Effects of a Brief Mindfulness-based Intervention in Patients with Psoriasis: A Randomized Controlled Trial.

Mindfulness is a special type of attention, namely focusing on the current moment in a non-judgmental manner. Extensive mindfulness-based interventions have been shown to have positive effects in patients with psoriasis. However, it is unclear whether brief (2-week) interventions are also beneficial. Therefore, the aim of this study was to investigate the effects of a 2-week mindfulness-based intervention in patients with psoriasis. Patients were randomly assigned to an experimental (treatment-as-usual + mindfulness-based intervention) or control group (treatment-as-usual) during their clinic stay. All variables were measured by self-report using validated questionnaires: primary outcomes were mindfulness and self-compassion, secondary outcomes were itch catastrophizing, social anxiety, stress and skin status. Variables were assessed prior to, immediately and 3 months after the intervention. Effects were tested by repeated-measures analysis of variance (ANOVA). Analyses of pre-post-measurements (n = 39) revealed a significant interaction effect on self-reported mindfulness [F(1,35) = 7.46, p = 0.010, η2p = 0.18] and a tendency to a significant effect on self-reported self-compassion [F(1,36) = 3.03, p = 0.090, η2p = 0.08]. There were no other significant effects, but most descriptive data were in favour of the experimental group. However, the control group showed a greater improvement in skin status. Further studies are needed to replicate these findings and investigate which subgroups especially profit from such an intervention.

Perceived Stigmatization among Dermatological Outpatients Compared with Controls: An Observational Multicentre Study in 17 European Countries.

Perceived stigmatization places a large psychosocial burden on patients with some skin conditions. Little is known about the experience of stigmatization across a wide range of skin diseases. This observational cross-sectional study aimed to quantify perceived stigmatization and identify its predictors among patients with a broad spectrum of skin diseases across 17 European countries. Self-report questionnaires assessing perceived stigmatization and its potential predictors were completed by 5,487 dermatology outpatients and 2,808 skin-healthy controls. Dermatological diagnosis, severity, and comorbidity were clinician-assessed. Patients experienced higher levels of perceived stigmatization than controls (p < 0.001, d = 0.26); patients with psoriasis, atopic dermatitis, alopecia, and bullous disorders were particularly affected. Multivariate regression analyses showed that perceived stigmatization was related to sociodemographic (lower age, male sex, being single), general health-related (higher body mass index, lower overall health), disease-related (higher clinician-assessed disease severity, presence of itch, longer disease duration), and psychological (greater distress, presence of suicidal ideation, greater body dysmorphic concerns, lower appearance satisfaction) variables. To conclude, perceived stigmatization is common in patients with skin diseases. Factors have been identified that will help clinicians and policymakers to target vulnerable patient groups, offer adequate patient management, and to ultimately develop evidence-based interventions.

White paper on psychodermatology in Europe: A position paper from the EADV Psychodermatology Task Force and the European Society for Dermatology and Psychiatry (ESDaP).

Psychodermatology is a subspecialty of dermatology that is of increasing interest to dermatologists and patients. The case for the provision of at least regional psychodermatology services across Europe is robust. Psychodermatology services have been shown to have better, quicker and more cost-efficient clinical outcomes for patients with psychodermatological conditions. Despite this, psychodermatology services are not uniformly available across Europe. In fact many countries have yet to establish dedicated psychodermatology services. In other countries psychodermatology services are in development. Even in countries where psychodermatolgy units have been established, the services are not available across the whole country. This is especially true for the provision of paediatric psychodermatology services. Also whilst most states across Europe are keen to develop psychodermatology services, the rate at which this development is being implemented is very slow. Our paper maps the current provision of psychodermatology services across Europe and indicates that there is still very much more work to be done in order to develop the comprehensive psychodermatology services across Europe, which are so crucial for our patients.

Body dysmorphia in common skin diseases: results of an observational, cross-sectional multicentre study among dermatological outpatients in 17 European countries.

BACKGROUND: Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective, interventions. BDD symptoms are more prevalent in patients with dermatological conditions than in the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. OBJECTIVES: To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. METHODS: This observational, cross-sectional, comparative multicentre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological outpatients at 22 clinics in 17 European countries, and 2808 healthy skin controls (66% female). BDD symptoms were assessed by the Dysmorphic Concern Questionnaire. Sociodemographic data and information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. The study was registered with number DRKS00012745. RESULTS: The average participation rate of invited dermatological patients was 82.4% across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than 11-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared with healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than sixfold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatization. CONCLUSIONS: Clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.

