Christina Schut

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.

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.

Patient education programs for childhood atopic dermatitis: who is interested?

Background: Atopic dermatitis (AD) is a skin disease which causes psychological distress to patients and their families. Patient education programs for childhood AD have positive effects on the severity of the skin disease as well as on psychological variables. So far it has not been determined whether particular patient characteristics lead to being interested in patient education programs. The aim of this cross‐sectional study was to identify exploratory predictors of being interested in patient education programs in parents of children with atopic dermatitis.

Role of personality and expectations for itch and scratching induced by audiovisual itch stimuli.

Itch is an unpleasant, bodily sensation, which – similar to pain – evokes behavioral reactions. As a response to itch, people start scratching. There are different ways to provoke itch and subsequent scratching in experimental settings. A non‐invasive method to induce itch and scratching is the presentation of itch‐related (audio‐) visual stimulus material, like slide‐supported lectures on skin diseases or crawling insects. Also, watching videos showing other people scratching provokes itch and the desire to scratch. In this review, we focus on psychological factors, which were shown to be associated with itch and scratching provoked by (audio‐) visual itch stimuli. First, we summarize the findings on the relationship between personality characteristics and (audio‐) visually induced itch. Agreeableness and self‐consciousness were shown to be associated with induced itch and scratching in patients with chronic skin diseases, while neuroticism was linked to induced itch in healthy subjects. Second, we present results of a recent study, in which we altered the expectations towards audio‐visually induced itch and scratching by changing the information given on upcoming itch stimuli. It was shown that subjects being informed about itch stimuli in a neutral way displayed a shorter scratch duration in itch inducing situations than subjects having catastrophizing expectations. Also, the increase in scratch duration and in the number of scratch movements induced by audiovisual itch stimuli was higher when the patients were not informed about itch induction. Thus, in itch patients neither catastrophizing nor trivializing symptoms seems to be helpful.

Psychological Stress and Skin Symptoms in College Students: Results of a Cross-sectional Web-based Questionnaire Study.

OR and 95% confidence intervals were calculated to conclude as to whether the low stress group had a lower probability of having (skin-) complaints than the high stress group. Due to the fact that sex was not equally distributed in the groups, sex and stress severity were used as a covariate in the binary logistic regressions which were subsequently conducted using the skin symptoms as dependent variables. This made it possible to report OR and 95% confidence intervals (CI) adjusted for sex.

Role of illness representations and coping in patients with atopic dermatitis: a cross-sectional study

Atopic dermatitis (AD) is a skin disease accompanied by psychological burden. It has been shown for other chronic diseases that illness representations and coping strategies are associated with disease‐related burden and other outcome variables like time until patients return to work or health care use.

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 childs 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.

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.