勃起功能障碍患者心理、社会支持状况及其与病耻感的关系

目的 探讨勃起功能障碍(ED)患者病耻感、负性心理和社会支持的现状及其相关性。方法 采用方便抽样法选择2020年8月至2021年2月南京某三甲医院160例ED患者作为研究对象,采用基本情况表、90项症状清单(SCL-90)、社会支持评定量表(SSRS)、社会影响量表(SIS)对其进行调查研究。结果 ED患者病耻感处于中等偏上水平,总分为(57.27±11.96)分,社会排斥、经济歧视、内在羞耻感维度得分高于国内常模(P<0.001);社会支持总分及其各维度得分均低于国内常模(P<0.001);患者负性心理阳性因子总检出率为55.9%,t检验SCL-90各因子阳性对患者病耻感的影响具有统计学意义;Pearson相关性分析结果显示,病耻感总得分及各维度得分与患者心理状况呈显著正相关(P<0.001),与社会支持呈显著负相关(P<0.001);线性逐步回归分析主观支持、对支持的利用度、精神病性因子对患者病耻感有显著影响(P<0.001)。结论 男性ED患者病耻感处于中等偏上水平,应在临床护理中增加对ED患者负性心理情绪疏导护理,提高社会支持,从而降低患者病耻感,...     

高校学生慢性前列腺炎患者病耻感现状及影响因素分析

目的 了解高校学生慢性前列腺炎患者病耻感现状,探讨其影响因素。方法 于2020年9月至2022年6月,采用一般资料调查表、中文版社会影响量表(SIS)对成都市某三甲医院泌尿外科诊治的高校学生慢性前列腺炎患者进行调查,分析调查结果。结果 共纳入503例高校学生慢性前列腺炎患者,病耻感总分为(61.65±16.24)分,社会排斥维度得分为(23.06±5.57)分,经济歧视维度得分为(7.07±2.39)分,内在羞耻感维度得分为(13.47±4.10)分,社会隔离维度得分为(18.06±4.80)分,均处于中等水平。其中,41.36%的学生病耻感为高水平,34.39%的学生病耻感为中水平,24.25%的学生病耻感为低水平。多元回归分析结果显示,有无性伴侣、文化程度、每个月生活费、每周手淫或性交次数、有无并发症、专业类别、疾病知晓情况是高校学生慢性前列腺炎患者病耻感的影响因素(P<0.05)。结论 高校学生慢性前列腺炎患者病耻感水平较高,且受多种因素影响,可从影响因素着手,改善其病耻感水平与身心状况。     

盆底功能障碍疾病病耻感现状及其影响因素研究

目的分析女性盆底功能障碍患者病耻感水平及其影响因素,为进一步开展盆底功能障碍患者心理干预研究提供科学依据。方法选取2018年10月至2019年7月武汉市某三甲医院产科及妇科诊治的237例盆底功能障碍疾病患者作为研究对象。使用自行设计的一般资料调查表、中文版社会影响量表,医学应对方式问卷,对研究对象进行横断面调查。本研究阶段完成问卷249份,共回收有效问卷237份。结果 237例盆底功能障碍患者病耻感水平总得分为(55.38±8.21)分;在年龄、文化程度、职业、家庭月收入和医保类型方面比较,差异具有统计学意义(P0.05);面对与病耻感呈负相关,差异具有统计学意义(r=-0.282、P0.05);回避、屈服与病耻感呈正相关,差异具有统计学意义(r=0.480、P0.01;r=0.434、P0.01);文化程度、回避是盆底功能障碍患者的重要预测因子,累积解释病耻感总分的59.5%。结论医护人员需要重点关注盆底功能障碍患者的心理情况,依据标准化指南制定并开展个体化的心理疏导方案,积极加强患者的心理健康教育,降低患者的疾病病耻感水平,改善其生活质量。     

