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Psychiatric morbidity among patients with psoriasis and acne: A comparative study.

Byline: Nidhi Jain, Atishay Bukharia, C. R. J. Khess and S. K. Munda

Abstract

Objective

To compare occurrence of psychiatric morbidity among psoriasis and acne patients.

Methods

It was a cross-sectional, comparative study between 50 psoriasis and 50 acne patients in tertiary care hospital. For assessing severity of skin lesions Psoriasis Area Severity Index (PASI) and Global Acne severity (GEA) scales were applied on psoriasis and acne patients, respectively. Then General Health Questionnaire-60 (GHQ-60) was applied on both the patient groups and Mini International Neuropsychiatric Interview (MINI), Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI) were applied on only those patients, who scored [greater than or equal to]12 in GHQ-60 (GHQ-60+ve).

Results

Psoriasis patients had significantly higher psychiatric morbidity, in terms of both GHQ -60 (p=0.00) and MINI (p=0.01). 35 (70%) and 20 (40%) patients were GHQ+ve (GHQ-60score [greater than or equal to]12) and psychiatric morbidity diagnosed by MINI were 22 (44%) and 10 (20%) among psoriasis and acne patients, respectively. The psychiatric diagnosis observed by MINI were: major depressive episode (18%), dysthymia (10%), generalized anxiety disorder (12%), suicidality (12%), alcohol abuse (12%), psychotic disorders (2%) among psoriasis patients and major depressive episode (6%), generalized anxiety disorder (6%), suicidality (6%), obsessive-compulsive disorder (2%), social phobia (2%), alcohol abuse (6%) among acne patients. The severity of psoriasis and acne skin lesions positively correlated with anxiety, depression in both psoriasis and acne patients.

Conclusion

The high psychiatric and psychosocial morbidity in psoriasis and acne patients indicates a need for regular liaison between dermatologists and psychiatrists.

Key words

Psychiatric morbidity, psoriasis, acne.

Introduction

The psychiatric co-morbidity of skin disease is a vital index of the overall associated disability.1 It has been established that at least 30% of dermatology patients suffer from significant psychiatric comorbidity.2 These conditions are often exacerbated by psychosocial stress and develop comorbid major psychiatric syndromes.

Biopsychosocial models in dermatology emphasize the multifactorial nature of skin disease by examining environmental, interpersonal, psychological and biological factors in determining both disease severity and the impact of the condition on functioning and life quality. While neither life threatening nor physically debilitating these conditions can severely affect social and psychological functioning and well-being. Psycho-neuro-immuno-endocrine-cutaneous model was proposed by O'Sullivan et al.3 to explain the mind and body relationship, in which they described the relationship of stress, immune system, environmental factors and skin disorder.

Chronic and severe dermatological disorders are often associated with psychiatric comorbidity, personality characteristics, psychosocial stress, sexual and psychosocial distress and impaired quality of life (QOL). The dermatological conditions most commonly and consistently found to be associated with psychiatric or psychological morbidity are Psoriasis, Acne and atopic eczema.4,5,6

Psoriasis is a common, chronic, disfiguring, inflammatory and proliferative condition of the skin that affects about 0.1% to 11.8% population according to published reports.7 There are studies that have indicated psoriasis patients to be anxious, depressed, engage in excessive worrying, restricted in everyday life as a result of their disease.5,8 Acne is the most common skin disease, affecting nearly 85% of people at some time of their lives.9 Although acne does not cause direct physical impairment, it can produce a significant psychosocial burden.10 It has been suggested that patients with moderate-to-severe acne suffer from low self-esteem, poor body image, and experience constriction of activities and social isolation.11 As part of the emotional impact increased levels of anger, frustration, depression and anxiety are also observed.12

Acne and psoriasis both are common, chronic, non-life threatening conditions with unsatisfactory treatments, having long term complication and significantly affect the psychological well-being of the person therefore present study was aimed at comparing psychiatric morbidity between psoriasis and acne patients.

