Eva Mazzotti

Sensitivity of the Dermatology Life Quality Index to clinical change in patients with psoriasis

Summaryu2003 Backgroundu2003Quality of life is increasingly recognized as an important outcome measure in dermatology. The Dermatology Life Quality Index (DLQI) is a self‐administered questionnaire designed to measure the impact of skin diseases on patients quality of life.

Psychosomatic Assessment of Skin Diseases in Clinical Practice

Background: Psychiatric disorders are frequent in dermatology patients, and many studies pointed out complex, mutual relationships between psyche and skin. Our aim was to provide a systematic psychosocial evaluation of a large and heterogeneous population of patients with skin diseases, including assessments of quality of life, psychiatric status according to the DSM-IV and psychological conditions with psychosomatic relevance according to established criteria (Diagnostic Criteria for Psychosomatic Research, DCPR). Methods: We studied 545 dermatological inpatients aged 18–65 years, free from dementia and cognitive impairment. They completed the Skindex-29 and the 12-item General Health Questionnaire (GHQ-12) and were administered the SCID-I and the Structured Interview for Psychological Conditions of Psychosomatic Relevance by a trained mental health professional blinded to questionnaire scores. Results: Overall, 38% of patients received a DSM-IV diagnosis. The most common diagnoses were mood (20%) and anxiety disorders (16%); 48% of patients also received a DCPR diagnosis. The most common were demoralisation, irritable mood, type A behaviour and various forms of abnormal illness behaviour. Adjusting for gender, age, and education, the presence of DSM-IV or DCPR diagnoses was significantly associated with high scores on the GHQ-12 and on the Functioning and Emotions scales of the Skindex-29. Also, DCPR diagnoses were significantly associated with high scores on the Symptoms scale of the Skindex-29. Conclusions: These findings highlight the high frequency of psychosocial problems in patients with skin disease and suggest that the joint use of DSM-IV and DCPR criteria may help identify those patients in whom psychiatric issues are worthy of increased clinical attention.

Screening for psychiatric disorders in patients with skin diseases: A performance study of the 12-item General Health Questionnaire

OBJECTIVEnAlthough psychiatric disorders are frequent among dermatological patients, no study has formally assessed the performance of any psychiatric screening questionnaire in dermatological practice. This study tested the ability of the 12-item General Health Questionnaire (GHQ-12) to identify psychiatric morbidity in dermatological patients.nnnMETHODSnA sample of 521 adult inpatients (81% of all eligible patients) completed the GHQ-12 and were administered the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) by a trained mental health professional masked to GHQ-12 score.nnnRESULTSnThe Receiver Operating Characteristic (ROC) analysis showed that GHQ-12 possesses substantial discriminatory ability (area under the curve=0.70). The best balance between sensitivity (68%) and specificity (64%) was found at the GHQ-12 cutoff score of 3/4. This threshold gave a likelihood ratio for a positive or negative result of 1.90 and 0.50, respectively.nnnCONCLUSIONnThe performance of GHQ-12 was reasonably good for a self-administered questionnaire requiring only a few minutes to be completed and scored. Its routine use might increase recognition of psychiatric disorders in dermatological patients and contribute to improve patients outcome.

Recognition of depressive and anxiety disorders in dermatological outpatients

Although mental disorders are frequent among dermatological patients, little is known about their recognition by dermatologists. This study aimed to assess dermatologists ability to recognize depressive and anxiety disorders. All adult outpatients who visited four dermatologists on predetermined days (n=317) completed the 12-item General Health Questionnaire (GHQ-12) and the section on depressive and anxiety disorders of the Patient Health Questionnaire (PHQ). Dermatologists, masked to GHQ-12 and PHQ scores, rated patients mental health status. The analysis was performed on 277 patients (87%) with complete data. With the PHQ as criterion standard, the dermatologists assessment sensitivity was 33%, while specificity was 76%. In most cases of disagreement between the dermatologists and the PHQ, the GHQ-12 corroborated the PHQ classification. Anxiety disorders tended to be recognized better than depressive disorders. Among patients with a PHQ diagnosis, male gender tended to be associated with misclassification by dermatologists. Although limitations inherent in self-report psychiatric assessment should be considered, this study suggests that mental disorders often go unrecognized in dermatological patients. This issue might be addressed by implementing specific training programmes, using validated screening questionnaires for depression and anxiety, and developing rational consultation-liaison services.

Psychometric properties of the Dermatology Life Quality Index (DLQI) in 900 Italian patients with psoriasis

The Dermatology Life Quality Index (DLQI) is one of the most frequently used questionnaires to evaluate the impact of dermatological diseases on patients lives. This study aimed to assess the reliability and validity of the instrument and to test its unidimensionality in a large sample of patients with psoriasis (n=976) hospitalized at IDI-IRCCS, Rome, Italy. Nine hundred patients completed the DLQI, the Psoriasis Disability Index (PDI) and the Skindex-29 (response rate 92%). The internal consistency of the DLQI was high (Cronbachs alpha=0.83). Evidence of convergent validity was provided by high (r=0.64-0.81) correlations between the DLQI, the PDI, and the functioning and emotions scales of Skindex-29. Exploratory factor analysis indicated the presence of four different principal common factors. Confirmatory factor analysis showed a clear second-order factor structure, with a homogeneous second-order factor underlying the four primary-surface factors. This study confirms that the DLQI is a reliable and valid instrument to assess patient-perceived impact of skin disease. Also, it supports the unidimensionality of the DLQI and hence corroborates the common practice of using the total score.

