Khawaja Abdul Rahman, Bokhari Syed Muhammad Azam, Tariq Rasheed, Atif Shahzad, Muhammad Hanif, Faisal Qadeer, Jafferany Mohammad
AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany).
Prim Care Companion CNS Disord. 2015 Jun 25;17(3). doi: 10.4088/PCC.14m01629. eCollection 2015.
BACKGROUND: Psoriasis is an immune-mediated, chronic disease with a genetic background that involves skin, nails, and joints. The incidence of psoriasis varies from 2.0% to 4.0% depending on the geographical location, ethnic background, and environmental conditions. Recent research has proved that psoriasis is a systemic inflammatory disease with extensive systemic implications. Objectives of the study were to explore the severity of psoriasis, dermatology-related quality of life, and psychiatric health of the patients with reference to sociodemographic, lifestyle, and clinical characteristics. METHOD: Consecutive patients with psoriasis (ICD-10 criteria) from skin outpatient clinics of 3 tertiary care hospitals in Lahore, Pakistan, between November 1, 2012, and December 31, 2012, were assessed in this prospective cross-sectional study. The final sample includes 87 patients who were evaluated for severity of psoriasis (Psoriasis Area Severity Index [PASI]), dermatology-related quality of life (Dermatology Life Quality Index [DLQI]), and psychiatric morbidity (12-item General Health Questionnaire [GHQ-12]) and were assessed on 23 sociodemographic, lifestyle, and clinical variables. RESULTS: Of the 23 variables, the PASI was significantly associated with education and habit of drinking alcohol (P < .05), the DLQI was significantly associated with disturbed eating (P < .05), and the GHQ-12 score was significantly associated with hair disease (P < .05), current income (P < .05), and disturbed eating and sleeping (P < .01). The PASI, DLQI, and GHQ-12 were not usually affected by sociodemographic, lifestyle, and clinical factors, except for some variables such as education of the patient, alcohol intake, eating and sleeping disturbance, and income status. A statistically significant correlation (P < .01) was found between all 3 scores (ie, PASI, DLQI, and GHQ-12). The correlation coefficients of the PASI with the DLQI and GHQ-12 are 0.345 and 0.460, respectively, and that of the DLQI with the GHQ-12 is 0.635. A moderating effect of the DLQI score was found on the relationship between the PASI and GHQ-12 scores. CONCLUSIONS: Psoriasis has an immense impact on the life of patients and common comorbidities in psoriasis including coronary heart disease, depression, cerebrovascular disease, and metabolic syndrome. Screening for these comorbidities in psoriasis patients is essential. Impaired quality of life negatively affects the psyche of patients and initiates coping mechanisms, which may lead to depression and anxiety, social dysfunction, and loss of confidence, and the psychosocial burden of the disease may become more than the physical burden. The dermatologist usually manages physical disease and fails to address the social, emotional, and psychological aspects. Quality of life improves if these psychological aspects are also properly dealt with.
背景:银屑病是一种具有遗传背景的免疫介导性慢性疾病,累及皮肤、指甲和关节。银屑病的发病率因地理位置、种族背景和环境条件而异,在2.0%至4.0%之间。最近的研究证明,银屑病是一种具有广泛全身影响的系统性炎症性疾病。本研究的目的是参照社会人口统计学、生活方式和临床特征,探讨银屑病患者的病情严重程度、皮肤病相关生活质量和心理健康状况。 方法:在这项前瞻性横断面研究中,对2012年11月1日至2012年12月31日期间来自巴基斯坦拉合尔3家三级护理医院皮肤门诊的连续性银屑病患者(符合ICD-10标准)进行评估。最终样本包括87例患者,对他们进行了银屑病严重程度(银屑病面积和严重程度指数[PASI])、皮肤病相关生活质量(皮肤病生活质量指数[DLQI])和精神疾病发病率(12项一般健康问卷[GHQ-12])的评估,并对23项社会人口统计学、生活方式和临床变量进行了评估。 结果:在这23个变量中,PASI与教育程度和饮酒习惯显著相关(P<.05),DLQI与饮食紊乱显著相关(P<.05),GHQ-12评分与毛发疾病(P<.05)、当前收入(P<.05)以及饮食和睡眠紊乱显著相关(P<.01)。除了一些变量,如患者的教育程度、饮酒情况、饮食和睡眠紊乱以及收入状况外,PASI、DLQI和GHQ-12通常不受社会人口统计学、生活方式和临床因素的影响。在所有3个评分(即PASI、DLQI和GHQ-12)之间发现了具有统计学意义的相关性(P<.01)。PASI与DLQI和GHQ-12的相关系数分别为0.345和0.460,DLQI与GHQ-12的相关系数为0.635。发现DLQI评分对PASI和GHQ-12评分之间的关系具有调节作用。 结论:银屑病对患者的生活有巨大影响,银屑病常见的合并症包括冠心病、抑郁症、脑血管疾病和代谢综合征。对银屑病患者进行这些合并症的筛查至关重要。生活质量受损会对患者的心理产生负面影响,并引发应对机制,这可能导致抑郁和焦虑、社会功能障碍以及信心丧失,而且疾病的心理社会负担可能会超过身体负担。皮肤科医生通常只处理身体疾病,而未能解决社会、情感和心理方面的问题。如果这些心理方面的问题也能得到妥善处理,生活质量将会提高。
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