Target/therapies for chronic recurrent erythema nodosum leprosum.

A Type 2 lepra reaction or erythema nodosum leprosum is an anticipated complication in the lepromatous spectrum of leprosy cases. It is an example of an immune complex-mediated complement activated disease (Type III hypersensitivity reaction). Hence, we tried to target the inflammatory mediators and the mental stressors for the possible management strategies.

Infertility-related stress and the risk of antidepressants prescription in women: a 10-year register study.

STUDY QUESTION: Is the first-time redeemed prescription of antidepressants predicted by the level of infertility-related stress in women seeking ART treatment? SUMMARY ANSWER: Infertility-related stress in the personal and marital domains and general physical stress reactions were significant predictors of a first redeemed prescription of antidepressants after ART treatment in this 10-year follow-up cohort study. WHAT IS KNOWN ALREADY: The literature has found inconsistent findings regarding the association between infertility-related stress and later psychological adjustment in fertility patients. The association between infertility-related stress and later prescription of antidepressants had never been explored in long-term cohort studies. STUDY DESIGN, SIZE, DURATION: All women (n = 1169) who participated in the Copenhagen Cohort Multi-centre Psychosocial Infertility (COMPI) cohort study in the year 2000 (questionnaire data) were linked with the register-based Danish National ART-Couple (DANAC) I cohort, which includes women and their partners having received ART treatment from 1 January 1994 to 30 September 2009. The study population were among other national health and sociodemographic registers further linked with the Danish National Prescription Registry. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women initiating ART treatment were followed until they had redeemed the first prescription of antidepressants or until 31 December 2009. Logistic regression analyses were conducted to test the association between general physical stress reactions and infertility-related stress in the personal, marital and social domains, respectively, and a future redeemed prescription of antidepressants. Age, education level, marital status, number of fertility treatments prior to study inclusion and female infertility diagnosis were included as covariates in the adjusted analyses. Further, the analysis was stratified according to childbirth or no childbirth during follow-up. MAIN RESULTS AND THE ROLE OF CHANCE: The final sample consisted of 1009 women with a mean age of 31.8 years. At study inclusion, women had tried to conceive for an average of 3.45 years. At 10-year follow-up, a total of 13.7% of women had a first redeemed prescription of antidepressant medication. The adjusted odds ratio (OR) showed that high general physical stress predicted the later prescription of antidepressants (adjusted (adj) OR = 2.85, 95% confidence interval (CI) 1.96-4.16). Regarding infertility-related stress domains, high personal stress (adj OR = 2.14, 95% CI 1.46-3.13) and high marital stress (adj OR = 1.80, 95% CI 1.23-2.64) were significantly associated with the later prescription of antidepressants. Social stress was not significantly associated with the future redeemed prescription of antidepressants (adj OR = 1.10, 95% CI 0.76-1.61). Among women not having achieved childbirth during follow-up, the risk of a first-time prescription of antidepressants associated with infertility-specific stress was higher compared to the risk among women having childbirth during follow-up. LIMITATIONS, REASONS FOR CAUTION: This study did not account for potential mediating factors, such as negative life events, which could be associated with the prescription of antidepressants. Second, we are not able to know if these women had sought psychological support during follow-up. Additionally, antidepressants might be prescribed for other health conditions than depressive disorders. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest that women presenting high infertility-related stress in the personal and marital domains were at higher risk of redeemed first-time prescription of antidepressants after ART, independently of having delivered a child or not after initiation of ART treatment. Women would benefit from an initial screening specifically for high infertility-related stress. The COMPI Fertility Problem Stress Scales can be used by clinical staff in order to identify women in need of psychological support before starting ART treatments. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the Portuguese Foundation for Science and Technology (FCT) under an individual doctoral grant attributed to the first author (SFRH/BD/103234/2014). The establishment of the DANAC I cohort was funded by Rosa Ebba Hansen's Fund. The COMPI Infertility Cohort project was supported by The Danish Health Insurance Fund (J.nr. 11/097-97), the Else and Mogens Wedell-Wedellsborgs Fund, the manager E. Danielsens and Wife's Fund, the merchant L.F. Foghts Fund, the Jacob Madsen and Wife Olga Madsens Fund. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER: NA.

The psychosocial impact of vitiligo in Indian patients.