S2k guideline: Diagnosis and treatment of chronic pruritus.

Pruritus is a cross-disciplinary leading symptom of numerous diseases and represents an interdisciplinary diagnostic and therapeutic challenge. In contrast to acute pruritus, chronic pruritus (CP) is a symptom of various diseases that is usually difficult to treat. Scratching and the development of scratch-associated skin lesions can alter the original skin status. In the presence of an itch-scratch-cycle, even secondary diseases such as chronic prurigo can develop. Chronic pruritus leads to considerable subjective suffering of those affected, which can result in restrictions on the health-related quality of life such as sleep disturbances, anxiety, depressiveness, experience of stigmatization and/or social withdrawal up to clinically relevant psychic comorbidities. Medical care of patients should therefore include (a) interdisciplinary diagnosis and therapy of the triggering underlying disease, (b) therapy of the secondary symptoms of pruritus (dermatological therapy, sleep promotion, in the case of an accompanying or underlying psychological or psychosomatic disease an appropriate psychological-psychotherapeutic treatment) and (c) symptomatic antipruritic therapy. The aim of this interdisciplinary guideline is to define and standardize the therapeutic procedure as well as the interdisciplinary diagnosis of CP. This is the short version of the updated S2k-guideline for chronic pruritus. The long version can be found at www.awmf.org.

[Medical Psychology and Medical Sociology in Transition - Review and Perspectives of the two Disciplines in Germany]. / Medizinische Psychologie und Medizinische Soziologie im Wandel ­ Bestandsaufnahme und Perspektiven der beiden Fächer in Deutschland.

AIM OF THE STUDY: Through the Master Plan for Medical Studies 2020 and the development of the National Competence-Based Learning Target Catalogue Medicine (NKLM), significant changes in university medicine were started. The aim of the study was a systematic analysis of the state and perspectives of the disciplines of medical psychology and sociology at the medical faculties in Germany. METHODOLOGY: An online survey was conducted on 5 topics (structure, teaching, research, care, perspectives). 46 departments and institutes of medical psychology and sociology were invited to the survey. RESULTS: 40 of the 46 contacted institutions have called up the online questionnaire, 35 have answered in full (return: 76.1%). 77% of the institutions are autonomous. In the median, the institutions have 15 employees (range: 1 to 149). 9 universities have established a model curriculum. More than half of the institutions use and train simulation patients. The main research priorities are clinical research, health care research, neuroscience and classical medical psychology or sociological research topics. The institutions receive primarily public funding and publish 19 publications (80% international, median) each year. Publication opportunities are considered "satisfactory" by 54% of institutions (2003: 44%), and by 29% as "very satisfactory" (2003: 21%). 9 out of 27 medical psychology institutes provide clinical services to patients and relatives with mental or chronic physical illness. Almost half of the institutions expect the Master Plan 2020 to further increase the relevance of the subjects. DISCUSSION: Since 2003 there has been a substantial increase in scientific staff, third-party funding and publications. The sites show a pronounced heterogeneity in terms of size and equipment, which leads to an imbalance in terms of teaching and research as well as clinical services. CONCLUSION: The subjects of medical psychology and medical sociology have developed very heterogeneously in terms of independence, size, equipment and possibilities at the various faculties in Germany. Therefore, it is very important in the future that the 2 disciplines intensify the dialogue with each other and also with other psychosocial disciplines in order to influence the current development regarding NKLM and Master Plan 2020 constructively. On the one hand, this calls for an expansion of disadvantaged institutions and a consolidation of the existing autonomous institutions.

Occurrence, Chronicity and Intensity of Itch in a Clinical Consecutive Sample of Patients with Skin Diseases: A Multi-centre Study in 13 European Countries.

Itch is an unpleasant symptom, affecting many dermatological patients. Studies investigating the occurrence and intensity of itch in dermatological patients often focus on a single skin disease and omit a control group with healthy skin. The aim of this multi-centre study was to assess the occurrence, chronicity and intensity (visual analogue scale 0-10) of itch in patients with different skin diseases and healthy-skin controls. Out of 3,530 dermatological patients, 54.3% reported itch (mean ± standard deviation itch intensity 5.5 ± 2.5), while out of 1,094 healthy-skin controls 8% had itch (3.6 ± 2.3). Chronic itch was reported by 36.9% of the patients and 4.7% of the healthy-skin controls. Itch was most frequent (occurrence rates higher than 80%) in patients with unclassified pruritus, prurigo and related conditions, atopic dermatitis and hand eczema. However, many patients with psychodermatological conditions and naevi also reported itch (occurrence rates higher than 19%).