外阴癌手术患者病耻感与自我效能和应对方式的相关分析

目的:分析外阴癌手术患者病耻感与自我效能和应对方式的相关性。方法:采用精神疾病自我病耻感量表(ISMI)、一般自我效能感量表(GSES)、医学应对方式问卷(MCMQ)对哈尔滨医科大学附属第一医院在2013年6月~2017年6月期间手术治疗的36例外阴癌患者进行问卷调查。观察外阴癌手术患者病耻感与自我效能和应对方式的相关性。结果:(1)在36例外阴癌手术患者中,无自我病耻感的患者占比25. 0%,轻、中、重度自我病耻感患者占比分别为25. 0%、27. 8%、22. 2%。外阴癌手术患者GSES各维度及总评分均明显低于全国常模水平(P 0. 05);(2)与其他慢性病比较,外阴癌手术患者多采用回避、屈服的应对方式(P 0. 05);(3)Spearman相关分析发现,外阴癌手术患者病耻感中的歧视体验、社会退缩、疏远体验、刻板印象认同与一般自我效能感量的4个维度和面对应对方式呈负相关,与回避、屈服应对方式呈正相关;病耻感抵抗与面对应对方式呈正相关,与回避、屈服应对方式呈负相关。结论:外阴癌手术患者的病耻感较高,自我效能水平较低,多采用回避、屈服的应对方式。临床工作者应当对外阴癌手术患者采取相应的措施,降低自我病耻感,提高自我效能水平。     

心理弹性在女性不孕症患者病耻感和抑郁之间的中介效应

目的 探讨心理弹性在女性不孕症患者病耻感和抑郁之间的中介效应。方法 选取2021年4月至10月在南京大学医学院附属鼓楼医院就诊的234例女性不孕症患者作为研究对象,采用基线资料调查表、不孕症病耻感量表、心理弹性量表及患者健康问卷抑郁量表进行调查,采用结构方程模型和Bootstrap程序分析和验证中介效应。结果 女性不孕症患者病耻感得分为(66.29±18.64)分、心理弹性得分为(56.51±12.90)分、抑郁得分为(7.51±4.65)分;病耻感与抑郁呈正相关(r=0.514,P<0.01),心理弹性与抑郁成负相关(r=-0.397,P<0.01);心理弹性是病耻感和抑郁的中介变量(β=0.100,P<0.01),中介效应占总效应的19.2%。结论 心理弹性在病耻感和抑郁之间起部分中介效应,应重视病耻感对不孕症患者心理状态的影响,采取针对性措施提高患者心理弹性,缓解抑郁症状。     

病耻感量表在男性不育症患者中的信效度检验

目的 检验病耻感量表在我国男性不育症患者中的信效度。方法 采用方便取样法,选取2021年12月15日至2022年2月15日在北京市某三甲医院生殖医学中心诊治的338例男性不育症患者作为研究对象。采用基本情况调查表、修订后的病耻感量表及生育生活质量量表进行研究调查。结果 本研究最终形成了包含4个公因子和22个条目的病耻感量表。修订后量表总的Cronbach′s α系数为0.974,折半信度为0.924。方差累计贡献率为78.9%,量表结构效度、聚敛效度、组合信度与区分效度经检验结果均较好,且与生育生活质量有较好的效标关联效度。结论 修订后的病耻感量表信效度良好,可用于我国男性不育症患者病耻感的评估。     

个性化护理干预对银屑病患者病耻感及康复效果的影响分析

目的观察个性化护理干预对银屑病患者病耻感及康复效果的影响。方法选取我院住院及门诊部2016年8月到2018年1月收治并确诊为银屑病的患者200例,按照随机对照的方法分成对照组和观察组,每组各100例。对照组给予常规护理,观察组在对照组的基础上给予个性化护理干预。比较两组病耻感及康复效果。结果观察组患者社交回避及苦恼量表(SAD)、皮肤病生活质量指数(DLQI)均明显低于对照组,差异具有统计学意义(P 0.05)。结论个性化的护理干预可有效改善患者病耻感,提高患者的生活质量。     

