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Psychological aspects of patients with psoriasis: Biological and clinical studies

Remröd, Charlotta LU (2014) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2014:116.
Abstract (Swedish)
Popular Abstract in Swedish

Psoriasis är en av våra vanligaste folksjukdomar, som drabbar 2-3 % av den vuxna befolkningen. Man vet i dag att många patienter med psoriasis lider av psykisk ohälsa och sänkt livskvalitet. Sjukdomen i sig innebär ofta en stor psykologisk påfrestning för patienten, men stress och psykisk ohälsa också kan vara en viktig orsak till insjuknande och återfall av psoriasis. Klåda är ett vanligt symtom vid psoriasis, som också visat sig ha en koppling till stress och psykisk ohälsa.

Huden är intimt sammankopplad ned nervsystemet och immunsystemet, vilket kan ligga till grund för sjukdomsutveckling och klåda vid psoriasis. Signalvägar via neuropeptiden substans P (SP) och dess receptor NK-1... (More)
Popular Abstract in Swedish

Psoriasis är en av våra vanligaste folksjukdomar, som drabbar 2-3 % av den vuxna befolkningen. Man vet i dag att många patienter med psoriasis lider av psykisk ohälsa och sänkt livskvalitet. Sjukdomen i sig innebär ofta en stor psykologisk påfrestning för patienten, men stress och psykisk ohälsa också kan vara en viktig orsak till insjuknande och återfall av psoriasis. Klåda är ett vanligt symtom vid psoriasis, som också visat sig ha en koppling till stress och psykisk ohälsa.

Huden är intimt sammankopplad ned nervsystemet och immunsystemet, vilket kan ligga till grund för sjukdomsutveckling och klåda vid psoriasis. Signalvägar via neuropeptiden substans P (SP) och dess receptor NK-1 (NK-1R) anses kunna spela en roll. I avhandlingens delarbete I fann vi signifikant ökad förekomst av SP och NK-1R i hudprover från psoriasisplack jämfört med frisk hud, men grad av klåda kunde inte associeras till ökad förekomst av varken SP eller NK-1R. Grad av kronisk stress, i form av salivkortisol var associerat till ökat förekomst av SP och NK1-R i frisk hud hos patienter med psoriasis. Således talar studieresultaten för att neuroimmunologiska signalvägar via SP kan ha betydelse vid psoriasis.

I avhandlingens delarbete II-IV gjordes omfattande psykologiska undersökningar av 101 patienter med psoriasis. Syftet var att försöka identifiera tydliga kliniska patientgrupper med potentiellt högre grad av psykisk ohälsa. Studierna baseras på enskilda intervjuer och psykologiska självskattningsformulär för kartläggning av psykosociala faktorer, personlighetsprofil samt grad av ångest och depression.

Någon speciell typ av personlighetsprofil för patienter med psoriasis som grupp kunde inte definieras. Patienterna hade inte heller mer ångest eller depressiva symptom än normalbefolkningen. Däremot fann vi att patienter med yngre ålder vid sjukdomsdebut (delarbete II) och patienter med svår klåda (delarbete III) visade sig ha signifikant högre medelvärden av ångest och depression, samt mer pessimistiska personlighetsdrag jämfört med patienter med senare debutålder eller lindrig klåda. Samtidigt fann vi att patienter som upplevde att deras psoriasis försämras av stress hade en mer sårbar och stresskänslig personlighetsprofil, samt mer ångest och depression, än de som inte upplevde att sjukdomen inte försämras av stress (delarbete IV). Således indikerar studieresultaten att de som träffar patienter med psoriasis bör vara extra lyhörda för eventuell psykisk ohälsa hos patienter med yngre debutålder, svår klåda eller patienter som upplever sjukdomsförsämring vid stress. (Less)
Abstract
Psychological distress is well known to be associated with psoriasis, both as a disease consequence, and as a causative factor for onset and exacerbations. Psychoneuroimmunological mechanisms have been suggested to be involved in the pathogenesis of psoriasis and have often been shown to be related to psychological distress and pruritus in psoriasis.

The general aim of this thesis was to investigate psychoneuroimmunological and psychological aspects of patients with plaque psoriasis and to identify potentially psychologically vulnerable individuals by means of clinical characteristics.

In Paper I, a significantly increased immunohistological expression of the neuropeptide substance P (SP) and its receptor neurokinin-1... (More)
Psychological distress is well known to be associated with psoriasis, both as a disease consequence, and as a causative factor for onset and exacerbations. Psychoneuroimmunological mechanisms have been suggested to be involved in the pathogenesis of psoriasis and have often been shown to be related to psychological distress and pruritus in psoriasis.

The general aim of this thesis was to investigate psychoneuroimmunological and psychological aspects of patients with plaque psoriasis and to identify potentially psychologically vulnerable individuals by means of clinical characteristics.