Agreeableness as Predictor of Induced Scratching in Patients with Atopic Dermatitis: A Replication Study.

In patients with atopic dermatitis agreeableness and public self-consciousness have previously been shown to be significant predictors of induced scratching, while depression was significantly related to induced itch. This study aimed to replicate these findings. Itch and scratching were induced by videos of crawling insects or skin diseases. Induced itch was measured using a visual analogue scale. Scratching behavior was evaluated by two raters. Psychological variables were assessed using validated questionnaires. Induced scratching could be predicted significantly by agreeableness (corrected R2 = 15.5% or 38 % after exclusion of one outlier): Patients scoring low on agreeableness showed a higher increase in scratch movements than patients scoring high on this scale. No associations between induced scratching/itch and public self-consciousness/depression were found. One clinical implication that arises from this study could be to offer patients scoring low on agreeableness certain psychological interventions.

Atopic Eczema and Stress among Single Parents and Families: An Empirical Study of 96 Mothers.

This study investigated the extent to which single mothers of children with atopic eczema experience disease-related stress. A total of 96 mothers were divided into 4 groups: mothers living with a partner, who had or did not have a child with atopic eczema, and single mothers, who had or did not have a child with atopic eczema. The following questionnaires were used to assess psychological burden: Short Stress Questionnaire (Kurzer Fragebogen zur Erfassung von Belastung; KFB), Satisfaction with Life Questionnaire (Fragebogen zur Lebenszufriedenheit; FLZ), General Depression Scale (Allgemeine Depressions-Skala; ADS), and the Questionnaire for Parents of Children with Atopic Eczema (Fragebogen für Eltern von Neurodermitis kranken Kindern; FEN). Single mothers had higher levels of helplessness and aggression due to their child's scratching behaviour than did mothers living with a partner and a child with atopic eczema. Single mothers of children with atopic eczema had the highest scores regarding experienced stress in the family and the lowest scores concerning general life satisfaction. Special care should be provided for single mothers with higher stress, in order to teach them how to deal with the scratching behaviour of their children.

Brain mechanism of itch in atopic dermatitis and its possible alteration through non-invasive treatments.

Atopic dermatitis (AD) is a common chronic skin disease that is characterized by intense pruritus and has high impairment of quality of life. AD is often described as "the itch that rashes, rather than the rash that itches". Several studies suggest that mechanisms of central modulation play an important role in the development and maintenance of chronic itch. Therefore, treating the neurosensory aspects of itch is an important part in the management of chronic itch. However, little attention has been paid to the role of the central nervous system in the processing of itch in AD. Targeting itch-related anatomical structures in the brain with non-invasive treatments such as psychological interventions and transcranial Direct Current Stimulation (tDCS) could have an antipruritic effect in AD. Therefore, in this review article, we discuss the current progress in brain imaging research of itch, as well as the efficacy of non-invasive interventions for itch relief in this patient group.

Differences Between Psoriasis Patients and Skin-healthy Controls Concerning Appraisal of Touching, Shame and Disgust.

Psoriasis is a chronic skin disease associated with high levels of psychological distress and considerable life impact. Feelings of shame and stigmatization can lead to avoidance of social activity and intimacy. In this study, the questionnaire TSD-Q was used to evaluate pleasure in touching oneself and in a partnership, parental touching during childhood and (skin-related) shame and disgust. Skin-related disgust and shame were significantly higher in psoriatic patients than in healthy controls. Moreover, psoriasis-patients scored significantly lower than skin-healthy controls concerning appraisal of self-touching and parental touching. In contrast, psoriasis-patients scored higher concerning appraisal of touching in a partnership. Due to the fact that low self-esteem might enhance the negative evaluation of touch and the feelings of shame and disgust, psychological interventions should be integrated in the treatment of psoriasis.

Shadows of Beauty - Prevalence of Body Dysmorphic Concerns in Germany is Increasing: Data from Two Representative Samples from 2002 and 2013.