Methods

Participants

It was a cross-sectional and hospital based study disorders are often associated with psychiatric comorbidity, personality characteristics, psychosocial stress, sexual and psychosocial distress and impaired quality of life (QOL). The dermatological conditions most commonly and consistently found to be associated with psychiatric or psychological morbidity are Psoriasis, Acne and atopic eczema.4,5,6

Psoriasis is a common, chronic, disfiguring, inflammatory and proliferative condition of the skin that affects about 0.1% to 11.8% population according to published reports.7 There are studies that have indicated psoriasis patients to be anxious, depressed, engage in excessive worrying, restricted in everyday life as a result of their disease.5,8 Acne is the most common skin disease, affecting nearly 85% of people at some time of their lives.9 Although acne does not cause direct physical impairment, it can produce a significant psychosocial burden.10 It has been suggested that patients with moderate-to-severe acne suffer from low self-esteem, poor body image, and experience constriction of activities and social isolation.11 As part of the emotional impact increased levels of anger, frustration, depression and anxiety are also observed.12

Acne and psoriasis both are common, chronic, non-life threatening conditions with unsatisfactory treatments, having long term complication and significantly affect the psychological well-being of the person therefore present study was aimed at comparing psychiatric morbidity between psoriasis and acne patients.

Methods

Participants

It was a cross-sectional and hospital based study conducted at tertiary psychiatric hospital. Samples were recruited from the outpatient dermatological department of another tertiary care hospital. After obtaining research ethics committee approval, written informed consent was taken following complete description of the study. Samples were collected by systematic sampling. The sample size consisted of 50 psoriasis and 50 acne patients, aged between 16-50 years, with at least primary level of education. Diagnosis was made according to ICD-10 (International Classification of Diseases - Tenth Edition). Patients with known psychiatric disorders and patients on systemic steroids or isotretinoin were excluded.

Assessment

The instruments used for the assessment of the selected variables were:

1. Socio-demographic and clinical data sheet

A specially designed semi-structured proforma included various socio-demographic variables (age, sex, education, religion, residence, marital status, socioeconomic status) and clinical variables (clinical diagnosis, the age of onset, duration of illness, treatment details) were applied.

2. Psoriasis Area and Severity Index (PASI)13-15

This scale is used to assess the skin area involved and the severity of the dermatological illness. Area coverage is for head, trunk, upper limbs and lower limbs corresponding to 10%, 20%, 30% and 40% of the total body surface area, respectively. Severity assessment is done along a 0-4 scale (0-no lesion, 4-severest possible lesion) for the three target signs of erythema, infiltration and desquamation. The total PASI score, ranging from 0 to 72; 0-3 for mild, >3-15 for moderate and >15-72 for severe psoriasis. PASI is considered as a gold standard for psoriasis.

3. Global Acne Severity Scale (GEA scale)16

This scale is a global scale for acne, which is also validated for photographs of Acne patients. It can be used either in clinical research or by the dermatologist in their office. The US FDA recommends a static global rating scale with six grades 0-5 (clear, almost clear, mild, moderate, severe and very severe).

4. General Health Questionnaire-60 (GHQ-60)17

The GHQ is a self-administered screening test, which is sensitive to presence of psychiatric disorders. The GHQ provides a measure of overall psychological health or wellness. It is a highly valid and reliable scale among the clinical and non-clinical sample. The original GHQ containing 60 items, derived from factor analysis of a checklist of 140 items. Any 12 positive scores on GHQ-60 identify a probable case.

5. Mini International Neuropsychiatric Interview (MINI)18

The MINI was designed as a brief structured interview for the major Axis I psychiatric disorders in DSM-IV and ICD-10. MINI has acceptably high validation and reliability scores than SCID-P and CIDI. It has an additional benefit of consuming less time in its application. (mean 18.7 +- 11.6 min., median 15 min ).

6. Hamilton Rating Scale for Anxiety (HAM-A)19

The HAM-A probe 14 parameters (items) and takes 15-20 minutes to complete the interview and score the results. Each parameter (item) is defined by a series of symptoms and measures both psychic anxiety and somatic anxiety. Each item is rated on 5-point scale 0-4. Total score: 0-56, normal <17; mild anxiety: 18-24; moderate anxiety: 25-30; severe anxiety [greater than or equal to]30.

7. Hamilton Rating Scale for Depression (HAM-D)20,21

The HAM-D form lists 21 items, the scoring is based on the first 17. Ten items are scored on a 5-point scale, ranging from 0 = not present to 4 = severe. Eleven items are scored from 0-2. Total score ranges from 0-62; scores of <7 considered normal; 8 to 13 mild; 14 to 18 moderate; 19 to 22 severe and above 23 very severe. It generally takes 15-20 minutes to complete the interview and score the results. It is the most commonly used measure of depression.

