Comparison of psoriasis patients with control groups in terms of psychiatric variables

Aim: A healthy and normal skin is important for physical and psychological well-being. Skin diseases may result in psychiatric disorders and a reduction in quality of life due to their effect on body image, self-esteem and social stigmatization. However, the relationship between skin and mind is not unidirectional; the mind might affect the skin as well. Psychiatric disorders, stress and other psychological factors may act as a precipitating factor in the onset or exacerbation of many skin diseases. But psychological impact depends on a number of factors like coping mechanisms with stress and personality traits. Psoriasis is one of the most known skin diseases affected from stress. There are many studies in the literature examining the relationship between psoriasis, psychiatric morbidity and stress but no study exist examining ego defense mechanisms and attachment styles which play an important role in perceiving stress. Our aim was to compare psoriasis patients with tinea pedis patients and healthy controls in terms of sociodemographic variables, psychiatric comorbidity, depression and anxiety severity, perceived stress, anger, defense mechanisms and attachment style and to see if there was an interaction between these factors, disease severity and quality of life. Method: 32 severe psoriasis and 9 mild psoriasis patients (total 41), 32 tinea pedis patients and 30 healthy controls were enrolled in the study. Patients were first examined by a dermatologist for psoriasis area severity index scoring, then sociodemographic information was collected from all participants and they were evaluated by SCID-I for psychiatric disorders. All participants were examined by Global Assessment of Functionality Scale, Hamilton Depression and Anxiety Scales, Hospital Anxiety and Depression Scale, Spielberger State-Trait Anger Inventory,Perceived Stress Scale, Adult Attachment Style Scale, Ego Defense Mechanisms Scale, Dermatology Life Quality Index and Visual Analog Scale. Results: A high prevalence of psychiatric comorbidity was detected in psoriasis patients. But although there was a high prevalence, only a scarce number of vipatients were diagnosed and treated. Emotional stress was also found to play a role in both the onset and exacerbation of psoriasis. In addition, depression and anxiety severity was found to be significantly higher in both psoriasis and tinea pedis patients compared to healthy controls. Depression and anxiety severity was positively correlated with the use of immature and neurotic defense mechanisms, insecure attachment style, perceived stress level, state and trait anger and disease severity and negatively correlated with anger control, functionality and quality of life. As psoriasis severity increased, medical and psychiatric comorbidity, especially depression and anxiety disorder comorbidity were found to be increased causing a parallel decrease in functionality. But, psoriasis severity was not associated with precipitating or exacerbating stress, quality of life, perceived stress level, anger level and anger control, attachment style and/or defense mechanisms. Conclusion: The high prevalence of psychiatric comorbidity especially in psoriasis patients but to a degree even in tinea pedis patients -which is not accepted as a psychosomatic disease- and the high degree of depression and anxiety severity, perceived stress and anger levelsin both patient groups compared to healthy controls and the association of depression and anxiety severity with the use of immature and neurotic defense mechanisms and insecure attachment style indicates a need to improve liaison studies between dermatology and psychiatry clinics in order to perform a detailed psychiatric evaluation of dermatological patients. Although, our findings once more demonstrated the stress- skin disease interaction, to be able to show a net cause-effect relation prospective studies should be designed evaluating the biologic component of this interaction. Key words; psoriasis, tinea pedis, anxiety, depression, perceived stress, anger, defense mechanisms, attachment style, quality of life