Transcript Temperament and character profile of patients with psoriasis

Temperament and character
profile of patients with
psoriasis
Kilic.A et al. Jeadv 2008, 22, 537542
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.

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.

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 1015% component and the environmental
influence is around 30-35%.
 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, passiveaggressive and obsessive-compulsive
profiles.

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.
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.
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), selftranscendence (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)
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.
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.
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.
 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 Selfdirectedness and cooperativeness.

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.

In the comparison of the dimensions of
personality between psoriasis and control
groups without the influence of other factors,
high Harm avoidance and low selfdirectedness 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 antidepressant treatment have been shown.

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.
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.

-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.