Dermatolojik Bozukluğu Olan Çocuklarda Psikiyatrik Komorbidite ve Psikososyal Bozulma

Abstract

Amaç:Sınırlı sayıda çalışma, çocuk psikodermatolojisi alanında psikiyatrik komorbidite, psikolojik ve sosyal faktörleri araştırmıştır, bun edenle çocuklar ve ergenlerle ilgili literatür sınırlıdır. Bu çalışmada, dermatolojik bozukluğu olan çocukların psikiyatrik komorbidite prevalansını ve örüntüsünü ortaya koymayı ve dermatolojik problemlerin psikolojik iyilik, okul performansı, benlik saygısı üzerindeki etkilerini araştırmayı amaçladık. Yöntem:Çalışmaya 4-17 yaş arası (ortalama yaş 11.81 ± 3.40 yıl), farklı dermatolojik bozukluğu olan 143’ü (% 52.9) kadın, 247 ayaktan hasta dahil edildi. Çocuğun ve ergenin yaş aralığına göre, psikiyatrik tanı koymada, yarı yapılandırılmış tanı görüşmesi ve Ruhsal Bozuklukların Tanısal ve İstatistiksel El Kitabı (DSM-5) kriterleri uygulandı. Özel olarak hazırlanmış kişisel bilgi formu, Rosenberg Benlik Saygısı Ölçeği ile Güçler ve Güçlükler Anketi kullanıldı. Bulgular:Çalışma grubumuzda psikopatoloji prevalansı % 58.7 olarak bulundu. En sık görülen psikiyatrik eştanılar anksiyete bozuklukları, duygu durum bozuklukları, dikkat eksikliği hiperaktivite bozukluğu ve yıkıcı davranış bozukluklarıydı. Dermatolojik tanılar 8 gruba ayrıldı. Dermatolojik tanı grupları içerisinde psikopatoloji, benlik saygısı, bedensel beğenilme kaygısı, akademik performans, sosyalizolasyon, damgalama, başlangıç ve / veya alevlenmedeki psikososyal stress faktörlerinin varlığı açısından en riskli olanlar psöriyazis, primeri psikiyatrik bozukluk olanlar, pigmentasyon bozuklukları ve saç bozuklukları idi. Sonuç:Dermatolojik hastalığı olan çocuk popülasyonunda psikiyatrik eştanıoldukça yaygındır (% 58.7). Dermatolojik hastalıkların psikososyal işlevler üzerindeki etkileri de çok fazladır. Hem dermatologlar hem de çocuk ve ergen psikiyatristleri psikiyatrik bozukluklar veya psikososyal bozukluğun farkında olmalıdır ve hastalar psikiyatrik destek açısından titizlikle değerlendirilmelidir.

Keywords

• Pediatrik psikodermatoloji
• çocuk psikiyatrisi
• psikiyatrik eş tanı
• psikososyal faktörler
• stres

Psychiatric Comorbidity and Psychosocial Impairments in Children with Dermatologic Disorders

Abstract

Objective: Few studies have explored the psychiatric comorbidity, psychological and social factors in the field of pediatric psycho-dermatology, thus the literature about children and adolescents is limited. In this study, we aimed to find out the prevalence and pattern of psychiatric comorbidity and to investigate the impacts of dermatological problems on psychological well-being, school performance, self-esteem in children suffering from dermatologic disorders. Method: In total, 247 consecutive outpatients with different dermatologic disorders aged 4–17 years (143 (52.9%) females, mean age 11.81±3.40 years) were included in this study. A semi-constructed diagnosis interview and The Diagnostic and Statistical Manual of Mental Disorders (DMS-5) criteria were performed to establish a psychiatric diagnosis according to the age range of the child and adolescent. A specially prepared personal information sheet, Rosenberg Self-Esteem scale and Strengths and Difficulties Questionnaire were applied. Results: The prevalence of psychopathology was found to be 58.7% in our study population. The most common psychiatric comorbidities were anxiety disorders, mood disorders, attention deficit hyperactivity disorder and disruptive behavior disorders. Dermatologic diagnoses were divided into 8 groups. The riskiest dermatologic diagnostic groups in terms of psychopathology, self-esteem, body appreciation anxiety, academic performance, social isolation, stigmatization, significant association with psychosocial stressors at onset and/or exacerbation were psoriasis, primary psychiatric disorders, pigmentation disorders and hair disorders. Conclusions: Psychiatric comorbidity is quite common (58.7%) in the pediatric population with dermatologic disorders. The impacts upon the psychosocial functioning of dermatologic conditions are also enormous. Both dermatologists and child and adolescent psychiatrists should be well aware of psychiatric disturbance or psychosocial impairment, and patients should be meticulously assessed for psychiatric support.

