Psychiatric morbidity in psoriasis: a study in Himachal Pradesh, India
Keywords:Depressive disorder, Psoriasis, Psychiatric morbidity
Background:Psychiatric morbidity in psoriasis is influenced by socio-cultural factors. Most of the studies in this perspective are done in western setup; to extrapolate them on Indian patients with different demographic and socio-cultural profile may not be appropriate. Our study was designed to evaluate the prevalence and its correlation to various socio-economic variables in Indian patients.
Methods: This was a non-interventional, cross-sectional study, in which 125 consecutive psoriasis patients over one year were screened for psychiatric morbidity. Demographic and disease parameters including Psoriasis Area and Severity Index (PASI), Psoriasis Disability Index (PDI), General Health Questionnaire (GHQ), Comprehensive Psychopathological Rating Scale (CPRS) were recorded along with the severity assessment of psychiatric morbidity and its relation to these variables was analyzed.
Results: Among 125 psoriasis patients, 43 (35.2%) had psychiatric morbidity. Thirty two (26.4%) had depression, 3 (2.4%) had dysthymia, generalized anxiety disorder and adjustment disorder each, and 2 (1.6%) suffered social phobia. A significant increase in psychiatric morbidity was seen with increase in PDI and PASI scores.
Conclusions: There is a significant psychiatric morbidity associated with psoriasis and it increases with severity of the disease.
Richards HL, Ray DW, Kirby B, Mason D, Plant D, Main CJ, Fortune DG, Griffiths CE. Response of the hypothalamic-pituitary-adrenal axis to psychological stress in patients with psoriasis. Br J Dermatol. 2005;153:1114-20.
Fortune DG, Main CJ, O'Sullivan TM, Griffith CEM. Quality of life in patients with psoriasis: the contribution of clinical variables and psoriasis specific stress. Br J Dermatol. 1997;137:755-60.
Devrimci-Ozguven H, Kundakci TN, Kumbasar H, Boyvat A. The depression and quality of life in psoriasis patients. J Eur Acad Dermatol Venereol. 2002;14:267-71.
Dika E. Maibach HI. Exogenous factors and psoriasis. Exog Dermatol. 2004;3:214-22.
Muammer S, Tuba A, Yelda K, Hamdi O. Psychiatric morbidity in dermatology patients: Frequency and results of consultations. Ind J Dermatol. 2006;51:18-22.
Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in psoriasis: prevalence and correlates in India. Ger J Psych. 2005;8:17-22.
SV Rakhesh, D'Souza M, Sahai A. Quality of life in psoriasis: a study from south India. Ind J Dermatol Venereol Leprol. 2008;74:600-6.
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.
Gaikwad R, Deshpande S, Raje S, Dhamdhere DV, Ghate MR. Evaluation of functional impairment in psoriasis. Indian J Dermatol Venereol Leprol. 2006;72:37-40.
Kumar R, Sharma A, Dogra S. Prevalence and clinical patterns of psoriatic arthritis in Indian patients with psoriasis. Indian J Dermatol Venereol Leprol. 2014;80:15-23.
Mehta V, Malhotra SK. Psychiatric evaluation of patients with psoriasis vulgaris and chronic urticaria. Ger J Psych. 2007;10:104-10.
Gautam S, Nijhawan M, Kamal P. Standardization of hindi version of goldberg's general health questionnaire. Ind J Psychiatry. 1987;29:63-6.
Asberg M, Montgomery SA, Perris C. A comprehensive psychopathological rating scale. Acta Psychiatr Scand Suppl. 1978;271:5-27.
World Health Organization. The international classification of diseases - 10th Revision. Geneva: World Health Organization. 1992;3:21-22.
Naldi L, Svensson A, Diepgen T. Randomized clinical trials for psoriasis 1997-2000. The EDEN survey. J Invest Dermatol. 2003;120:738-41.
Simonic E, Kastelan M, Cabrijan L, Stasic A, Gruber F. The influence of psychological factors on the development and course of psoriasis. Acta dermatoveneriologica. 2000:9:2-12.
Hanan MS, M Salem SA, Rania S. Comparative study of psychiatric morbidity and quality of life in psoriasis, vitiligo and alopecia areata. Egy J Dermatol. 2008;4:2-12.
Esposito M, Saraceno R, Giunta A, Maccarone M, Chimenti S. An italian study on psoriasis and depression. Dermatology. 2006;212:123-7.
Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420-6.
Attah Johnson FY, Mostaghimi H. Co-morbidity between dermatologic diseases and psychiatric disorders in Papua New Guinea. Int J Dermatol. 1995;34:244-48.
Bharath S, Shamasundar C, Raghuram R, Subbakrishna DK. Psychiatric morbidity in leprosy and psoriasis - a comparative study. Ind J Lepr. 1997;69:341-6.
Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. American J Clin Dermatol. 2003;833-42.
Ramsay B, O'reagan Myra. A survey of the social and psychological effects of psoriasis. Br J Dermatol. 2008;118:195-201.
Aurangabadkar SJ. Comorbidities in psoriasis. Indian J Dermatol Venereol Leprol. 2013;79:10-7.
Sinniah B, Devi SS, Prashant BS. Epidemiology of psoriasis in Malaysia: a hospital based study. Med J Malaysia. 2010;12:112-4.
Russo PA, Ilchef R, Cooper AJ. Psychiatric morbidity in psoriasis: a review. Australas J Dermatol. 2004;45:155-9.
Magin P, Pond C, Smith W, Watson A, Goode SA. Cross-sectional study of psychological morbidity in patients with acne, psoriasis and atopic dermatitis in specialist dermatology and general practices. J Euro Aca Dermatol and Venereol. 2008;22:1435-44.
Kurd SK, Andrea B, Paul Crits-Christoph, Gelfand JM. Quality of life in psoriasis. Arch Dermatol. 2010;146:891-5.
Sampogna F, Sera F, Abeni D. Measures of clinical severity, quality of life, and psychological distress in patients with psoriasis: a cluster analysis. J Invest Dermatol. 2004;122:602-7.