8. Beck Depression Inventory (BDI)22,23

It has a high coefficient alpha, (0.80). Its construct validity has been established, and it is able to differentiate depressed from non-depressed patients. It is a subjective scale in which patient has to give a response to 20 statements on 4-point scale 0-3. Total inventory score is 0-60.

Procedure

After making diagnosis of psoriasis and acne by dermatologist in dermatological outpatient department, relevant socio-demographic and clinical data were applied on both the groups. For assessing the severity of the skin disorder Psoriasis Area Severity Index (PASI) was applied on Psoriasis and Global Acne severity (GEA) scale was applied on acne patients by one of the author who is dermatologist. Then GHQ-60 was applied on both the patient groups and MINI, HAM-A, HAM-D, BDI were applied to only those patients who scored positive in GHQ-60 ([greater than or equal to]12), by psychiatrist authors.

Statistical analysis

Data were analyzed using Statistical Packages for Social Sciences (SPSS Version 22). Descriptive statistics were used to define the sample characteristics. For testing the variance, chi-square, independent t-test was used. Pearson correlation was done to assess the correlation between clinical variables across study groups.

Results

The demographic profile of psoriasis patients was: married (58%), Hindu (84%), rural (38%), education above 12th grade (32%) and mean age of psoriasis patients were 28.24+-7.15 years. This profile was statistically similar to acne patient group except in marital status. In acne majority of patients were unmarried i.e. 64% (Table 1) The severity of skin lesions by using PASI and GEA scores respectively showed that the majority of psoriasis patients were moderate in severity (54%) and majority of acne patients were mild (34%) to moderate (32%) in severity. The mean duration of illness was 49.84+-50.62 months in psoriasis, and 3 6.64+-29.11 months in acne. There was no statistically significant difference in terms of duration of illness. Psoriasis patients had significantly higher psychiatric morbidity than acne patients in terms of both GHQ-60 (p=.00) and MINI (p=.01). In this study 35 (70%) psoriasis patients were GHQ+ve in comparison to 20 (40%) acne patients.

Table 1 Comparison of socio-demographic and clinical profile across psoriasis and acne patients.

Variables###Psoriasis###Acne patients###t/2/Fisher's###df###P value

###patients###N=50###exact test

###N=50

Sex###Male###28 (56%)###21 (42%)###1.96###1###0.16

###Female###22 (44%)###29 (58%)

Education###6th-12th###34 (68%)###28 (56%)###1.52###1###0.22

###Above 12th###16 (32%)###22 (44%)

Religion###Hindu###42 (84%)###35 (70%)###2.77###1###0.10

###Non-Hindu###8 (16%)###15 (30%)

Residence###Rural###19 (38%)###15 (30%)###.71###1###0.40

###Urban###31 (62%)###35 (70%)

Marital status###Married###29 (58%)###18 (36%)###4.86###1###0.03*

###Single###21 (42%)###32 (64%)

Socioeconomic###Higher###0 (0%)###3 (6%)###2.90###1###0.23

status

###Middle###16 (32%)###17 (34%)

###Lower###34 (68%)###30 (60%)

Mean age (years)###28.24+-7.15###26.18+-5.48###1.61###98###0.11

Mean duration of illness (months)###49.84+-50.62###34.64+-29.11###0.33

Table 2 Comparison of psychiatric morbidity across patients with psoriasis and acne.

Variables###Patients with###Patients###2/Fisher's exact###P value

###psoriasis###with Acne###test

###N=50###N=50###(df=1)

###n (%)###n (%)

GHQ 60###<12###15(30%)###30(60%)###9.09###0.00**

###[greater than or equal to]12###35(70%)###20(40%)

Psychiatric###Present###22(44%)###10 (20%)###6.62###0.01*

diagnosis by###Absent###28(56%)###40(80%)

MINI

Table 3 Psychiatric disorders observed by MINI in GHQ+ve psoriasis and acne patients.

