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Biomedical subjects

M A Gupta

Publications and source records attributed to M A Gupta.

At least 19 recordsLinked to original sources
PubMed1998

Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis.

We examined the prevalence of depression (measured by the Carroll Rating Scale for Depression, CRSD), wishes to be dead and acute suicidal ideation among 480 patients with dermatological disorders that may be cosmetically disfiguring, i.e. non-cystic facial acne (n = 72; 5.6% suicidal ideation), alopecia areata (n = 45; 0% suicidal ideation), atopic dermatitis (n = 146; 2.1% suicidal ideation) and psoriasis (79 outpatients, 2.5% suicidal ideation and 138 inpatients, 7.2% suicidal ideation). Analysis of variance revealed that the severely affected psoriasis inpatients (mean +/- SD total body surface area affected: 52 +/- 23.4%) had the highest (P < 0.05) CRSD score, followed by the patients with mild to moderate acne; both scores were in the range for clinical depression (CRSD score > 10). The 5.6-7.2% prevalence of active suicidal ideation among the psoriasis and acne patients was higher than the 2.4-3.3% prevalence reported among general medical patients. Our findings highlight the importance of recognizing psychiatric comorbidity, especially depression, among dermatology patients and indicate that in some instances even clinically mild to moderate disease such as non-cystic facial acne can be associated with significant depression and suicidal ideation.

Acne Vulgaris↗
PubMed1998

The development of an Acne Quality of Life scale: reliability, validity, and relation to subjective acne severity in mild to moderate acne vulgaris.

We developed a disease-specific 9-item Acne Quality of Life scale that is sensitive to changes in patient-rated indices of acne severity and the psychological morbidity that is associated with acne. Seventy patients with mild to moderate acne vulgaris completed a 12-item scale that was developed to assess both the social and vocational impacts of acne. Factor analysis revealed the presence of two dimensions underlying the quality of life construct. The first dimension consisted of 9 items and addressed the social impact of acne, while the second dimension consisted of 3 items and addressed the vocational impact of acne. Only the first dimension correlated with indices of acne severity, such as pustules and scarring, and all 3 scales correlated with a wide range of psychopathologic measures. The 9-item scale had a very high degree of internal consistency and test-retest reliability. This 9-item scale may be used to evaluate the relation between acne severity and quality of life, especially among mildly to moderately affected patients for whom quality of life issues are often a major consideration in deciding whether or not to institute therapies for the acne.

Acne Vulgaris↗
PubMed1998

Perceived deprivation of social touch in psoriasis is associated with greater psychologic morbidity: an index of the stigma experience in dermatologic disorders.

Touch is a powerful medium of social validation. Patients with skin disorders often experience social rejection when people avoid touching them, possibly fearing contagion or filth. We examined the psychologic impact of the stigma experience among 137 patients with moderate to severe psoriasis; 26.3 percent of patients reported that during the previous month they had experienced an episode when "people made a conscious effort not to touch them" because of their psoriasis. The stigmatized group did not have greater psoriasis severity than the non-stigmatized control group. However, in contrast to the non-stigmatized group, the stigmatized group had higher (P = 0.0003) depression scores (in the range for clinical depression, as measured by the Carroll Rating Scale for Depression), by stepwise logistic regression analysis using a wide range of psychopathologic measures as the independent variables. These findings underline the profound impact of the stigma experience in psoriasis, and possibly other dermatologic conditions that are associated with social stigma.

Adaptation, Psychological↗
PubMed1997

Psoriasis and sex: a study of moderately to severely affected patients.

