Psoriasis can affect every aspect of life – relationships, social life, lifestyle
and work and is associated with increased levels of depression and anxiety.
Understanding the beliefs, behaviours and emotions of people with psoriasis is essential
to formulating effective and appropriate management plans with patients.
Psychological factors in people with psoriasis, such as alexithymia, anticipation of
harm and stigma together with time constraints in clinic and skin-focused consultations,
can lead to distress and life-impact going un-recognised and untreated. There is some
evidence that treating distress can have a positive impact on the severity of psoriasis,
and that distress in the form of worry is a major determinant of the outcome of
treatment.
Screening for quality of life impact and distress in clinic using relevant questionnaires
is a useful tool to identify patients in need of further support, and also provides a
trigger to initiate discussion. A patient-centred consultation with setting of agendas for
patient and clinician is an efficient way of targeting consultations. Questioning style in
clinic is key to eliciting relevant responses which guide treatment decisions and inform
treatment goals. Setting of patient-derived treatment goals and step-by-step minitargeted
approach to reaching the final goal ensures response to treatment is
accompanied by improved life-impact.
Communicating measures of distress, quality of life and patient-derived treatment goals
to general practitioners provides an educational tool and will raise the standard of care for people with psoriasis.
Keywords: Alcohol, Alexithymia, Anti-depressant, Anxiety, Beliefs, Cognitivebehaviour-
therapy, Consultation, Coping, Depression, Distress, Hypnosis, Lifeimpact,
Lifestyle, Obesity, Psoriasis, Psychology, Shame, Smoking, Stigma,
Suicide.