###GHQ+ve###GHQ+ve

###2/Fisher's exact

###Psoriasis patients Acne patients###P value

Variables###test

###N=22###N=10

###(df=1)

###n (%)###n (%)

Major depressive###Present###9(40.9%)###3(30.0%)###0.34###0.56

episode (current)###Absent###13 (59.1%)###7 (70.0%)

Major depressive###Present###3 (13.6%)###0 (0.0%)###1.46###0.23

episode (past)###Absent###19 (86.4%)###10 (100.0%)

Major depressive###Present###2 (9.1%)###0 (0.0%)###0.94###0.33

episode, with

melancholic

features

###Absent###20 (90.9%)###10 (100.0%)

Dysthymia###Present###5 (22.7%)###3 (30.0%)###0.19###0.66

###Absent###17 (77.3%)###7 (70.0%)

Suicidality###Present###6 (27.3%)###3 (30.0%)###0.02###0.88

###Absent###16 (72.7%)###7 (70.0%)

(Hypo) Manic###Present###0 (0.0%)###0 (0.0%)###-###-

episode

###Absent###22 (100.0%)###10 (100.0%)

Panic disorder###Present###0 (0.0%)###0 (0.0%)###-###-

###Absent###22 (100.0%)###10 (100.0%)

Agoraphobia###Present###0 (0.0%)###0 (0.0%)###-###-

###Absent###22 (100.0%)###10 (100.0%)

Social phobia###Present###0 (0.0%)###1 (10.0%)###2.20###0.14

###Absent###22 (100.0%)###9 (90%)

Obsessive-###Present###0 (0.0%)###1 (10%)###2.20###0.14

compulsive###Absent###22 (100.0%)###9 (90%)

disorder

Post-traumatic###Present###0 (0.0%)###0 (0.0%)###-###-

stress disorder###Absent###22 (100.0%)###10 (100.0%)

Alcohol###Present###0 (0.0%)###0 (0.0%)###-###-

dependence###Absent###22 (100.0%)###10 (100.0%)

###Present###6 (27.3%)###3 (30.0%)###0.02###0.88

Alcohol abuse

###Absent###16 (72.7%)###7 (70.0%)

Drug dependence###Present###0 (0.0%)###0 (0.0%)###-###-

/abuse###Absent###22 (100.0%)###10 (100.0%)

Psychotic###Present###1 (4.5%)###0 (0.0%)###0.45###0.50

disorders###Absent###21 (95.5%)###10 (100.0%)

###Present###0 (0.0%)###0 (0.0%)###-###-

Anorexia nervosa

###Absent###22 (100.0%)###10 (100.0%)

###Present###0 (0.0%)###0 (0.0%)###-###-

Bulimia nervosa

###Absent###22 (100.0%)###10 (100.0%)

Generalized###Present###6 (27.3%)###3 (30.0%)###0.02###0.88

anxiety disorder###Absent###16 (72.7%)###7 (70.0%)

Antisocial###Present###0 (0.0%)###0 (0.0%)###-###-

personality###Absent###22 (100.0%)###10 (100.0%)

disorder

Table 4 Correlation between severity of skin lesions , anxiety and depression in psoriasis and acne patients.

Psoriasis severity (PASI)###0.50**###0.64**###0.63**

Acne severity (GEA)###0.40**###0.46**###0.47**

Psychiatric morbidity diagnosed by MINI was 22 (44%) and 10 (20%) in psoriasis and acne patients, respectively (Table 2). The psychiatric diagnosis as observed by MINI in GHQ +ve psoriasis patients was: major depressive episode (18%), dysthymia (10%), generalized anxiety disorder (12%), suicidality (12%), alcohol abuse (12%) and psychotic disorders (2%). Psychiatric diagnosis observed by MINI in GHQ+ve acne patients was: major depressive episode (6%), generalized anxiety disorder (6%), suicidality (6%), obsessive-compulsive disorder (2%), social phobia (2%) and alcohol abuse (6%). The psychotic disorder was observed only in the psoriasis group while obsessive compulsive disorder and social phobia were observed only in acne group (Table 3).

Significant positive correlations found between severity of skin lesions (PASI, GEA) and anxiety (HAM-A), depression (HAM-D, BDI) in both psoriasis and acne patients (Table 4). Duration of illness was also positively correlated with anxiety and depression in both the groups, but it was not statistically significant.

Discussion

The present study was conducted by dermatologist and psychiatrists, associated with two different tertiary care hospitals. Most of the scales used were highly valid, reliable and had been recognized worldwide in various studies. We applied General Health Questionnaire-60 (GHQ-60) to select the cases having some psychological problem then patients with GHQ - 60 score [greater than or equal to]12 (GHQ+ve) were subjected to a detailed psychiatric assessment and the diagnosis were made as per Mini International Neuropsychiatric Interview (MINI). In socio- demographic profile samples were matched properly except in marital status. In acne significantly more patients were unmarried in comparison to psoriasis. Acne mainly affects the face and unmarried persons seem to be more worried about their appearance so these patients frequently visit the hospital prior to marriage. This might be probable reason behind unmarried predominance in acne patients.