BACKGROUND: Psoriasis can have a significant impact upon sexual functioning for 30%-70% of patients. We examined the dermatologic and psychologic factors associated with the effect of psoriasis on this important dimension of quality of life. METHODS: One hundred and twenty consenting psoriasis patients (63 men and 57 women; mean +/- SD age, 46.8 +/- 15.7 years; mean +/- SD total body surface area affected, 53.4% +/- 22.9%) completed a battery of questionnaires which included their response (endorsed with a "Yes" or "No") to the following question: "Do you believe that since the onset of psoriasis your sexual activity has declined?" The differences in dermatologic and psychologic measures between the subgroup that endorsed a "Yes" response and the subgroup that endorsed a "No" response were examined. RESULTS: Forty-nine out of 120 patients (40.8%) were sexually affected, i.e. they endorsed a "Yes." There were no significant differences between the affected and unaffected groups with respect to marital status, age, sex, and duration of psoriasis. The affected group reported more joint pains (P = 0.01), marginally greater psoriasis severity affecting the groin region (P = 0.07), greater scaling (P = 0.06), and greater pruritus severity (P = 0.07). Psychologically, the affected group had higher depression scores (P = 0.02) which were in the range for clinical depression, a greater tendency (P = 0.02) to seek the approval of others, and a marginally greater tendency (P = 0.08) to drink alcohol. A decline in sexual activity was related to a decrease in the patient's sex drive for 42.6% of patients; however, only 14.9% of these patients attributed the decline in their sexual activity to decreased sex drive of their spouse/partner. CONCLUSION: In addition to some dermatologic factors, comorbid psychologic factors, such as depression and a tendency for alcohol use, may be important determinants of decreased sexual functioning in psoriasis.

Alcoholism↗
PubMed1997

Stress and alopecia areata: a psychodermatologic study.

Psychosocial stress has been reported to play a role in the onset and/or exacerbation of alopecia areata. Little is known about the clinical characteristics of alopecia areata patients whose alopecia is stress-reactive. We examined the relation between the stress reactivity of alopecia areata and a wide range of psychosocial measures among 16 patients with alopecia areata/totalis and 28 patients with alopecia universalis. The degree to which the alopecia was exacerbated by stress was measured by patient ratings on a 10-point scale. A wide range of psychologic measures correlated (p<0.05) with the stress reactivity score. Stepwise logistic regression analysis revealed that patients with higher depression scores were more likely to be in the high-stress reactor group. Patients whose alopecia is stress-reactive may suffer from depressive illness, a potentially important consideration in the overall management of such patients.

Adult↗
PubMed1996

Psychodermatology: an update.

It has been estimated that in at least one third of dermatology patients, effective management of the skin disorder involves consideration of associated emotional factors. This article provides an overview of psychodermatology with a focus on the more recent literature and an emphasis on the clinical aspects and psychologic therapies for (1) cutaneous associations of psychiatric disorders and (2) psychiatric associations of certain cutaneous disorders that are known to be influenced by psychosomatic factors. This article also provides an update on the use of psychotropic drugs (i.e., the antianxiety, antidepressant, and antipsychotic agents) for the treatment of mental disorders that occur in conjunction with cutaneous conditions. Some of their other pharmacologic properties, such as the antihistaminic and analgesic effects of some antidepressant agents are also reviewed.

Analgesics↗
PubMed1996

Early onset (< 40 years age) psoriasis is comorbid with greater psychopathology than late onset psoriasis: a study of 137 patients.

Early onset (< age 40 years) psoriasis has been reported to be more readily triggered by environmental factors such as stress, in contrast to late onset (> or = age 40 years) psoriasis. We examined whether certain psychopathologic factors differentiated the psoriasis patient with early onset versus late onset disease. One hundred and thirty-seven psoriasis inpatients completed a battery of psychosocial questionnaires. Logistics regression analysis, using the psychologic measures, age and TBSA affected as independent variables, revealed that higher Anger-in (Anger Expression Scale) scores significantly (p < 0.05) increased the odds or probability of having early versus late onset psoriasis. Psoriasis with onset prior to age 40 is comorbid with greater difficulties with assertion and expression of anger, a personality trait that may adversely affect the patient's capacity to cope with stress.

Adolescent↗
PubMed1995

Touch deprivation has an adverse effect on body image: some preliminary observations.

Body image in childhood initially develops in response to the empathic reflections of the mother or caregiver that are communicated mainly by physical sensations such as touching, secure holding, or tactile nurturing. In a nonclinical sample of 173 shoppers, we observed an inverse correlation between perceived tactile nurturing during childhood and Drive for Thinness (Eating Disorder Inventory [EDI]; Pearson r = -.19, p < or = .05) and Body Dissatisfaction (EDI; Pearson r = -.23, p < or = .05) among the females (n = 102). Furthermore, among the females there was a direct correlation (r = .29, p < .05) between a current desire to get more tactile nurturance and Drive for Thinness. Our empirical finding are consistent with the earlier developmental literature and support the importance of tactile nurturance in the development of body image especially among females.