Keywords

• pediatric psychodermatology
• child psychiatry
• psychiatric comorbidity
• psychosocial factors
• stress

References

1. 1. Gupta MA, Gupta AK. Current concepts in psychodermatology. Curr Psychiatry Rep. 2014 Jun;16(6):449. doi: 10.1007/s11920-014-0449-9.
2. 2. Bilginer SC. Consultation liaison psychiatry in child and adolescent with skin diseases. Turkiye Klinikleri J Child Psychiatry-Special Topics. 2016;2(2):75-80.
3. 3. Mitchell AE. Bidirectional relationships between psychological health and dermatological conditions in children. Psychol Res BehavManag. 2018 Jul 31;11:289-298. doi: 10.2147/PRBM.S117583.
4. 4. Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J AllergyClinImmunol. 2013 Feb;131(2):428-33. doi: 10.1016/j.jaci.2012.10.041.
5. 5. Miniksar DY. Psychiatric disorders in children and adolescents with dermatological diseases. Inonu University Faculty of Medicine Department of Child and Adolescent Psychiatry (Master’s Thesis), 2015.
6. 6. Kimball AB, Wu EQ, Guérin A, Yu AP, Tsaneva M, Gupta SR, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. J Am Acad Dermatol. 2012 Oct;67(4):651-7.e1-2.doi: 10.1016/j.jaad.2011.11.948.
7. 7. Bilgic O, Bilgiç A, Akis HK, Eskioglu F, Kilic EZ. Depression, anxiety and health-related quality of life in children and adolescents with vitiligo. ClinExpDermatol. 2011 Jun;36(4):360-5.doi: 10.1111/j.1365-2230.2010.03965.x.
8. 8. Dharshana S, Singh AK, Sharma S, Mohan SK, Joshi A. Depression, mood change and self-esteem among adolescents aged 12-25 years with acne vulgaris in India. Ann Trop Med Public Health. 2016;9:31-6.

9. 9. Magin P, Adams J, Heading G, Pond D, Smith W. The psychological sequelae of psoriasis: results of a qualitative study. Psychol Health Med. 2009 Mar;14(2):150-61. doi: 10.1080/13548500802512294.
10. 10. Prindaville B, Antaya RJ, Siegfried EC. Pediatric dermatology: past, present, and future. Pediatr Dermatol. 2015 Jan-Feb;32(1):1-12. doi: 10.1111/pde.12362.
11. 11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: 5th ed: DSM 5. Washington DC: American Psychiatric Association, 2013.
12. 12. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997 Jul;36(7):980-988. doi: 10.1097/00004583-199707000-00021 .
13. 13. Gokler B, Unal F, Pehlivanturk B, Kultur EC, Akdemir D, Taner Y. Reliability and validity of schedule for affective disorders and schizophrenia for school age children-present and lifetime version- Turkish version (K-SADS-PL-T) [in Turkish]. Turk J Child Adolesc Mental Health. 2004;11:109-116.
14. 14. Rosenberg M. Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press, 1965. http://dx.doi.org/10.1515/9781400876136
15. 15. Cuhadaroglu F. Self-esteem in adolescents (in Turkish). Unpublished master’s thesis, Hacettepe University, Ankara, Turkey, 1986.
16. 16. Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997 Jul;38(5):581-6.
17. 17. Guvenir T, Ozbek A, Baykara B, Arkar H, Senturk B, Incekas S. Psychometric properties of the Turkish version of the Strengths and Difficulties Questionnaire (SDQ). Turk J Child AdolescMent Health. 2008;15(2):65-74.
18. 18. Gupta MA, Gupta AK. A practical approach to the assessment of psychosocial and psychiatric comorbidity in the dermatology patient. ClinDermatol. 2013 Jan-Feb;31(1):57-61. doi: 10.1016/j.clindermatol.2011.11.007.
19. 19. Daramola OO, Ayoola OO, Ogunbiyi AO. The comparison of intelligence quotients of atopic and nonatopic children in ibadan, Nigeria. Indian J Dermatol. 2010 Jul-Sep;55(3):221-4. doi: 10.4103/0019-5154.70665.