In Paper I, a significantly increased immunohistological expression of the neuropeptide substance P (SP) and its receptor neurokinin-1 (NK-1R) was found in involved psoriatic skin compared with non-involved (n = 13). The expression of SP and NK1-R was, however, not associated with levels of pruritus. The degree of chronic stress indicated by salivary cortisol was significantly associated with increased expression of SP and NK1-R in non-involved psoriatic skin.

Papers II-IV are based on individual psychosocial interviews and three psychometric validated questionnaires (Swedish Universities Scales of Personality, Spielberger State-Trait Anxiety Inventory and Beck Depression Inventory-II) from 101 consecutively recruited patients with psoriasis. Three subgroups of patients with an increased psychological vulnerability could be identified:

Early age at onset of psoriasis, but not disease duration, was significantly associated with pessimistic personality traits and higher scores of anxiety and depression, compared with late onset psoriasis (Paper II). Patients with higher levels of pruritus showed primarily higher scores of depression and also higher scores of anxiety and negative pessimistic personality traits compared with patients with mild pruritus (Paper III). Sixty-four patients (63 %) reported a subjective association between disease exacerbation and stress, and were defined as “stress reactors” (SRs). SRs showed a significantly more vulnerable and stress susceptible personality profile and higher scores of both depression and anxiety, compared with non-stress reactors (Paper IV).

In conclusion, our results indicate that neuroimmunological pathways involving SP may play a key role in psoriasis. From a clinical perspective, our results suggest that when meeting patients with psoriasis, health care professionals should be more attentive to potential psychological vulnerability in patients with young age at onset, and/or severe pruritus, and/or patients who experience disease exacerbation during stress. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Dalgard, Florence, Oslo
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Psoriasis, psychology, Substance P, Neurokinin-1, stress, pruritus, anxiety, depression, personality
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2014:116
pages
86 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Kvinnoklinikens Aula, Jan Waldenströms gata 47, ing 74, plan 3, SUS, Malmö
defense date
2014-11-07 13:00
ISSN
1652-8220
ISBN
978-91-7619-045-6
language
English
LU publication?
yes
id
b287f20b-3ad9-478c-a3b0-478874566f35 (old id 4695395)
date added to LUP
2014-10-15 09:59:30
date last changed
2016-09-19 08:44:45
@phdthesis{b287f20b-3ad9-478c-a3b0-478874566f35,
  abstract     = {Psychological distress is well known to be associated with psoriasis, both as a disease consequence, and as a causative factor for onset and exacerbations. Psychoneuroimmunological mechanisms have been suggested to be involved in the pathogenesis of psoriasis and have often been shown to be related to psychological distress and pruritus in psoriasis. <br/><br>
The general aim of this thesis was to investigate psychoneuroimmunological and psychological aspects of patients with plaque psoriasis and to identify potentially psychologically vulnerable individuals by means of clinical characteristics. <br/><br>
In Paper I, a significantly increased immunohistological expression of the neuropeptide substance P (SP) and its receptor neurokinin-1 (NK-1R) was found in involved psoriatic skin compared with non-involved (n = 13). The expression of SP and NK1-R was, however, not associated with levels of pruritus. The degree of chronic stress indicated by salivary cortisol was significantly associated with increased expression of SP and NK1-R in non-involved psoriatic skin.<br/><br>
Papers II-IV are based on individual psychosocial interviews and three psychometric validated questionnaires (Swedish Universities Scales of Personality, Spielberger State-Trait Anxiety Inventory and Beck Depression Inventory-II) from 101 consecutively recruited patients with psoriasis. Three subgroups of patients with an increased psychological vulnerability could be identified: <br/><br>
Early age at onset of psoriasis, but not disease duration, was significantly associated with pessimistic personality traits and higher scores of anxiety and depression, compared with late onset psoriasis (Paper II). Patients with higher levels of pruritus showed primarily higher scores of depression and also higher scores of anxiety and negative pessimistic personality traits compared with patients with mild pruritus (Paper III). Sixty-four patients (63 %) reported a subjective association between disease exacerbation and stress, and were defined as “stress reactors” (SRs). SRs showed a significantly more vulnerable and stress susceptible personality profile and higher scores of both depression and anxiety, compared with non-stress reactors (Paper IV).<br/><br>
In conclusion, our results indicate that neuroimmunological pathways involving SP may play a key role in psoriasis. From a clinical perspective, our results suggest that when meeting patients with psoriasis, health care professionals should be more attentive to potential psychological vulnerability in patients with young age at onset, and/or severe pruritus, and/or patients who experience disease exacerbation during stress.},
  author       = {Remröd, Charlotta},
  isbn         = {978-91-7619-045-6},
  issn         = {1652-8220},
  keyword      = {Psoriasis,psychology,Substance P,Neurokinin-1,stress,pruritus,anxiety,depression,personality},
  language     = {eng},
  pages        = {86},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Psychological aspects of patients with psoriasis: Biological and clinical studies},
  volume       = {2014:116},
  year         = {2014},
}