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51 - Brit I Psychiat(1983 143 5154 Psychiatric Symptoms in...

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Brit. I. Psychiat. (1983), 143, 51—54 Psychiatric Symptoms in Dermatology Patients J. E.HUGHES,B. M. BARRACLOUGH,L.G. HAMBLINand J. E.WHITE Summary: The 30-item General Health Questionnaire (GHQ)(Goldberg, 1972) was administered to 196 consecutive new dermatology out-patients and 40 consecutive admissions to dermatology beds. Thirty per cent of the out patients and 60 per cent of the in-patients obtained high scores, while half the high scorers in each group scored high on the Wakefield Self-Assessment Depression Scale (Snaith eta!, 1971).Thesefindings suggest that dermatology out-patients have a higher prevalence of psychiatric disorder than the general population, and dermatology in-patients a higher prevalence than general medical in-patients. High GHQ scores were associated with (a) diagnoses of acne, eczema, psoriasis or alopecia; with (b) extensive lesions on exposed parts of the body; and with (c)the useof high potency topical steroid. We indicate other areasthat might be profitably explored in afull-scale study. There are several hypothetical mechanisms which might account for a link between disorders of the mind and the skin: 1. Psychosomatic mechanisms may precipitate skin disease in predisposed subjects (MacAlpine, 1954). 2. Psychiatrically disturbed patients may present to the dermatologist (Sneddon, 1979; Cotterill, 1981) on account of hypochondriasis, delusions or hallucinations related to the skin, or self mutilation. 3. Disfigurement, social stigma or some disruption of the lifestyle resulting from skin disease may precipitate psychiatric symptoms. 4. Drugs used to treat skin disease, for instance steroids, may cause psychiatric disturbance, and drugs used in psychiatry, for example chiorpro mazine and lithium, may affect the skin. 5. Systemic diseases, systemic lupus erythematosus or porphyria, for example, may produce both skin lesions and psychiatric disturbances. Numerous publications on the psychiatric aspects of skin disease have appeared in the last 100 years, and have been reviewed by Whitlock (1976). Most of the articles have been concerned with psychosomatic or psychoanalytic theories of causation. The earlier literature relied more on speculation than on con trolled observation, but a paper by Sainsbury (1960) provided evidence in support of psychosomatic theory. He administered the Maudsley Personality Inventory (Eysenck, 1959) to 1,352 hospital out-patients, and found that those with supposedly psychosomatic conditions, including urticaria, eczema, alopecia, psoriasis and dermatitis, scored higher both on neuroticism and introversion than did patients with illnesses not thought to have a psychosomatic compo nent (e.g. injuries, osteo-arthritis). This and other previous studies focussed on person ality in dermatology patients rather than on their psychiatric symptomatology; there is no study which conclusively establishes that dermatology patients have a higher prevalence of psychiatric disorder than is found in the general population. The aims of our study were to discover whether indeed there was a higher prevalence of psychiatric disorder
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