Title Psihosocijalna obilježja bolesnika sa psorijazom i psorijatičnim artritisom : doktorski rad
Title (english) Psychosocial characteristics of psoriatic patients and psoriatic arthritis
Author Edita Simonić
Mentor Marija Kaštelan (mentor)
Mentor Ika Rončević-Gržeta (mentor)
Committee member Marija Kaštelan (predsjednik povjerenstva)
Committee member Ika Rončević-Gržeta (član povjerenstva)
Granter University of Rijeka Faculty of Medicine Rijeka
Defense date and country 2010-12-03, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences
Universal decimal classification (UDC ) 616 - Pathology. Clinical medicine
Abstract Uvod: Etiopatogeneza psorijaze i psorijatičnog artritisa nije u cijelosti poznata. Pretpostavlja se da psorijaza i psorijatični artritis nastaju međudjelovanjem genetskih i okolišnih čimbenika. U suvremenom poimanju etiologije i klasifikacije bolesti psorijaza se ubraja u psihosomatske psihokutane bolesti. Psihosocijalni čimbenici u kombinaciji s genetskom predispozicijom imaju ključnu ulogu u razvoju psorijaze i psorijatičnog artritisa.
Cilj istraživanja bio je ispitati pozitivna i negativna životna iskustva, različite stresne događaje koji su prethodili pojavi psorijaze i psorijatičnom artritisu te životne stilove, odnosno mehanizme obrane i vrste agresivnosti u bolesnika sa psorijazom i psorijatičnim artritisom. Također je ispitana njihova moguća povezanost s težinom kliničke slike psorijaze.
Ispitanici i postupci: U studiji je sudjelovalo 100 bolesnika sa psorijazom i 45 bolesnika koji osim psorijaze imaju psorijatični artritis. U kontrolnoj skupini bio je 101 ispitanik liječen zbog dermatoza koje nemaju nikakav utjecaj na tjelesno ili duševno zdravlje. Svi ispitanici ispunili su upitnik sa sociodemografskim podatcima te psihologijske upitnike: trauma antecedentni upitnik, ljestvicu životnih događaja, upitnik životnog stila te upitnik za mjerenje agresivnosti. U svih bolesnika sa psorijazom kliničkim je pregledom određena težina kliničke slike bolesti izražena ljestvicom PASI.
Rezultati: Bolesnici sa psorijazom i psorijatičnim artritisom su značajno češće izloženi mnogobrojnim negativnim životnim iskustvima uz istovremeno smanjenje pozitivnih životnih iskustava napose tijekom školske (p=0.02) i adolescentne dobi (p=0.01). Nadalje, bolesnici sa psorijazom pokazuju značajno češće indirektnu prenesenu agresiju (p=0.026), verbalnu latentnu agresiju (p=0.018) i ukupnu agresiju (p=0.039). Oboljeli od psorijaze i psorijatičnog artritisa ne doživljavaju intenzivnije stresove prije početka bolesti, međutim, značajno su više uznemireni nego kontrolna skupina ispitanika (p=0.0001). Bolesnici sa psorijatičnim artritisom značajno češće koriste negaciju (p=0.005), projekciju (p=0.025) i intelektualizaciju (p=0.0001) dok psorijatičari uz ove mehanizme obrane češće koriste i mehanizme reaktivne formacije (p=0.051) i regresije (p=0.029) u usporedbi s kontrolom. Težina kliničke slike psorijaze značajno korelira s obrambenim mehanizmom premještanja. Premještanje značajno korelira sa svim oblicima agresije i jedino značajno predviđa težinu kliničke slike psorijaze ( Beta = 0.366; p=0.007).
Zaključci: Rezultati istraživanja povezanosti pozitivnih i negatinih životnih iskustava, stresa, agresivnosti i mehanizama obrane u bolesnika sa psorijazom i psorijatičnim artritisom ukazuju na važnu ulogu psihosocijalnih čimbenika u multifaktorijalnoj etiopatogenezi tih bolesti. Stoga je u liječenju ovih bolesnika potreban interdisciplinaran pristup koji uz dermatologa uključuje sudjelovanje psihijatra i psihoterapeuta.
Abstract (english) Introduction: The etiopathogenesis of psoriasis and psoriatic arthritis is not entirely acknowledged. It is assumed that the development of psoriasis and psoriatic arthritis is influenced by interaction of genetic and environmental factors. According to the new data psoriasis is classified as a psychosomatic skin disease. Psychosocial factors in combination with genetic background play a key role in the development of psoriasis and psoriatic arthritis. For their treatment it is neccessary to use an interdisciplinary approach.
The aim of the research was to explore both positive and negative life experiences, different stress situations that happened before the appearance of psoriasis and psoriatic arthritis, defense mechanisms and types of aggression in patients with psoriasis and psoriatic arthritis. It has also been investigated their possible correlation with the disease severity.
Patients and methods: The study includes 100 psoriatic patients and 45 psoriatic patients with psoriatic arthritis. The control group consisted of 101 patients that suffered from dermatosis which had no influence on their psychological and physical wellbeing. All participants were asked to fill out a questionnaire with sociodemografic data and several psychological questionnaires: a trauma antecedent questionnaire, a life experience scale, a life style questionnaire and a questionnaire for the evaluation of aggression. In all psoriatic patients the severity of psoriasis has been estimated according to the Psoriasis Area and Severity Index (PASI scale).
Results: Patients with psoriasis and psoriatic arthritis were exposed more frequently to multiple negative life experiences with the lack of positive life experience, especially during school (p=0.02) and adolescent age (p=0.01). Patients with psoriasis showed more frequently indirect or transposed aggression (p=0.026), verbal latent aggression (p=0.018) and total aggression (p=0.039). Patients with psoriasis and psoriatic arthritis do not experience more intense stress before the beginning of the disease, but they are more upset than the controls (p=0.0001). Patients with psoriatic arthritis significantly often use negation (p=0.005), projection (p=0.025) and intellectualization (p=0.0001) while psoriatic patients with these defense mechanism more often use reactive formation (p=0.0051) and regression (p=0.029) in comparison to the control group. The severity of psoriasis is in significant correlation with the defense mechanism of transponding. The transposition significantly correlates with all forms of aggression and is an important predictor of the severity of the clinical picture of psoriasis (Beta =0.366; p= 0.007).
Conclusions: The study results of the association of positive and negative life experience, stress, aggression and defense mechanisms in psoriatic patients and patients with psoriatic arthritis show the important role of psychosocial factors in the multifactor etiopathogenesis of these diseases. Thus for the treatment of these patients interdisciplinary approach is needed which includes the participation of a dermatologist and a psychiatrist-psychotherapist.
Keywords
Psihološka trauma
Psihološki čimbenici
Psihosomatske bolesti
Psorijatični artritis
Psorijaza
Stres
Keywords (english)
Psoriasis
psoriatic arthritis
psychological factors
psychcological trauma
psychosomatic deseases
stress
Language croatian
URN:NBN urn:nbn:hr:188:409725
Study programme Title: Biomedicine Postgraduate (doctoral) study programme Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
Catalog URL https://libraries.uniri.hr/cgi-bin/ucat/unilib.cgi?form=D1120728057
Type of resource Text
Extent 157 str.
File origin Born digital
Access conditions Open access
Terms of use
Created on 2017-01-19 19:20:50