Temperament and character profile of patients with psoriasis

1. Temperament and character profile of patients with psoriasis Kilic.A et al. Jeadv 2008, 22, 537-542

2. Introduction • Psoriasis is a chronic inflammatory disorder of the skin with a 1 to 2% prevalence in general population. • First described in 1851 by F. Hebra. • The EXACT etiopathogenesis has still not been totally clarified.

3. Moreover psoriasis is thought to be a psychosomatic disorder because stress plays an important role in the onset and/or exacerbation of psoriasis in 40 to 80% of cases. Psoriasis has the potential for significant and social morbidity. • Stress seems to be the most powerful inducer of psoriatic lesions. Stress can be defined as an abnormal or extreme adjustment of the individual to cope with adverse effects of its environment and mangement. Therefore stress and the personality of the subject should be considered.

4. The evaluation of the personality model is developped by Cloninger who defines personality as having two fundamental components: -temperament: aptitude to show automatic reaction to emotional warnings -character: individuals' relatively unchanging objectively observed behaviors. • The components of the temperament are genetically independant and show hereditary characteristics (by 40 to 60%) • The genetic effects in character have a 10-15% component and the environmental influence is around 30-35%.

5. It has been described that psoriatic patients have an increased tendancy of being obsessive, being in the feeling of stigmatization, and being aggressive. • Controlled studies provided the data of more schizoid, avoidant, passive-aggressive and obsessive-compulsive profiles.

6. This study assessed personality components of psoriasis patients and compared them with healthy controls using the Temperament and Character Inventory (TCI). In addition this study evaluated the correlations between temperament and character dimensions with clinical factors such as the illness duration and the severity of the symptoms and psychological factors such as depression and anxiety of psoriasis patients.

7. Materials and methods. • Admitted patients with psoriasis-105 (54 female), 18-60 years. • excluded: unable or unwilling to fill questionnaire, psychiatric disorder or usage of psychotropic drugs • age, sex, educational background, duration of the illness, PASI recorded • control of 109 patients age-sex and education matched.

8. Psychiatric evaluation • Temperament and character inventory (TCI): true-false for : -4 temperament dimensions (Novelty seeking (NS), harm avoidance (HA), reward dependance (RD), persistance (P) -3 character dimensions (Self directedness (SD), coopertiveness (C), self-transcendence (ST) • Beck depression inventory (BDI): 0 to 3 based on a 21-item self-report questionanire (0 to 63) • Beck anxiety inventory (BAI): 0 to 3 based on a 21-item self-report questionnaire (0 to 63)

9. Statistical analysis ! Happy reading! • Komogorov-Smirnov test to test normal distribution of the data. Differences in the BDI, BAI and TCI scores between patients and controls were analysed using an umpaired Student's t-test... Pearson's correlation coefficients were obtained between the PASI score and the illness duration and psychometric factors. Partial correlation was used to determine the relationship between the TCI and the illness duration, controlling for the symptoms, depression and anxiety. To determine the relationship between the TCI scores and the PASI score, partial correlation analysis was also used to adjust for the duration of the illness, coexisting anxiety and depression. Partial correlation analysis to determine the relationship between TCI and depression, anxiety respectively.

10. Results • mean age patient group 35.43 +/- 8.77, duration 9.54 +/- 8.26, PASI 7.65 +/- 7.41 (0 to 44) • mean age control group 33.31 +/- 10.21 • The duration of illness and the PASI scores were not correlated with BDI and BAI scores.

12. Discussion • Although it has not been definitely proved, recent reports have also supported that the temperament and character is affected by genetic and environmental, respectively. • In this study, in order to clarify the etiopathogenesis in psoriasis, the TCI, and Cloininger’s 7 factor model of temperament and character. • Because depression and anxiety can influence TCI scores, the comparison of TCI between psoriasis and control groups was analyzed using these items ascovariants. The relation between the dimensions of personality, the duration, and severity of psoriasis, depression and anxiety was evaluated. • Results showed that the patients with psoriasis were more depressive, showed more harm avoidance and less self directedness.

17. This difference is not independent from the effects of depression and anxiety. The study shows a statistically significant positive correlation between BDI scores and Harm avoidance and a negative correlation with Self-directedness and cooperativeness.

19. Reward dependence considering anxiety and depression influencing factors was observed more in the psoriasis group. The comparison of the psoriatic patients with the control group by eliminating the effects of depression, the authors detected that the RD scores were significantly higher in the psoriasis group. Individuals who have high RD scores might be influenced easily and might lose their impartiality because they are sensual, tender, dependant and amiable.

20. In the comparison of the dimensions of personality between psoriasis and control groups without the influence of other factors, high Harm avoidance and low self-directedness were detected. The presence of no difference in High HA and low SD scores between 2 groups indicates the vigorous relation between personality dimensions and depression. -Serotonin has already been shown playing a role in personality and depression -Studies have shown that high HA and low self directedness scores were related with high depressive situation. -Improvement in scores of HA by anti-depressant treatment have been shown.

21. In contrast studies have shown that in atopic dermatitis, patients show a high harm avoidance score and low RD scores which corresponds to being cunning, devious, ineffectual, reserved, underachieving, alienated and cynical. • As an opposition the authors came to consider that patients with psoriasis are social, emotional, dependant and easily influenced individuals. Because depression affects RD scores, these features could be hidden by it.

22. Conclusion • -relationship between the dimensions of personality, duration and severity of the illness; depression and anxiety. • -By correlation analysis between these different variables using them as covariants: -depression correlates -positively with harm avoidance (HA) -negatively with temperament, with self-directedness (SD) and compliance (C) of personality.

23. -Psoriasis patients have distinct temperament traits such as reward dependence when compared with healthy controls. • -Furthermore, one temperament dimension (harm avoidance) and some character dimensions ( self directedness, cooperativeness) may be linked to depressive symptoms in psoriatic patients.