Risk factors in the early family life of patients suffering from dissociative disorders

Objective:u2002To test the hypothesis that not only intrafamiliar childhood abuses inflicted to the patient, but also major losses or other severe life events suffered by the mother within 2u2003years of patients birth, are risk factors for the development of dissociative disorders (DDs).

Predictors of existential and religious well-being among cancer patients

Well-being and mental health are not only direct functions of amount of stress, but also depend on how people appraise and face critical situations. Spiritual well-being seems to be a central component of psychological health in physically healthy individuals and it offers some protection against end-of-life despair in those with chronic diseases. In this study, 250 out and in-patients with a cancer diagnosis were interviewed with standardised instruments to measure two aspects of spirituality, existential and religious well-being, coping strategies, psychological state, and quality of life (QoL). Using multivariate logistic regression models we found that coping strategies characterized by acceptance and positive reinterpretation of the stressor, and the absence of anxiety disorder, independently increased the likelihood of the existential well-being (Odds Ratio, OR, 7.7, and OR, 4.5, respectively), whereas religious well-being was not significantly associated with these variables. Our findings show that existential and religious well-being may be very different. A spirituality-based intervention could be differently utilized by patients with different beliefs, cognitive and behaviour characteristics. Measure of coping strategies and psychological state should be part of routine management of cancer patients.

Predictors of mood disorders in cancer patients' caregivers

IntroductionPatients’ care has been associated with a high burden of psychological symptoms in caregivers. This study identifies characteristics associated with mood disorders in caregivers of cancer patients.MethodsOne hundred fifty-two caregivers, aged 24–78xa0years (average age 51; 60xa0% females), of cancer patients completed Family Strain Questionnaire (FSQ), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), and Coping Orientations to the Problems Experienced. We combined this information with patient chart abstraction data.ResultsSixty-three percent of females and 38xa0% of males were scored as positive when screened for mood disorders, as measured by HADS (total score ≥16), and 17 and 5xa0% for emotional distress as measured by IES (total score ≥50). High scores in FSQ-satisfaction with family relationships and FSQ-need for more information about cancer, and low scores in FSQ-thoughts about death are reported. FSQ-emotional burden and FSQ-problems in social involvement are the areas more compromised in females, compared to males. Females, compared to males, use emotional-oriented coping strategies more frequently. Factors independently associated with mood disorders included emotional burden, problems in social involvement, and non-attendance of meeting places; help and assistance from public local services (for patients) decreased the risk of mood disorders in caregivers.ConclusionsPrevalence of mood disorders is high in cancer patients’ caregivers. These results highlight the need to develop family intervention strategies to minimize the impact of patient’s care on caregivers’ mental health.

Somatoform and Psychoform Dissociation Among Women with Orgasmic and Sexual Pain Disorders

Since the 20th century, psychogenic female sexual dysfunctions (FSD), like some somatoform and conversion disorders, have been considered an expression of somatoform dissociation. Several studies have reported dissociative symptoms in different somatoform and conversion disorders, but limited data are available on dissociation among patients with FSD. The aim of this study was to assess somatoform and psychoform dissociation among patients with womens orgasmic disorder, dyspareunia, and vaginismus. A battery of self-administered questionnaires (Somatoform Dissociation Questionnaire, Dissociative Experiences Scale, Hospital Anxiety and Depression Scale, Impact of Event Scale–Revised) was given to 200 gynecological outpatients to assess psychoform and somatoform dissociation and their association with FSD. A strong association between somatoform dissociation and FSD was observed (adjusted odds ratio [OR] = 5.39, 95% confidence interval [CI] = 1.15–25.32), the association between somatoform and psychoform dissociation being estimated by an adjusted OR of 4.83 (95% CI = 1.17–19.91). Our results are compatible with the idea that some forms of FSD could be regarded as somatoform dissociative disorders.

Treatment-related side effects and quality of life in cancer patients

BackgroundCancer leads to a complicated pattern of change in quality of life (QoL).ObjectiveThe aims of this study were to assess the impact of treatment-related side effects on QoL in cancer patients and to explore which other factors, and to what extent, contribute to explain low QoL scores.MethodsOne hundred twenty-three cancer patients receiving chemotherapy completed the self-administered questionnaires (Medical Outcomes Short-Form-36 (SF-36) and 12-item General Health Questionnaire). Multiple regression analyses were conducted with the SF-36 physical component summary (PCS) and SF-36 mental component summary (MCS) scores as the dependent variables and demographic and clinical factors as independent variables.ResultsSeventy-two percent of patients experienced treatment-related side effects, and 32% resulted positive for psychiatric diseases. Two multivariate analyses showed that worse PCS scores, like worse MCS scores, were significantly and independently predicted by treatment-related side effects (odds ratio (OR)u2009=u20095.00, 95%CI 1.29–19.45; ORu2009=u20098.08, 95%CI 2.03–32.22, respectively) and changes in health over the last 12xa0months (OR =2.34, 95%CI 1.47–3.76; ORu2009=u20093.21, 95%CI 1.90–5.41, respectively), after adjustment for age, gender, years of school, time from cancer diagnosis, and psychiatric disease.ConclusionsGiven the new emphasis on QoL, we suggest that physicians have a responsibility to openly discuss therapy efficacy, prognosis as well as the potential for adverse events with their patients. Changes in health, as perceived by patient, should also be monitored at follow-up.