Background:Psoriasis has a detrimental effect on patients’quality of life. H owever, there is a relative dearth of information on which aspects of a patient ’s well-being are affected by successful treatment. Object...Background:Psoriasis has a detrimental effect on patients’quality of life. H owever, there is a relative dearth of information on which aspects of a patient ’s well-being are affected by successful treatment. Objectives:To investigate whether, and to what extent, improvement in the clinical severity of psoriasis induced by photochemotherapy with psoralen plus ultraviolet A (PUVA) translates into meaningful changes in beliefs about psoriasis, coping, stress, distress or disability. Methods:In a prospective study, 72 patients were assessed before PU VA therapy and again when they had achieved clearance of their psoriasis. Result s:Patients demonstrated significant reductions in psoriasis-related disability , psoriasis-related stress or daily hassles and in the frequency of psoriasis- related symptoms. By comparison, there were no significant differences in levels of anxiety, depression or worrying. Similarly, patients’perceptions about cure , potential chronicity, causes, consequences and coping also remained unchanged. Conclusions:These results suggest that while clearance of psoriasis produces a significant reduction in factors specific to psoriasis (disability and stress), it does not impact upon psychological distress, on patients’beliefs about psor iasis or on coping. This observation highlights the complex features of patients ’psychological experience of psoriasis and may provide further impetus for inte gration of psychological interventions into standard care protocols.展开更多
Background:Researchers have indicated that 30-40%of patients with psoriasis suffer significant psychological distress. For the appropriate clinical managem ent of the patient with psoriasis it is important that dermat...Background:Researchers have indicated that 30-40%of patients with psoriasis suffer significant psychological distress. For the appropriate clinical managem ent of the patient with psoriasis it is important that dermatologists are able t o recognize this distress. Objectives:To examine the level of agreement between dermatologists and patients with psoriasis as to the presence of clinically sig nificant psychological distress. Methods:Forty-three consultations between der matologists and patients with psoriasis were assessed. Following the consultatio n two assessments were undertaken:the patients completedmeasuresofanxietyanddep ression,andtheconsulting dermatologists recorded whether they believed the patie nt to be psychologically distressed and, if so, their subsequent action. Attheen dofthestudy,alldermatologistswhoparticipated completed the Jefferson Scale of Ph ysician Empathy. Results:Self-report questionnaires indicated that 37%and 12 %of patients were identified as probable clinical cases for anxiety and depress ion, respectively. In general, the level of agreement between patient rating and dermatologist rating as to the presence of anxiety or depression was low (kappa statistic 0.24 and 0.26, respectively). Dermatologist empathy level did not app ear to influence identification of distress. In only 39%of cases were the psych ological difficulties of significantly distressed patients raised by dermatologi sts during the consultation. Conclusions:Agreement between dermatologists and p atients with psoriasis regarding the presence of clinically significant psycholo gical distress was low. When dermatologists did identify patients as being anxio us and/or depressed, in the majority of cases no further action was taken follow ing the consultation. This study highlights a number of areas for improvement in the psychological management of patients with psoriasis.展开更多
文摘Background:Psoriasis has a detrimental effect on patients’quality of life. H owever, there is a relative dearth of information on which aspects of a patient ’s well-being are affected by successful treatment. Objectives:To investigate whether, and to what extent, improvement in the clinical severity of psoriasis induced by photochemotherapy with psoralen plus ultraviolet A (PUVA) translates into meaningful changes in beliefs about psoriasis, coping, stress, distress or disability. Methods:In a prospective study, 72 patients were assessed before PU VA therapy and again when they had achieved clearance of their psoriasis. Result s:Patients demonstrated significant reductions in psoriasis-related disability , psoriasis-related stress or daily hassles and in the frequency of psoriasis- related symptoms. By comparison, there were no significant differences in levels of anxiety, depression or worrying. Similarly, patients’perceptions about cure , potential chronicity, causes, consequences and coping also remained unchanged. Conclusions:These results suggest that while clearance of psoriasis produces a significant reduction in factors specific to psoriasis (disability and stress), it does not impact upon psychological distress, on patients’beliefs about psor iasis or on coping. This observation highlights the complex features of patients ’psychological experience of psoriasis and may provide further impetus for inte gration of psychological interventions into standard care protocols.
文摘Background:Researchers have indicated that 30-40%of patients with psoriasis suffer significant psychological distress. For the appropriate clinical managem ent of the patient with psoriasis it is important that dermatologists are able t o recognize this distress. Objectives:To examine the level of agreement between dermatologists and patients with psoriasis as to the presence of clinically sig nificant psychological distress. Methods:Forty-three consultations between der matologists and patients with psoriasis were assessed. Following the consultatio n two assessments were undertaken:the patients completedmeasuresofanxietyanddep ression,andtheconsulting dermatologists recorded whether they believed the patie nt to be psychologically distressed and, if so, their subsequent action. Attheen dofthestudy,alldermatologistswhoparticipated completed the Jefferson Scale of Ph ysician Empathy. Results:Self-report questionnaires indicated that 37%and 12 %of patients were identified as probable clinical cases for anxiety and depress ion, respectively. In general, the level of agreement between patient rating and dermatologist rating as to the presence of anxiety or depression was low (kappa statistic 0.24 and 0.26, respectively). Dermatologist empathy level did not app ear to influence identification of distress. In only 39%of cases were the psych ological difficulties of significantly distressed patients raised by dermatologi sts during the consultation. Conclusions:Agreement between dermatologists and p atients with psoriasis regarding the presence of clinically significant psycholo gical distress was low. When dermatologists did identify patients as being anxio us and/or depressed, in the majority of cases no further action was taken follow ing the consultation. This study highlights a number of areas for improvement in the psychological management of patients with psoriasis.
