Mental health in patients with systemic sclerosis: a controlled investigation.

BACKGROUND: Despite the undeniable impact of systemic sclerosis (SS) on quality of life, only a few studies so far have focused on its psychiatric or psychological aspects. We aimed at assessing psychiatric symptoms and self-image in inpatients with SS and comparing them with patients with either a very mild skin condition or a serious skin condition. METHODS: Three groups were recruited: (i) 38 consecutive female inpatients with SS; (ii) 38 age-matched female outpatients with melanocytic naevi; (iii) 35 age-matched female inpatients with melanoma. All participants completed the Zung Anxiety Scale, the Zung Depression Scale and a self-report questionnaire measuring self-perceived personal qualities. Patients with SS were also clinically interviewed by a psychologist. RESULTS: The clinical interview revealed the presence of a psychiatric disorder in most (81%) patients with SS. The Zung scales corroborated the presence of mild to moderate anxiety and depression among patients with SS, who scored significantly higher than patients with either naevi or melanoma on both scales. Scores on the questionnaire assessing self-perceived personal qualities were very similar in the three groups and indicated a fairly high level of self-esteem. CONCLUSIONS: This study suggested that psychosocial issues are quite relevant in patients with SS and underscored the need for a biopsychosocial approach to the clinical management of these patients. Timely detection of psychosocial difficulties and appropriate psychological or psychiatric intervention may represent important steps toward better adherence to medical treatment and improved psychological well-being and quality of life.

Characteristics and possible significance of the answers to Rorschach from patients suffering from psoriasis.

The authors have tried to ascertain the statistical significance of the differences between the answers to H. Rorschach Psychodiagnostic tests given to 80 male and female adult patients, suffering from psoriasis and by 'normal' patients. The absolute frequencies and the averages of the results concerning 55 items obtained through the administration of Rorschach to patients with psoriasis were compared with the results of the test made to the general population. The analysis of the data and of the correlations has confirmed the hypothesis that the pathology of psoriasis, is (seriously) damaging, especially as regards the inhibitions, the cerebral potential, the emotional balance and the social relationships of the patient and furthermore, it can be related, ecologically, to problems concerning the identification-individualization process of the patient. This hypothesis has taken into account the high emotional value, in particular as regards the image of oneself, self-acceptance and self evaluation as well as social acknowledgement, and the communicative value given to the skin.

Psoriasis, stress and psychiatry: psychodynamic characteristics of stressors.

The aim of this investigation was to learn how a stressful event, often very mild, can determine a relapse of psoriasis. The research was carried out with clinical interviews and with the administration of Rorschach Psychoreactive, MMPI and H-T-P tests to 80 in-patients. Our data revealed a high prevalence of psychic disorders: 71.2% of patients showed symptoms which allowed a precise psychiatric diagnosis based on DSM-III-R criteria. 35% had personality disorders, 17.5% were moody, 12.5% were anxious and 6.25% had a schizophrenic trait. The analysis of the stressful events enabled us to determine the presence of a specific event in 88.7% of cases. For the majority of patients, the stressful event was felt as very mild: 67.6% of patients reported the existence of a low-impact stressful event according to the DSM-III-R classification. The average evaluation of the stressful event for all patients, based on a five-stage rating (ranging from 2 'light' to 6 'catastrophic') was 2.56. In conclusion, the analysis of the psychic conditions of in-patients showed that the importance in inducing an acute episode of psoriasis is the meaning of a stressful event as experienced by the patient, i.e. the questioning of his own identity, rather than the intensity of the aforementioned stressful event. In this case, the disease appears to be an attempt to express a defensive somatic response to a possible identity crisis.