In terms of mean duration of illness, no significant difference has been found between both the groups. In the current study majority (54%) of psoriasis patients were moderate in severity in PASI scale. These findings are consistent with Mehta and Malhotra24 study findings in which majority (58%) of psoriasis patients had moderate severity. Majority of acne patients were mild (34%) and moderate (32%) in severity in GEA scale. These findings are comparable with Golchai et al.25 study findings. In both groups, disease-specific scales were applied to assess the severity of skin lesions, therefore, a severity of skin lesions were not directly comparable in both the groups.

Current study findings of 70% GHQ-60+ve (GHQ score [greater than or equal to]12) psoriasis patients are corroborated by Sharma et al.26 study in which they reported 53.3% GHQ-12+ve psychiatric morbidity in psoriasis patients. It was found that 40% acne patients were GHQ+ve. These findings are similar to Mallon et al.27 study in which they reported 41% GHQ+ve acne cases and Hughes et al.4 study in which they screened 46% acne patients with general psychiatric comorbidity. Psychiatric morbidity diagnosed by MINI was 22 (44%) and 10 (20%) in psoriasis and acne patients, respectively. Several studies conducted earlier reported variable rates of psychiatric morbidity ranging from 11% to 87% in psoriasis.24,28-31 Psychiatric morbidity among patients with mixed dermatological diseases was found to be 12.2%-47.6%.4,32,33

The prevalence of depression in psoriasis patients detected by current study (18%) is higher than the general population (3-15%).34,35

But these findings are comparable with various studies, in which they reported 10%-30% depression in psoriasis patients.24,26,36,37

Generalized anxiety disorder was 12%, which is supported by 3%-50% anxiety disorders reported in psoriasis patients in various studies.24,26,28,30,32

The current study showed high prevalence of suicidal ideation (12%) as compared to the general population reported 0.01%-1.2%38,39 but it was comparable to 7.2% suicidal ideation in patients with psoriasis5 and 7.3% in patients with acute medical illness.40 In present study, alcohol abuse was 12%, which is comparable to 6% reported in Mehta and Malhotra24 study. The psychotic disorder was 2% in the current study, which is almost similar to 3.3%-4% psychotic disorder reported in previous studies.24,37

Major depressive episode was found in 6% acne patients, which is comparable to 7.9% depressive disorders reported by Yazici et al.41 in acne patients. Generalized anxiety disorder in the current study was 6%, which is supported by 0%-30% anxiety disorder reported in most of the studies of acne.37,41-43 In current study, acne patients manifested no psychotic disorder and only 2% social phobia. Previously, most of the studies conducted on acne patients reported mainly depression and anxiety.43,44 In contrast Behnam et al.45 study showed 34% psychoticism and social phobia was the most common axis I disorder in patients with acne in Ozturk et al.46 study. Acne could lead to psychological problems, including low self-esteem, lower self-attitude and self-worth, low levels of body satisfaction, hastiness, avoidance, depression, anxiety, shame, suicidal thoughts and attempts, and difficulties in applying for a job.47-51

Variation in the prevalence of psychiatric disorders could be related to sample size, patient selection. It could be a reflection of the diagnostic system used i.e. MINI,24 DSM-III-R,30 DSM-IV,46 ICD-1037 and self-reporting questionnaire-24,52 symptom checklist-90.45

Significantly higher psychiatric morbidity was found in psoriasis patients, in comparison to acne. The findings of more psychiatric morbidity in psoriasis can be explained by the 'stress' which is more perceived by these patients. A factor analysis of the Psoriasis Life Stress Inventory revealed two stress-related factors contributing to the psychosocial impact of psoriasis: stress associated with anticipation of the reaction, avoidance by others, and stress associated with patients' experience or beliefs about being evaluated exclusively on the basis of their skin.53 So, stress is largely secondary to the cosmetic disfigurement associated with psoriasis, with great impact on quality of life and possibly resulting in psychological morbidity. Stigmatization also causes stress in psoriasis patients. Vardy et al.54 found that psoriasis patients experienced more 'stigma' than other skin problem patients.