Adult↗
PubMed1995

Concerns about aging and a drive for thinness: a factor in the biopsychosocial model of eating disorders?

OBJECTIVE: Examine the association between concerns about aging and a drive for thinness. METHOD: Two groups were studied: (1) randomly selected nonclinical subjects (77 men, M +/- SD age: 44.4 +/- 18.3 years; 140 women, M +/- SD age: 41.9 +/- 15.3 years) from Ann Arbor, Michigan (replication of an earlier shopping mall-based survey); and (2) women (N = 54) who were concerned about their aging appearance (18 women with mild to moderate skin aging, M +/- SD age: 41 +/- 4 years; 36 women with moderate to severe skin aging, M +/- SD age: 62 +/- 6 years) and had volunteered for 24-week, prospective, controlled studies evaluating the efficacy of topical retinoic acid versus placebo for the treatment of aging skin. All subjects rated their aging-related concerns on previously developed scales, and completed the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorder Inventory (EDI). RESULT: In the random community survey there was a direct correlation between both concerns about the effect of aging on the appearance (men: r = .28, p < .05; women: r = .32, p < .01) and concerns about the cutaneous stigmata of aging (men: r = .38, p < .01; women: r = .28, p < .01) and DT (EDI). In the aging skin study both DT (EDI) and BD (EDI) were lower (p < .01) at 24 weeks posttherapy, in the retinoic acid (n = 32) but not the placebo (n = 22) group. DISCUSSION: Concerns about an aging appearance can be associated with a drive for thinness and excessive dieting, factors that are important in the development of eating disorders.

Administration, Topical↗
PubMed1995

Perceived touch deprivation and body image: some observations among eating disordered and non-clinical subjects.

The developmental literature suggests that touch, consisting of secure holding and hugging, plays an important role in the formation of body image. We tested the hypothesis that women with anorexia nervosa and/or bulimia nervosa (N = 59), conditions associated with body image problems, report a greater deprivation of tactile nurturance than a sample of non-clinical randomly selected women (N = 140) from the community. Measures of body image included the Drive for Thinness and Body Dissatisfaction subscales of the Eating Disorder Inventory. Perceived touch deprivation was rated on a 10-point scale, previously developed by the author. Analysis of covariance, controlling for the effects of age and body mass index, revealed that the eating disorder group reported greater (p < 0.0001) body image concerns and perceived greater (p < 0.0001) touch deprivation both during their childhood and their current life, than the non-clinical group. Our preliminary empirical findings suggest that touch deprivation may play a role in body image pathologies.

Adult↗
PubMed1995

Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium.

Lithium is frequently used in the management of several psychiatric disorders including acute mania, bipolar (manic-depressive) disorder, and recurrent depression. We describe a patient in whom hidradenitis suppurativa developed while the patient was receiving lithium. The cutaneous side effects of lithium are reviewed. The most frequent are psoriasis, acneiform lesions, folliculitis, alopecia, and a maculopapular/macular eruption. Many of these side effects respond less readily to conventional therapy while the patient is receiving lithium.

Acne Vulgaris↗
PubMed1995

Age and gender differences in the impact of psoriasis on quality of life.

BACKGROUND: The impact of psoriasis upon the quality of life contributes significantly to the overall morbidity associated with the disease. An older age at onset of psoriasis and being a man have been associated previously with lower psychosocial morbidity. In order to further evaluate these potentially important mitigating factors, we examined the relation of age and gender on some aspects of psoriasis-related psychosocial morbidity. METHODS: Two hundred and fifteen consenting psoriasis patients, representing a wide range of disease severity, were studied. They included 110 men and 105 women, age range 19-87 years (age: mean +/- SD: 48.0 +/- 15.9 years); all endorsed a list of 30 items (by checking a "Yes" or "No") pertaining to life events related to psoriasis that they had experienced in the previous one month. The patients self-rated the severity of their psoriasis. The patients were categorized into four age groups of 18-29 years (N = 28), 30-45 years (N = 77), 46-65 years (N = 76), and > 65 years (N = 34), respectively, for the statistical analyses. RESULTS: No age or gender differences in the severity of psoriasis were observed. Patients of both sexes in the 18 to 29 and 30 to 45 year age groups reported more frequent (P < or = 0.05) problems related to both appearance/socialization and occupation/finances, in contrast to patients in the 46-65 and over-65-year age groups. No gender differences (P < or = 0.05) were observed in the frequency of items related to appearance and socialization; however, men reported greater work-related stresses. CONCLUSION: Psoriasis has a greater impact upon the quality of life of patients in the 18 to 45 year age range and affects the socialization of both sexes equally. Men face greater work-related stresses as a result of their psoriasis.

