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Psychiatric comorbidity is seen in half of chronic urticaria patients.

BERLIN -- Half of a consecutive series of patients with severe chronic spontaneous urticaria proved to have a previously undiagnosed psychiatric disorder in a multidisciplinary prospective study.

The most common psychiatric comorbidities were anxiety disorders, depression, and somatization disorders, Dr. Martin Metz reported at the annual congress of the European Academy of Dermatology and Venereology.

"The patients who show psychosomatic comorbidities also have significantly higher levels of emotional distress, and this is the main driver of poor quality of life in patients with chronic spontaneous urticaria. So [dermatologists] think it is important to identify these patients," said Dr. Metz, a dermatologist at Charite University Hospital, Berlin.

He reported on 100 consecutive patients with severe chronic spontaneous urticaria and no known baseline psychiatric disease who were evaluated by dermatologists seeking underlying causes of the skin disease, including food or drug intolerance, chronic infection, and autoreactive phenomena.

The dermatologists also evaluated patients with the Hospital Anxiety and Depression Scale (HADS), the Symptom Check List (SCL-90R), the Screening for Somatoform Symptoms (SOMS), and the Skindex quality of life questionnaires. Psychiatrists followed up on abnormal psychometric test results and made all the formal psychiatric diagnoses after conducting structured psychosomatic interviews.

Twenty-eight percent of patients were found to have underlying chronic infections, 29% had food or drug intolerance, and 21% had autoreactive urticaria.

Overall, 50% of patients received a psychiatric diagnosis: 30% were diagnosed with one or more anxiety disorders, 18% with a depressive disorder, and 18% with a somatoform disorder. Agoraphobia was the most common of the anxiety disorders, with 15% of study participants receiving this diagnosis.

Psychiatric comorbidity appeared to be more common in certain subtypes of chronic spontaneous urticaria, most notably chronic idiopathic urticaria, with a 70% prevalence of psychiatric comorbidity, and autoreactive urticaria, with a 62% comorbidity rate. The patient numbers, however, are too small to make definitive statements on this score, according to Dr. Metz.

He and his fellow dermatologists were particularly impressed with the clinical utility of the HADS because it is short and easy to use in the office and can easily be done by a dermatologist without having any knowledge of psychosomatic medicine. "When patients have an abnormal score you can approach a psychosomatic medicine specialist for follow-up," he explained.

Urticaria patients with psychiatric comorbidities are more emotionally distressed, which results in a poor quality of life.

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Author:Jancin, Bruce
Publication:Clinical Psychiatry News
Article Type:Clinical report
Date:Jan 1, 2010
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