Stigmatization of the disease in psoriasis patients significantly related to poor social support.55 It worsens their quality of life and at times leads to depression. Psychological disturbances, including the perception of stigmatization, are stronger determinants of disability in psoriasis patients than are disease severity, location, and duration.56 Psoriasis negatively impact physical, emotional, social, sexual, professional and financial well-being.57,58 Rapp et al.59 found that in patients with psoriasis the impaired physical and mental functioning was comparable to that seen in cancer, arthritis, hypertension, heart disease, diabetes, and depression. Scharloo et al.60 concluded that perceptions of psoriasis as a severe illness were associated with a greater frequency of medical consultations and poorer quality of life in terms of physical health, social functioning, and mental health.\

Other risk factors for mental illness in psoriasis patients have a high burden of symptoms, strong beliefs about the consequences of the disease, little use of positive coping strategies and substance abuse.61,62

Although we found overall significantly higher psychiatric morbidity in patients with psoriasis (in terms of both General Health Questionnaire-60 and MINI), but the individual diagnosis made by MINI (elements of MINI) was not significantly different in both groups, probably the data were not sufficient to elicit the difference.

Significant positive correlation was found between psoriasis skin lesions and anxiety and depression. Few studies also reported correlation between Psoriasis severity and depression.5,63

Significant positive correlation was found between acne severity and anxiety. Similarly Ozturk et al.46 concluded that social anxiety levels of severe acne cases were significantly higher and a few studies found a positive relationship between severity of acne and severity of anxiety and depression.64,65

In present study, psoriasis patients had significantly higher psychiatric morbidity in comparison to acne. Psoriasis and acne severity positively correlated with anxiety and depression. So, identification and treatment of comorbid psychiatric conditions play an important role for efficient management of such conditions. This was the cross-sectional, hospital-based study, in which sample size was modest, so authors recommended further studies with large sample size.

References

1. Woodruff PWR, Higgins EM, Du Vivier AWP, Wessely S. Psychiatric illness in patients referred to a dermatology- psychiatry clinic. Gen Hosp Psychiatry. 1997;19:29-35.

2. Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. Am J Clin Dermatol. 2003;4:833-42

3. O'Sullivan RL, Lipper G, Lerner EA. The neuro-immuno-cutaneous-endocrine network: Relationship of mind and skin. Arch Dermatol. 1998;134:1431-5.

4. Hughes JE, Barraclough BM, Hamblin LG, White JE. Psychiatric symptoms in dermatology patients. Br J Psychiatry. 1983;143:51-4.

5. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139:846-50.

6. Linnet J, Jemec GB. An assessment of anxiety and dermatology life quality in patients with atopic dermatitis. Br J Dermatol. 1999;140:268-72.

7. Raychaudhuri SP, Farber EM. The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol. 2001;15:16-7.

8. Fortune DG, Richards HL, Griffiths CE. Psychologic factors in psoriasis: consequences, mechanisms, and interventions. Dermatol Clin. 2005;23:681-94.

9. Spencer EH, Ferdowsian HR, Barnard ND. Diet and acne: A review of the evidence. Int J Dermatol. 2009;48:339-47.

10. Koo J. The psychosocial impact of acne: patients' perceptions. J Am Acad Dermatol. 1995;32:S26-S30.

11. Fried RG, Wechsler A. Psychological problems in the acne patient. Dermatol Ther. 2006;19:237-40.

12. Thomas DR. Psychosocial effects of acne. J Cutan Med Surg. 2004;8(Suppl 4):3-5.

13. Feldman SR, Fleischer AB Jr, Reboussin DM, Rapp SR, Exum ML, Clark AR et al. The self-administered psoriasis area and severity index is valid and reliable. J Invest Dermatol. 1996;106:183-6.

14. Puzenat E, Bronsard V, Prey S, Gourraud PA, Aractingi S, Bagot M et al. What are the best outcome measures for assessing plaque psoriasis severity? A systematic review of the literature. J Eur Acad Dermatol Venereol. 2010;24 Suppl 2:10-6.

15. Fredriksson T, Pettersson U. Severe psoriasis - oral therapy with a new retinoid. Dermatologica. 1978;157:238-44.

16. Thiboutot DM, Weiss J, Bucko A. Adapalene-benzoyl peroxide, a fixed-dose combination for the treatment of acne vulgaris: results of a multicenter, randomized double-blind, controlled study. J Am Acad Dermatol. 2007;57:791-9.