Adult↗
PubMed1995

The Psoriasis Life Stress Inventory: a preliminary index of psoriasis-related stress.

The psychosocial impact of psoriasis may result in significant daily stress for the patient. We present a questionnaire, the Psoriasis Life Stress Inventory (PLSI), which provides a rating of psoriasis-related stress. Two hundred and seventeen psoriasis patients endorsed a list of psoriasis-related items they had experienced over the previous one month and rated the degree of stress associated with each item on a 4-point scale. The final version of the PLSI consisted of 15 items, each of which had been endorsed by at least 15% of patients. A PLSI score of > or = 10 (range 0 to 43) delineated patients with greater overall psoriasis severity (p = 0.007), more cosmetically disfiguring psoriasis (p < 0.01), greater number of flare-ups of psoriasis (p = 0.009) and greater pruritus severity (p = 0.001). This preliminary instrument provides a clinically useful index of psoriasis-related stress and needs to be tested among patients from different centers and in prospective studies.

Activities of Daily Living↗
PubMed1995

Chronic idiopathic urticaria associated with panic disorder: a syndrome responsive to selective serotonin reuptake inhibitor antidepressants?

We present two patients with a history of chronic idiopathic urticaria occurring in conjunction with a panic disorder (DSM-IIIR), in whom both the urticaria and panic disorder responded favorably to a course of the selective serotonin reuptake inhibitor antidepressants fluoxetine and sertraline, respectively. Both patients had previously required systemic corticosteroids to manage their urticaria. Panic disorder is an anxiety disorder characterized by the presence of recurrent unexpected panic attacks. Serotoninergic mechanisms play an important role in panic disorder. In contrast to antidepressants such as doxepin, which have previously been found to be effective in the treatment of chronic urticaria, the newer selective serotonin reuptake inhibitor antidepressants are only weakly antihistaminic and anticholinergic. The response of both the urticaria and panic disorder to selective serotonin reuptake inhibitor antidepressants may suggest a common pathogenic factor involving serotoninergic mechanisms.

1-Naphthylamine↗
PubMed1994

Psychosocial correlates of the treatment of photodamaged skin with topical retinoic acid: a prospective controlled study.

BACKGROUND: The psychosocial aspects of the treatment of photodamaged skin have received little attention. OBJECTIVE: We prospectively examined the psychosocial correlates of the treatment of mildly to severely photodamaged skin. DESIGN: Sixty subjects (age, 53.3 +/- 1.3 years [mean +/- standard error]; 35 receiving retinoic acid and 25 the inactive vehicle) completed a battery of psychosocial ratings before starting therapy and after 24 weeks of therapy with retinoic acid or vehicle. RESULTS: Before therapy, the subjects had pathologically high obsessive-compulsiveness scores (measured by the Brief Symptom Inventory [BSI]). From before to after therapy, the retinoic acid group reported decreased obsessive-compulsiveness (BSI) (p = 0.01), and decreased phobic anxiety (BSI) (p = 0.04), whereas the vehicle group reported an increase (p < 0.05) in both these symptom dimensions. CONCLUSION: High obsessive-compulsiveness (BSI), which is associated with excessive perfectionism and need for control, probably predisposed the subjects to seek treatment of their wrinkles. In the retinoic acid group but not the vehicle group there was an improvement in obsessive-compulsiveness and decreased anxiety in previously anxiety-provoking situations.

Administration, Cutaneous↗