Schneider G, Hockmann J, Ständer S, Luger T A, Heuft G
Department of Psychosomatics and Psychotherapy, University of Müenster, Germany.
Br J Dermatol. 2006 Jan;154(1):61-6. doi: 10.1111/j.1365-2133.2005.06852.x.
It has been suggested that psychological factors such as repressing anger and altruistic interpersonal behaviour may play a role in the aetiology of chronic itching in prurigo nodularis (PN). Whether these issues are specific for PN or are also common in other chronic skin diseases, e.g. psoriasis, has not been investigated until now.
To investigate psychosomatic problem areas and psychiatric comorbidity in patients with PN in comparison with patients with psoriasis.
Ninety-four patients with PN and 91 patients with psoriasis were administered the Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, State-Trait Anger Expression Inventory, Inventory of Interpersonal Problems, Screening for Somatoform Disorders and the Whiteley Index for hypochondriasis.
After Bonferroni post hoc adjustment, the metrical scales demonstrated no significant differences between patients with PN and those with psoriasis. There was only a tendency to less 'anger-out' and to less autocratic/dominant and more insecure/submissive behaviour in the patients with PN. Patients with PN were, in general, comparable with those with psoriasis with regard to alexithymia, somatization symptoms, hypochondriasis, anxiety and depression, with 18% cases of anxiety and 22% cases of depression.
The hypotheses formulated in the literature on the specific aetiology of PN could not be proven for the majority of patients with PN in our study. Concerning their psychopathology, patients with PN were comparable with those with psoriasis. Therefore the clinical management of PN should include psychosomatic assessment.
有人提出，诸如压抑愤怒和利他性人际行为等心理因素可能在结节性痒疹（PN）慢性瘙痒的病因中起作用。这些问题是否是PN所特有的，还是在其他慢性皮肤病（如银屑病）中也很常见，目前尚未得到研究。
与银屑病患者相比，调查PN患者的心身问题领域和精神共病情况。
对94例PN患者和91例银屑病患者进行了医院焦虑抑郁量表、多伦多述情障碍量表、状态-特质愤怒表达量表、人际问题量表、躯体形式障碍筛查量表和怀特利疑病症指数评估。
经过Bonferroni事后调整，测量量表显示PN患者和银屑病患者之间没有显著差异。PN患者只是有较少“愤怒爆发”、较少专制/主导行为和较多不安全/顺从行为的倾向。总体而言，PN患者在述情障碍、躯体化症状、疑病症、焦虑和抑郁方面与银屑病患者相当，焦虑病例占18%，抑郁病例占22%。
在我们的研究中，大多数PN患者无法证实文献中关于PN特定病因的假设。在精神病理学方面，PN患者与银屑病患者相当。因此，PN的临床管理应包括心身评估。
