急性荨麻疹中的焦虑和非精神病性精神障碍
Anxiety and nonpsychotic mental disorders in acute urticaria.
作者信息
Magen Eli, Merzon Eugene, Ashkenazi Shai, Weizman Abraham, Manor Iris, Magen Israel, Yakov Avi, Geishin Akim, Green Ilan, Golan-Cohen Avivit, Vinker Shlomo, Israel Ariel
机构信息
Leumit Health Services, Tel Aviv-Yafo, 6473817, Israel.
Department of Medicine A, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, 8410501, Israel.
出版信息
Brain Behav Immun Health. 2025 Aug 10;48:101088. doi: 10.1016/j.bbih.2025.101088. eCollection 2025 Oct.
BACKGROUND
Acute urticaria (AU) is characterized by the sudden onset of wheals, angioedema, or both, with symptoms resolving within 6 weeks. While the association between chronic urticaria and mental health disorders is well-documented, the relationship between AU and psychological conditions remains understudied.
OBJECTIVE
To investigate the association between AU and anxiety and personality disorders, and to explore the potential psychoneuroimmunological mechanisms underlying these relationships.
METHODS
We conducted a population-based case-control study using the comprehensive electronic health records database of Leumit Health Services in Israel. The study included 72,805 AU patients and 291,220 matched controls. Subjects were matched for gender, age, ethnicity, year of first documented visit, and socioeconomic status. We analyzed the 20-year prevalence of anxiety disorders, personality disorders, and various nonpsychotic mental disorders in both groups.
RESULTS
AU patients demonstrated significantly higher prevalence of anxiety disorders (7.02 % vs. 5.22 %, , OR = 1.37 [95 % CI: 1.33-1.42]), personality disorders (0.23 % vs. 0.134 %, , OR = 1.73 [95 % CI: 1.44-2.08]), and adjustment disorders (0.91 % vs. 0.67 %, , OR = 1.37 [95 % CI: 1.25-1.50]) compared to controls. Particularly notable were the associations with personality disorders characterized by persistent mood disturbances (OR = 1.91 [95 % CI: 1.53-2.38]) and adjustment disorders with depressive features (OR = 1.49 [95 % CI: 1.27-1.74]).
CONCLUSIONS
Our findings reveal significant associations between AU and various mental health disorders, particularly anxiety and personality disorders. These associations suggest a complex bidirectional relationship mediated through psychoneuroimmunological pathways involving the HPA axis, mast cell activation, and inflammatory cytokines. We recommend implementing specific screening tools (HADS, GAD-7) and a stepped-care approach for integrated dermatological and psychological management of AU patients.
背景
急性荨麻疹（AU）的特征是突然出现风团、血管性水肿或两者兼有，症状在6周内消退。虽然慢性荨麻疹与精神健康障碍之间的关联已有充分记录，但AU与心理状况之间的关系仍研究不足。
目的
研究AU与焦虑症和人格障碍之间的关联，并探讨这些关系背后潜在的心理神经免疫学机制。
方法
我们利用以色列Leumit健康服务机构的综合电子健康记录数据库进行了一项基于人群的病例对照研究。该研究纳入了72,805例AU患者和291,220例匹配的对照。受试者在性别、年龄、种族、首次有记录就诊年份和社会经济地位方面进行了匹配。我们分析了两组中焦虑症、人格障碍和各种非精神病性精神障碍的20年患病率。
结果
与对照组相比，AU患者的焦虑症患病率显著更高（7.02%对5.22%，OR = 1.37 [95% CI：1.33 - 1.42]）、人格障碍患病率（0.23%对0.134%，OR = 1.73 [95% CI：1.44 - 2.08]）和适应障碍患病率（0.91%对0.67%，OR = 1.37 [95% CI：1.25 - 1.50]）。特别值得注意的是与以持续性情绪障碍为特征的人格障碍（OR = 1.91 [95% CI：1.53 - 2.38]）和具有抑郁特征的适应障碍（OR = 1.49 [95% CI：1.27 - 1.74]）之间的关联。
结论
我们的研究结果揭示了AU与各种精神健康障碍之间的显著关联，尤其是焦虑症和人格障碍。这些关联表明存在一种复杂的双向关系，通过涉及下丘脑 - 垂体 - 肾上腺（HPA）轴、肥大细胞活化和炎性细胞因子的心理神经免疫学途径介导。我们建议实施特定的筛查工具（医院焦虑抑郁量表、广泛性焦虑障碍量表 - 7）以及一种阶梯式护理方法，用于对AU患者进行综合的皮肤科和心理管理。
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