Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Net letter
2011:77:5;625-625
doi: 10.4103/0378-6323.84074
PMID: 21860173

Psychiatric morbidity in psoriasis patients: A pilot study

Surender Kumar1 , Dilip Kachhawha2 , Ghanshyam Das Koolwal1 , Sanjay Gehlot1 , Ankit Awasthi1
1 Department of Psychiatry, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
2 Department of Dermatology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India

Correspondence Address:
Dilip Kachhawha
Bunglow No. 3, Outside M.D.M Hospital, Jodhpur, Rajasthan
India
How to cite this article:
Kumar S, Kachhawha D, Koolwal GD, Gehlot S, Awasthi A. Psychiatric morbidity in psoriasis patients: A pilot study. Indian J Dermatol Venereol Leprol 2011;77:625
Copyright: (C)2011 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Psoriasis is a relatively common, chronic, inflammatory, and hyperproliferative skin disease that affects 1.4%-2.0% of the population. The skin and the central nervous system are embryologically related, and they share several hormones, neurotransmitters, and receptors. The skin plays a key role as a sensory organ in the socialization processes throughout the life cycle. Numerous skin changes are seen in response to emotional stimuli, and skin appearance greatly influences body image and self-esteem. It has been reported that psychological stress perturbs the epidermal permeability barrier homeostasis, thus acting as a precipitant for psoriasis. Psychiatric and psychosocial factors play an important role in several skin diseases and the prevalence of psychiatric morbidity in these patients is also very high. Most of the data available on psychosocial dysfunction and psychiatric morbidity in psoriasis is from the West. Only a few studies are available from India.

Approval for this study was obtained from the Ethical Committee of Dr SN Medical College. The study was conducted over a period of 7 months, from June 2009 to December 2009 in the OPD of the Skin and STD Department, MDM Hospital, Jodhpur. We selected 50 psoriasis patients of both sexes between 12-65 years of age. In all patients the diagnosis had been confirmed by a dermatologist. These patients were compared with 50 matched controls. Patients having chronic debilitating disease and other concomitant skin diseases were excluded from the study. The tools used were Goldberg′s General Health Questionnaire-12 (GHQ-12), which is a self-administered 12-item questionnaire that was originally designed for use in the general practice setting as a screening tool. In the GHQ-12 the respondent was asked to compare his recent state of health with his usual state of health. Interpretation of the answer was based on a four-point response scale scored using a bimodal method. The maximum score was 12 and the cutoff score was ≥2. The Hamilton Rating Scale for Anxiety (HAM-A) consisted of 14 items and was heavily focused on somatic symptoms, with a great reliance on the patient′s subjective report. Each item was rated on a 0-4 scale. The Zung Self-Rating Depression Scale (ZSRDS) consisted of 20 items and was used for quantitative measurement of depression. Information gained after administration of these questionnaires was subjected to suitable statistical analysis (Chi-square test and Pearson coefficient of correlation).

Psychiatric morbidity was studied by using the GHQ-12 [Table - 1]. It revealed that 84% of the psoriasis patients had psychiatric morbidity, while only 32% of the control subjects had psychiatric morbidity. The difference was found to be statistically significant (P<0.0001).

Table 1: Distribution according to General Health Questionnaire-12

Anxiety symptoms were assessed using the HAM-A. We found that 52% psoriasis patient had mild anxiety, 36% had mild to moderate anxiety, and 12% had moderate to severe anxiety. The corresponding figures among the controls were 84%, 14%, and 2%, respectively. The difference between the groups was statistically significant (P=0.0023).

The ZSRDS was used to assess depression. It revealed that 68% of the psoriasis patient had mild depression, 18% had moderate depression, 4% had severe depression, and 10% had minimal or no depression, compared to 16%, 2%, 0%, and 82%, respectively, of the control group. The difference between the two groups was extremely significant (P<0.0005).

Thus, depression and anxiety were the most common psychiatric morbidities evident in psoriasis patients. Earlier studies by Picardi et al., [1] Mattoo et al., [2] and Saleh et al.[3] reported psychiatric morbidity in 45%, 24.27%, and 38% of the subjects, respectively, which is quite low as compared to the results of our study. Previous studies by Saleh et al.[3] and Deshpande et al. [4] found low prevalence of anxiety also, with only 58% and 15%-50% of psoriasis patients, respectively, having features of anxiety.

Our study found that 90% of psoriasis patients had depression of some grade, which is very high as compared to 51% reported by Devrimici-Ozguven et al.[5] and 30% reported by Saleh et al. [3] The study by Deshpande et al.[4] found that 50%-97% of psoriasis patient had depression, which is quite close to our own findings.

The relatively higher percentage of psychiatric morbidity found in our study is probably partly due to increased awareness regarding psychiatric illness in the current decade, with people becoming more concerned about their behavior and attitude. Moreover, cosmetic awareness has also increased, and people today are more concerned about their looks and appearance. Competition and the stresses of day-to-day life make psoriasis patients feel inferior and less competent as compared to the normal population, which leads to anxiety and depression. The chronicity of the disease and the frequent relapses are also causes for the increased anxiety and depression in psoriasis patients.

References
1.
Picardi A, Abeni D, Melchi CF. Psychiatric morbidity in dermatologic outpatients: An issue to be recognized. Br J Dermatol 2000;143:983-91.
[Google Scholar]
2.
Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in psoriasis: Prevalence and correlates in India. German J Psychiatry 2005;8:17-22.
[Google Scholar]
3.
Hanen MS, Samar AM, Rania S, Afaf MA. Comparative study of psychiatric morbidity and quality of life in psoriasis, vitiligo and alopecia areata. Egypt Dermatol Online J 2008;4:45-51.
[Google Scholar]
4.
Deshpande N, Desai N, Mundra VK. Psychiatric aspects of Psoriasis. Arch Indian Psychiatry 1998;4:61-4.
[Google Scholar]
5.
Devrimici-Ozguven H, Kundakci N, Kumbaser H, Boyvat A. The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. J Eur Acad Dermatol Venereol 2000;14:267-71.
[Google Scholar]

Fulltext Views
117

PDF downloads
125
Show Sections