BACKGROUND: Vitiligo has a special significance in Indian patients both because depigmentation is obvious on darker skin and the enormous stigma associated with the disease in the culture. AIMS: This study was carried out to determine the beliefs about causation, aspects of the disease that cause concern, medical, and psychosocial needs of the patients, expectation from treatment and from the treating physician, and effects of disease on the patient's life. METHODS: Semi-structured interviews were conducted in 50 patients with vitiligo. Purposive sampling was used to select subjects for the study. Each interview was recorded on an audio-cassette and transcripts were analyzed to identify significant issues and concerns. RESULTS: Patients had a range of concerns regarding their disease such as physical appearance, progression of white patches onto exposed skin and the whole body, ostracism, social restriction, dietary restrictions, difficulty in getting jobs, and they considered it to be a significant barrier to getting married. The condition was perceived to be a serious illness. Stigma and suicidal ideation was reported. While there were several misconceptions about the cause of vitiligo, most patients did not think their disease was contagious, heritable or related to leprosy. Multiple medical consultations were frequent. Complete repigmentation was strongly desired, but a lesser degree of repigmentation was acceptable if progression of disease could be arrested. The problems were perceived to be more severe in women. The disease imposed a significant financial burden. CONCLUSION: Addressing psychosocial factors is an important aspect of the management of vitiligo, particularly in patients from communities where the disease is greatly stigmatizing.

Role of cultural factors in the biopsychosocial model of psychosomatic skin diseases: an Indian perspective.

Cultural factors can influence the experience and presentation of diseases, including psychosomatic diseases. Psychosomatic dermatology refers to skin diseases in which psychogenic causes, consequences, or concomitant circumstances have an essential and therapeutically important influence. Indian culture is one of the oldest and most diverse, and encompasses the various traditions and beliefs of people all over the vast Indian subcontinent. This paper discusses how cultural factors can influence the clinical course of some dermatologic problems and reviews the cultural dimension of some common skin conditions in India, including vitiligo, facial hypermelanosis, acne, atopic dermatitis, psoriasis, and leprosy. The paper illustrates some examples of the contributions of a patient's cultural values, beliefs, and practices to the biopsychosocial model of psychosomatic skin disorders.

Evaluation of psychodynamic psychotherapy in a community mental health center.

This study describes an evaluation of the effectiveness of psychodynamic psychotherapy provided in an outpatient community mental health clinic. The study used a single group pretest-posttest design involving 78 clients. Clinical outcomes included overall psychosocial functioning and quality of life, level of subjective distress, interpersonal functioning and role functioning, measured by the Outcome Questionnaire (Lambert, Hansen, Umpress, Lunnen Okilshi, & Burlingame, 2000). Clients showed statistically significant improvement from pretest (first sessions) to completion of treatment in overall functioning, and quality of life, level of subjective distress, interpersonal functioning and role functioning. Eighty-five percent of clients made statistically and clinically significant change. Calculation of effect sizes for each outcome found moderate to strong change effects ranging from d = .4 to .9. The study illustrates a method of intervention research that therapists and agencies can use to integrate practical evaluation methods into their clinical services in order to improve mental health service to clients, to demonstrate the effectiveness of interventions, and to provide data to support coverage for needed services for clients.

Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria.

BACKGROUND: The possibility of a causal influence of emotional stress, especially of stressful life events, on the course of various skin diseases has long been postulated. Previous reports addressing its influence on skin psoriasis and chronic urticaria have been mainly anecdotal. OBJECTIVE: The aim of this study was to evaluate the stressful events of life within 1 year preceding onset or exacerbation of skin disease in patients of psoriasis vulgaris and chronic urticaria. METHOD: Fifty consecutive clinically diagnosed psoriasis patients and 50 consecutive clinically diagnosed chronic urticaria patients were examined clinically and administered Gurmeet Singh's presumptive stressful life events scale. RESULTS: Stressful life events were seen in 26% of the patients in the psoriasis vulgaris group and 16% of the patients in the chronic urticaria group within 1 year preceding onset or exacerbation of skin disease. In the psoriasis vulgaris group, the most common stressful life event seen was financial loss or problems (8%), followed by death of close family member (4%), sexual problems (4%), family conflict (2%), major personal illness or injury (2%), and transfer or change in working conditions (2%), failure in examinations (2%), family member unemployed (2%), illness of family member (2%), getting married or engaged (2%), miscellaneous (2%). In the chronic urticaria group, the most common stressful life event seen was death of a close family member (6%), followed by family conflict (2%), financial loss or problems (2%), sexual problems (2%), illness of family member (2%), getting married or engaged (2%), trouble at work with colleagues, superiors, or subordinates (2%), going on a pleasure trip (2%) and extramarital relations (2%). CONCLUSION: Psychological stress plays a significant role in triggering or exacerbating dermatological diseases. Our study indicates the role of relaxation therapies and stress management programs in chronic diseases such as psoriasis and chronic urticaria. Psychological interventions can help individuals to reinterpret events and develop strategies to cope with stressful events, thus decreasing morbidity due to these diseases.

An assessment of emotional pain among subjects with chronic dermatological problems in Lagos, Nigeria.

