness when compared with psoriasis patients and control patients. METHODS Thirty-four adult patients with atopic dermatitis were compared to 28 patients with psoriasis and 32 controls, dental patients without major skin disease. Standard measures of anxiety, anger, assertion, depression, and locus of control as well as a measure of anger effectiveness, designed for this study, were used. RESULTS There were significant differences between atopic dermatitis patients and controls in that atopics felt angry more readily but were less likely to express it, were more anxious and less assertive, and felt less effective in expressing anger. The only difference between psoriasis patients and controls was less ability to express anger. Atopic patients were more chronically anxious than those with psoriasis. CONCLUSIONS Adult atopic dermatitis patients are often chronically anxious and feel ineffective in handling anger which suggests that psychological interventions may prove helpful.
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Affiliation(s)
- I H Ginsburg
- Department of Consultation Liaison Psychiatry and Behavioral Medicine, Columbia Presbyterian Medical Center, New York, New York
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Abstract
A survey of 40 patients with long-standing atopic eczema was carried out to test for the presence of certain psychological traits which had been reported in studies in earlier decades. A series of standardised personality tests was administered to these patients and the results compared with the findings for a normal group for each test. It was demonstrated that atopic eczema patients do have significantly high levels of anxiety and problems in dealing with anger and hostility. Whether such findings make any contribution to understanding the aetiology of this disorder is debatable, but they do have implications for treatment and management, and some of these are discussed.
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Affiliation(s)
- A White
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital
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