17. Goldberg DP, Hillier VF. A Scaled version of the General Health Questionnaire. Psychological Med. 1979;9:139-45.

18. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al. The Mini International Neuropsychiatric Interview. The development and validation of a structured diagnostic interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22-3.

19. Hamilton M. The Assessment of anxiety scales by rating. Br J Med Psychol. 1959;32:50-5.

20. Hamilton MA. Rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.

21. Williams JB: Standardizing the Hamilton Depression Rating Scale: past, present, and future. Eur Arch Psychiatry Clin Neurosci. 2001;251 (suppl 2):II6-II12

22. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.

23. McPherson A, Martin CR. A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent population. J Psychiatr Ment Health Nurs. 2010;17:19-30.

24. Mehta V, Malhotra SK. Psychiatric evaluation of patients with psoriasis vulgaris and chronic urticaria. Ger J Psy. 2007; 10(4):104-110.

25. Golchai J, Khani SH, Heiderzadeh A, Eshkevari SS, Alizade N, Eftekhari H. Comparison of anxiety and depression in patients with Acne vulgaris and healthy individuals. Indian J Dermatol. 2010;55:352-4.

26. Sharma N, Koranne RV, Singh RK. Psychiatric co-morbidity in Psoriasis and vitiligo: A comparative study. J Dermatol. 2001;28:419-23.

27. Mallon E, Newton JN, Klassen A. The quality of life in Acne: a comparison with general medical conditions using generic questionnaires. Br J Dermatol. 1999;140:672-6.

28. Attah Johnson FY, Mostaghimi H. Co-morbidity between dermatologic diseases and psychiatric disorders in Papua New Guinea. Int J Dermatol. 1995;34:244-8.

29. Pulimood S, Rajagopalan B, Rajagopalan M, Jacob M, John JK. Psychiatric morbidity among dermatology inpatients. Nat Med J India. 1996;9:208-10.

30. Deshpande N, Desai N, Mundra VK. Psychiatric aspects of psoriasis. Arch Indian Psychiatry. 1998;4:61-4.

31. Kumar S, Kachhawha D, Das Koolwal G, Gehlot S, Awasthi A. Psychiatric morbidity in psoriasis patients: A pilot study. Indian J Dermatol Venereol Leprol. 2011;77:625.

32. Bharath S, Shamasundar C, Raghuram R, Subbakrishna DK. Psychiatric morbidity in leprosy and psoriasis - a comparative study. Indian J Lepr. 1997;69:341-6.

33. Picardi A, Abeni D, Melchi CF, Puddu P, Pasquini P. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol. 2000;143:983-91.

34. Myers JK, Weissman MM, Tischler GE, Holzer CE, Leaf PJ, Orvaschel H et al. Six-month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry. 1984;41:959-70.

35. Poongothai S, Pradeepa R, Ganesan A, Mohan V. Prevalence of depression in a large urban South Indian population-the Chennai Urban Rural Epidemiology Study (CURES-70). PLoS One. 2009;4:e7185.

36. Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in psoriasis, prevalence and correlates in India. Ger J Psychiatry. 2005;8:17-22.

37. Kumar V, Mattoo SK, Handa S. Psychiatric morbidity in pemphigus and psoriasis: A comparative study from India. Asian J Psychiatr. 2013;6:151-6.

38. Kumar LV. Suicide and its prevention: The urgent need in India. Indian J Psychiatry. 2007;49:81-4.

39. Callahan CM, Hendrie HC, Nienaber NA. Suicidal ideation among older primary care patients. J Am Geriatrics Soc. 1996;44:1205-9.

40. Kishi Y, Robinson RG, Kosier JT. Suicidal ideation among patients with acute life-threatening physical illness: patients with stroke, traumatic brain injury, myocardial infarction, and spinal cord injury. Psychosomatics. 2001;42:382-90.

41. Yazici K, Baz K, Yazici AE, Kokturk A, Tot S, Demirseren D et al. Disease-specific quality of life is associated with anxiety and depression in patients with acne. J Eur Acad Dermatol Venereol. 2004;18:435-9.

42. Mazzotti E, Mastroeni S, Lindau J, Lombardo G, Farina B, Pasquini P. Psychological distress and coping strategies in patients attending a dermatology outpatient clinic. J Eur Acad Dermatol Venereol. 2012;26:746-54.