Body dysmorphic disorder (BDD) is a psychosomatic disease associated with reduced quality of life and suicidal ideations. Increasing attention to beauty and the development of beauty industries lead to the hypothesis that BDD is increasing. The aim of this study was to test this hypothesis in two representative samples of Germans, assessed in 2002 and 2013. In 2002, n = 2,066 and in 2013, n = 2,508 Germans were asked to fill in the Dysmorphic Concern Questionnaire (DCQ), which assesses dysmorphic concerns. Subclinical and clinical dysmorphic concerns increased from 2002 to 2013 (subclinical from 0.5% to 2.6%, OR = 5.16 (CI95% = 2.64; 10.06); clinical from 0.5% to 1.0%, OR = 2.20 (CI95% = 1.03; 4.73). Women reported more dysmorphic concerns than men, with rates of 0.7% subclinical and 0.8 clinical BDD in women and 0.3% subclinical and 0.1% clinical BDD in men in 2002. In 2013, 2.8% subclinical and 1.2% clinical BDD were found in women and 2.4% subclinical and 0.8% clinical BDD in men. Further studies should assess predictors for developing a BDD and evaluate factors determining the efficacy of disease-specific psychotherapeutic and psychotropic drug treatments.

Psychological Interventions in the Treatment of Chronic Itch.

Patients with chronic itch suffer from higher levels of depression and anxiety than their healthy counterparts. Furthermore, psychological factors, such as stress, are known to aggravate itch. The mere act of thinking about itching can induce the sensation. Interventions like habit reversal training and arousal reduction have been shown to have positive effects on itch relief. Yet, there is still limited data on the psychological management to control the itch scratch cycle and a description of methods suitable to address itch. In this review, we describe different psychological interventions shown to be effective in the treatment of chronic itch. We also provide suggestions based on our experience of suitable interventions for patients with different types of itch.

Coping as mediator of the relationship between stress and itch in patients with atopic dermatitis: a regression and mediation analysis.

Even though it has been shown that stress and itch are associated in patients with atopic dermatitis (AD), it remains unclear whether this relationship occurs due to certain coping strategies being activated under stress. Therefore, this study investigates the role of coping as possible mediating factor between stress and itch in 31 patients with AD. Coping and itch were assessed by self-reported measures, while stress was measured both by a validated questionnaire and by a physiological stress marker, the postawakening cortisol. Using a regression and a mediation analysis, this study showed a relationship between perceived stress and itch (corrected R2 = 0.21), which was fully mediated by negative itch-related cognitions. 62.3% of the variance of itch intensity could be explained by negative itch-related cognitions. This finding helps to explain the positive effects of cognitive restructuring in the treatment of chronic itch.

Personality traits, depression and itch in patients with atopic dermatitis in an experimental setting: a regression analysis.

It is known that itch is associated with psychological variables, but it is not known whether personality characteristics, depression or anxiety are predictors of experimentally induced itch in patients with atopic dermatitis (AD). In this study itch was induced in 27 patients with AD and 28 healthy controls by the presentation of an experimental video on crawling insects and skin diseases. Itch intensity was measured by self-ratings and by observing the number of scratch movements. Itch increase was determined by subtracting itch intensity induced by the experimental video from itch intensity induced by a control video. Psychological variables were assessed using validated questionnaires. In patients with AD, depression was a significant predictor of self-rated induced itch (corrected R2 = 0.175); while agreeableness and public self-consciousness were significant predictors of induced scratching (corrected R2 = 0.534). In healthy controls no associations were found. These results imply that a special group of patients with AD might benefit from certain psychological interventions.

Psychophysiological effects of stress management in patients with atopic dermatitis: a randomized controlled trial.

Atopic dermatitis leads to, and can be triggered by, stress. Psychological interventions have been shown to have positive effects on skin status, itch and scratching behaviour. However, it has not been analysed whether stress management leads to a change in physiological stress level and psychophysiological stress reaction under acute stress in this patient group. In this study 28 patients with atopic dermatitis were randomized to an experimental group (cognitive behavioural stress management) or a control group. The endocrine stress level and skin status were measured before and after the stress management programme. A public-speaking paradigm was used to induce acute stress. The study revealed that the experimental group had a tentatively reduced cortisol awakening response after the stress management programme. In addition, the experimental group remained calmer and showed lower salivary cortisol levels under acute stress. Thus, stress management might be a useful addition to standard treatment in patients with atopic dermatitis.