女性不孕症患者病耻感相关因素的Meta分析

目的 采用Meta分析探讨女性不孕症患者病耻感的相关因素,为病耻感干预方式的选择提供依据。方法 检索EMbase、PubMed、Web of Science、CINAHL Complete、The Cochrane Library、CNKI、CBM、WanFang Data和VIP数据库,检索时间均从建库至2020年12月,对文献进行严格筛选、资料提取及偏倚风险评估后,应用R 4.0.2软件进行数据合并Meta分析。结果 共纳入16个研究,包含4 159例女性不孕症患者。Meta分析结果显示：病耻感与自我评判[r=0.77,95%CI(0.66,0.87)]、生活质量[r=-0.76,95%CI(-0.82,-0.69)]、抑郁[r=0.70,95%CI(0.48,0.93)]、生育相关压力[r=0.66,95%CI(0.47,0.85)]之间存在强相关;与社会支持[r=-0.39,95%CI(-0.46,-0.31)]、不孕时间[r=0.31,95%CI(0.01,0.61)]、焦虑[r=0.29,95%CI(0.03,0.55)]之间存在弱相关;与夫妻关系之间存在极弱相关[r=-0...     

心理干预对银屑病患者的影响

目的观察心理干预对银屑病患者的影响,为银屑病患者心理干预治疗提供依据。方法采用公认的评估工具与心理干预的方法,评定银屑病患者的心理指标,对比和统计学分析结果。结果干预前的50例银屑病疾病耻感平均分值、汉密顿抑郁量表(HAMD)平均分值分别达(2.50±0.54)和(30.72±6.85),干预后,对照组的疾病耻感平均分值和HAMD平均分值分别为(2.51±0.51)、(29.73±7.11)和干预组分别为(2.18±0.46)、(20.14±7.35),干预前后结果有统计学差异(P0.05)。结论心理干预能有效改善患者的疾病耻感和抑郁状况,对银屑病患者诊疗,除给予常规药物治疗外,还应进行必要的心理干预。     

某些个体因素在浅部真菌病感染中的作用探讨

为探讨某些个体因素在浅部真菌病感染中的作用，对６７６例门诊浅部真菌病患者作了性别、年龄、职业性质、病损部位、病种分布、感染情况、解剖等差异及其他发病诱因等的统计学分析研究。结果表明：发病率无性别差异：青壮年人对癣病易感，婴幼儿和老年人发病率较低，工人和干部好发癣病，农民和渔民患癣病者较少；足部是最易好发的病损部位；最多见的病种是足癣；癣病的感染和复发还与个体易感性、遗传素质、多汗、局部皮肤毗邻间隙、个人生活习惯和社会公共卫生环境密切相关。文章还对浅部真菌病的病因病机和某些个体因素在浅部真菌病中的作用分别作了扼要地阐述，提出癣病防治的主要病种是足癣，预防重点是个人和社会公共卫生。     

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self‐esteem and life‐satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross‐sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire‐12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.     

Feelings of stigmatization in patients with psoriasis

The concept of stigma, defined as a discrediting mark that sets a person off from others, is used in a systematic, in-depth examination of how 100 adults with psoriasis experience their illness. Information on demographic and illness variables that might predict feelings of being stigmatized were obtained. Through factor analysis of a specially designed questionnaire, six dimensions of the stigma experience were identified: anticipation of rejection, feeling of being flawed, sensitivity to others' attitudes, guilt and shame, secretiveness, and positive attitudes. There was marked variability in the presence and magnitude of these feelings. Different predictors emerged for different dimensions of the stigma experience, the most frequent being age at onset, extent of bleeding, employment status, duration, and rejection experience. Of all the aspects of the illness, bleeding proved the strongest predictor of stigma feelings and of despair, which correlates highly with stigma. Despair and feeling stigmatized may lead to noncompliance with treatment, possibly worsening the status of the psoriasis.     

Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study

BackgroundInternalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons'' illness, has not been studied previously in pediatric psoriasis patients.ObjectiveWe aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients.MethodsThis multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study.ResultsThe mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores.ConclusionInternalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.     

Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression

Psoriasis can be a socially isolating disease due to debilitating physical symptoms and the stigma patients feel because of the appearance of their skin. Mental health comorbidities such as anxiety, depression and suicidal ideation and behaviour (SIB) are prevalent in patients with psoriasis. Patients with mild psoriasis can experience psychiatric comorbidities; however, disorders such as depression and SIB are more common in patients with severe psoriasis or psoriatic arthritis. Psychiatric disorders can both result from and contribute to progression of psoriasis, suggesting that psoriasis and psychiatric conditions, such as depression, may have overlapping biological mechanisms. Proinflammatory cytokines such as interleukin (IL)‐1 and IL‐6 are elevated in both psoriasis and depression, indicating that the inflammatory process may be involved in the progression of both diseases. Elevated cytokine levels in the central nervous system cause physiologic and biochemical changes that may contribute to the development of depression. In this review of the literature, we discuss the evidence that supports the association of psoriasis with mental health disorders and the tools used to detect the presence of these comorbidities. Additionally, we review the most prominent hypotheses on the mechanisms by which the inflammatory response and elevated cytokines can cause depression. These results highlight the role that systemic inflammation plays in the various mental health comorbidities associated with psoriasis, including depression and SIB.     

Management of nail psoriasis

Nail involvement is estimated to affect 80–90% of patients with psoriasis at some point in their lives and is often associated with severe disease. Patients with nail involvement experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. Nail psoriasis is also considered a risk factor for the development of psoriatic arthritis (PsA). Management of nail psoriasis is deemed challenging and as a result, it is often left untreated by physicians. Assessing the severity of nail disease can also be difficult in clinical practice. While the Nail Psoriasis Severity Index is used widely in trials, it is time‐consuming and rarely used in the clinic, highlighting the need to develop a simplified disease severity score for nail psoriasis. All patients should be advised to keep their nails short, wear gloves for wet and dirty work, and regularly apply emollient to the nail folds and nail surface. Patients with mild nail psoriasis, without signs of severe cutaneous psoriasis or PsA, may benefit from topical treatment, while systemic treatment is indicated in patients with severe nail involvement. Evidence suggests that all anti‐tumour necrosis factor (TNF)‐α, anti‐interleukin (IL)‐17, and anti‐IL‐12/23 antibodies available for plaque psoriasis and PsA are highly effective treatments for nail psoriasis. This article aims to provide an up‐to‐date review of the therapeutic options currently available for the management of nail psoriasis in patients with or without skin psoriasis. Therapeutic options for the management of nail psoriasis in children will also be discussed.     

Recommendations for the treatment of nail psoriasis in patients with moderate to severe psoriasis: a dermatology expert group consensus

Background Nail involvement is common in psoriasis patients and is often associated with severe disease. Patients with nail psoriasis experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. However, nail psoriasis often goes untreated, as many physicians believe it is difficult to treat, despite the availability of effective treatment options. Clinical data and guidelines for managing and treating psoriasis patients with both skin and nail symptoms are limited. Objective To prepare recommendations for the management and treatment of patients with moderate to severe psoriasis with nail involvement. Methods A collaborative Delphi survey was used to obtain consensus on current practice in the management of nail disease in patients with moderate to severe psoriasis from an expert panel of 11 dermatologists from Europe and Canada with substantial clinical expertise in managing these patients. Agreement was defined utilizing a Likert scale of 1–9. Consensus regarding agreement was an interquartile range (IQR) ≥7; consensus regarding disagreement was an IQR ≤3. Results The expert panel addressed several topics including burden of disease, nail assessment, treatment goals and treatment options. The panel agreed that: it is extremely important to assess nail involvement in patients with psoriasis; nail assessments are rarely performed in routine clinical practice; full skin and nail clearance is an achievable goal with appropriate systemic therapy in patients with moderate to severe psoriasis with nail involvement. Conclusion This article provides useful and practical considerations for the management and treatment of patients with moderate to severe skin and nail psoriasis.     