43. Agrawal JP, Dubey AK, Sharma DK. Study of prevalence of psychiatric morbidity, especially depressive and anxiety disorders in acne vulgaris patients in Hadoti region. J Evol Med Dent Sci. 2014;3:3689-94.

44. Magin P, Adams J, Heading G, Pond D, Smith W. Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelae: results of a qualitative study. Scand J Caring Sci. 2008;22:430-6.

45. Behnam B, Taheri R, Ghorbani R, Allameh P. Psychological impairments in the patients with acne. Indian J Dermatol. 2013;58:26-9.

46. Ozturk A, Deveci E, Bagcioglu E, Atalay F, Serdar Z. Anxiety, depression, social phobia, and quality of life in Turkish patients with acne and their relationships with the severity of acne. Turk J Med Sci. 2013;43:660-6.

47. Mulder MMS, Sigurdsson V, van Zuuren EJ, Klaassen EJ, Faber JA, de Wit JB et al. Psychosocial impact of Acne vulgaris: evaluation of the relation between a change in clinical acne severity and psychosocial state. Dermatology. 2001;203:124-30.

48. Layton AM. Disorders of the sebaceous glands. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. Oxford: Wiley-Blackwell; 2010. P. 42.1-42.89.

49. Dalgard F, Gieler U, Holm JO, Bjertness E, Hauser S. Self-esteem and body satisfaction among late adolescents with acne: results from a population survey. J Am Acad Dermatol. 2008;59:746-51.

50. Uhlenhake E, Yentzer BA, Feldman SR. Acne vulgaris and depression: a retrospective examination. J Cosmet Dermatol. 2010;9:59-63.

51. Shahzad N, Nasir J, Ikram U, Asmaa-ul-Haque UA, Qadir A, Sohail MA. Frequency and psychosocial impact of acne on university and college students. J Coll Physicians Surg Pak. 2011;21:442-3.

52. Sarkar S, Sarkar A, Saha R, Sarkar T. Psoriasis and psychiatric morbidity: a profile from a tertiary care centre of Eastern India. J Family Med Prim Care. 2014;3:29-32.

53. 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.

54. Vardy D, Besser A, Amir M. Experiences of stigmatization play a role in mediating the impact of disease severity on quality of life in psoriasis patients. Br J Dermatol. 2002;147:736-42.

55. Lu Y, Duller P, Van Der Valk PGM, Evers AWM. Helplessness as predictor of perceived stigmatization in patients with psoriasis and atopic dermatitis. Dermatol Psychosom. 2003;14:146-50.

56. Richards HL, Fortune DG, Griffiths CE, Main CJ. The contribution of perceptions of stigmatisation to disability in patients with psoriasis. J Psychosom Res. 2001;50:11-5.

57. Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y. The psychosocial burden of psoriasis. Am J Clin Dermatol. 2005;6:383-92.

58. Meyer N, Paul C, Feneron D, Bardoulat I, Thiriet C, Camara C et al. Psoriasis: an epidemiological evaluation of disease burden in 590 patients. J Eur Acad Dermatol Venereol. 2010;24:1075-82.

59. Rapp SR, Feldman SR, Exum ML, Fleischer AB, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41:401-7.

60. Scharloo M, Kaptein AA, Weinman, J. Patients' illness perceptions and coping as predictors of functional status in psoriasis: A 1-year follow-up. Br J Dermatol. 2002;142:899-907.

61. Fortune DG, Richards HL, Griffiths CEM, Main CJ. Psychological stress, distress and disability in patients with psoriasis: Consensus and variation in the contribution of illness perceptions, coping and alexithymia. Br J Clin Psychol. 2002;41:157-74.

62. Gupta MA, Gupta AK. Psoriasis and sex: a study of moderately to severely affected patients. Int J Dermatol. 1997;36:259-62.

63. Madhulika AG, Nicholas JS, Aditya KG. Suicidal ideation in psoriasis. Int J Dermatol. 1993;32:188-90.

64. Grahame V, Dick DC, Morton CM. The psychological correlates of treatment efficacy in acne. Dermatol Psychosom. 2002;3:119-25.

65. Arnold L. Dermatology. In: Levenson JL, ed. Essentials of Psychosomatic Medicine. Arlington, VA: American Psychiatric Publishing; 2007. P. 217-39.
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Publication:Journal of Pakistan Association of Dermatologists
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Date:Dec 31, 2016
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