BACKGROUND: In dermatology, it is known that there is a significant co-morbidity between dermatological disorders and psychological complications, and it has been estimated that in at least one-third of patients with skin diseases, their effective management involves consideration of associated emotional factors. In Africa, particularly Nigeria, despite the prevalent dermatological disorders with their possible attendant mental health complications, little or no work has been done in the field of psycho-dermatology, hence the rationale for this study. METHODS: A prospective study was carried out in the dermatology/venerology clinic of Lagos University Teaching Hospital (LUTH). Ethical clearance and consent were obtained to conduct the study. The subjects were selected by simple random sampling from adult patients that have had their dermatological disorders for at least six months before presentation in the clinic. Those with other co-existing chronic medical illness such as hypertension, diabetes, or haemoglobinopathy were excluded from the study. Controls were obtained to match for age and sex from apparently healthy workers in a nearby general hospital. Each subject was evaluated with a questionnaire to obtain necessary socio-demographic data: Psychache scale (PAS), and subscales C, D, and J of Symptom Check List (SCL-90). The data generated was analyzed to obtain means, and t-test was used to compare the means; p = 0.05 was taken as being significant. The analyses were done using SPSS version 10. RESULTS: Eighty subjects with dermatological disorders, and of equal sex distribution, were evaluated, with mean age of 33 +/- 12.1 years. Equal number of controls matched for sex and mean age of 34.6 +/- 7.3 years were also evaluated. Among the subjects, 16.3% had Acne, followed by Urticaria (13.8%), Vitiligo (12.5%), Tinea (11.3%), Hansen's disease (5%), and others (41.1%). From assessment with PAS and SCL subscales, the mean scores by the subjects were much higher than those of the controls and in each group the males scored slightly higher than their female counterparts. On assessment with PAS, the subjects had much higher mean score of 28.94 +/- 12.61 and the controls: 18.92 +/- 7.1 with "t" of 6.19*; and the difference was statistically significant at p < 0.05 and critical "t" of 1.66. On SCL; subscale C, the mean scores for the subjects and controls were: 7.89 +/- 7.69 and 5.02 +/- 5.23 respectively and the difference was statistically significant with "t" of 2.75*. For subscale D, the mean score by the subjects was 11.09 +/- 10.56, and the controls had 4.84 +/- 6.08; and statistically significant difference with "t" of 4.59*. On subscale J, the subjects' mean score was 4.68 +/- 5.44, the controls: 1.98 +/- 3.19 with statistically significant "t" of 3.83*. CONCLUSIONS: The results showed that subjects with dermatological disorders suffered from significant emotional pain when compared to the healthy controls; the males had higher mean scores on PAS and SCL subscales, hence more likely to suffer emotional pain than their female counterparts. Finally, the need to have consultation-liaison psychiatry in the dermatology facilities in Nigeria was emphasized.

Recent advances in the neurophysiology of chronic pain.

UNLABELLED: The chronic pain syndrome patient has become the 'leper' of emergency medicine. There are no emergency medicine guidelines and minimal research into managing this challenging group of patients. OBJECTIVE: To summarize the recent advances in laboratory research into the development of chronic pain that have relevance to emergency management. When the level of supporting evidence is low, it is imperative that emergency physicians understand the physiology that underpins those expert opinions upon which they base their treatment strategies. METHODS: Literature was searched via Medline, Cochrane, Cinahl, and PsycINFO from 1996 to 2004, under 'chronic pain and emergency management'. Medline from 1996 was searched for 'chronic pain and prevention', 'chronic pain and emergency' and 'chronic pain'. Bibliographies were manually searched for older keynote articles. RESULTS: Advances in understanding the biochemical changes of chronic pain are paralleled by lesser known advances in delineation of the corticol processing. CONCLUSIONS: Drug manipulation causes complex action and reaction in chronic pain. Emergency physicians must also optimize cognitive and behavioural aspects of treatment to successfully manage this systemic disease.

[The patient with Hansen's disease confronts his distress]. / Le hansénien face à son angoisse.

This article is about the effect of Hansen's disease on the personality of 29 patients of the Institute of Applied Leprology of Dakar, Foundation of the Order of Malta. This approach to the distress of these patients was done by an inquiry based on sociocultural and clinical variables and compared to a study composed of tubercular and psychiatric patients. This study reports four distress levels (loss of identity, loss of object, forlornness, culpability) which are distinguished by sex and age. The actual analysis of the experience of this distress shows the importance of support of the traditional representation of these leprous patients' psychology.

Psychosocial stress in Hansen's disease: a comparison with other chronic illness patients.

The present study investigated stress, as measured by a standardized life events scale, in Hansen's disease (HD) patients and as compared to renal patients and non-illness controls. Statistical analyses indicated that experimental groups were well matched on variables of age, sex, and marital status. Regarding analyses of the life events scale, significant differences were found across groups for negative change scores and total change scores. Post-hoc analyses revealed that the outpatient HD group and the renal group were significantly different from the non-illness controls. The results are viewed as support for the hypothesis that HD patients are similar to other chronic illness groups in terms of psychosocial characteristics.