PSYCHOSOCIAL CONSEQUENCES OF REJECTION AND STIGMA FEELINGS IN PSORIASIS PATIENTS

Background. Many studies as well as clinical experience indicate that patients often feel stigmatized by their psoriasis and may experience rejection due to their skin disease. Methods. In this study of connections between feelings about having psoriasis, rejection by others, and the impact on work experience, alcohol use, and psychiatric help-seeking, 100 adults with moderate to severe psoriasis responded to a specially designed questionnaire. Multiple regression analysis is used to determine whether, and how, rejection experience and stigma feelings are associated with the three psychosocial outcomes after controlling for psoriasis severity. Results. Nineteen percent of the subjects experienced 50 episodes of gross rejection as a result of their psoriasis, most often from a gym, pool, hairdresser, or job. Rejection experience leads to feeling stigmatized, which is then associated with help seeking and, to some degree, with interference with work. Rejection can lead to feeling stigmatized and to increased alcohol consumption, but the data show that patients may drink without conscious awareness of their feelings. Conclusions. When patients experience psoriasis-related rejection, they may feel stigmatized and suffer further adverse effects on their emotional and occupational life. It is urgent that ways of helping people deal with the impact of psoriasis, its stigmatizing potential, and the consequences of psoriasis-induced rejection be emphasized.     

Quantifying the harmful effect of psoriasis on health-related quality of life

BACKGROUND: Psoriasis affects 7 million people in the United States, causing substantial cost, social stigma, and disability. OBJECTIVE: The purpose of this study was to evaluate the health effects of skin disease by comparing psoriasis to other primary medical disorders using 3 different scales of health-related quality of life. METHODS: A self-administered questionnaire consisting of 3 health-related quality of life measures was given sequentially to 35 eligible patients with psoriasis presenting to the Dermatology Branch of the National Cancer Institute (NCI) for an investigational therapeutic protocol. RESULTS: All patients (100%) agreed to participate. The median Psoriasis Area and Severity Index (PASI) score was 13.0. Overall, 82.9% at least often felt the need to hide their psoriasis, and 74.3% claimed their self-confidence was at least often affected by their psoriasis. The median EQ-5D health state utility score was 13.0% less than healthy individuals (P <.001). On the SF-36, the mean general health score was 13.2% less (P =.005) and the median social functioning score 18.7% less (P =.005) than that of patients with no chronic conditions. CONCLUSION: Individuals with psoriasis are significantly affected in their health state utility, perception of general health, and social functioning when compared with individuals without chronic disease and those with certain primary medical conditions.     

Factors affecting responses on Dermatology Life Quality Index items among vitiligo sufferers

Finlay and Khan have recently suggested that the Dermatology Life Quality Index (DLQI) can be used to measure the effects of dermatological conditions on the quality of patients' lives. The aims of this study were to assess its applicability in a nonclinic sample of vitiligo sufferers and to measure its relationship with questionnaires designed to measure a variety of psychological and demographic factors. The DLQI was completed by 614 members of the Vitiligo Society in a postal survey. The results supported the validity of the DLQI for this sample. DLQI scores were related to perceived stigma (a version of Ginsburg and Link's psoriasis stigma questionnaire), recent experiences, self-esteem (Rosenberg's scale), personal distress (both a symptom checklist and the 12-item General Health Questionnaire) and race, suggesting that levels of disability might be reduced by interventions that target these variables.     

Quality of life in mothers of children with psoriasis

Background

Patients' and their mothers' quality of life is severely affected by childhood psoriasis. Almost all children have a chronic illness that lasts until adulthood, which puts them at risk for lifelong difficulties like stigma, psychiatric comorbidity, and suicide.

Objective

Evaluation of the effects of childhood psoriasis on the mothers' quality of life was the project's primary objective.

Subjects and Methods

100 mothers of children with various kinds of psoriasis participated in the study. The Family Dermatology Life Quality Index (FDLQI) was used to evaluate the mothers' quality of life.

Results

The mother's FDLQI score was between 3 and 25, with a mean of 13. In terms of how the FDLQI was interpreted, 8 moms had an incredibly enormous impact, 63 mothers had a very significant impact, 26 mothers had a moderate impact, and 3 mothers had a modest impact. We discovered a substantial direct link between the mother's FDLQI and the children's PASI scores. Furthermore, we discovered that scalp and pustular psoriasis had the highest FDLQI scores, indicating a poor quality of life.

Conclusion

Both the quality of life for affected children and their cares may be negatively impacted by childhood psoriasis. Age of the children, PASI score, and kind of psoriasis can all have an impact on how psoriasis in childhood affects the mother.