Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria

doi:10.1016/S1081-1206(10)60617-5

Annals of Allergy, Asthma & Immunology

Volume 99, Issue 1, July 2007, Pages 29-33

https://doi.org/10.1016/S1081-1206(10)60617-5 Get rights and content

Background

Chronic idiopathic urticaria (CIU) is a frequently occurring disease that has a great impact on the health-related quality of life (HRQL) of patients and seems to be associated with a number of psychological factors.

Objectives

To determine the prevalence of psychiatric morbidity in patients with CIU and to determine HRQL of CIU patients compared with controls.

Methods

A semistructured interview form, a generic form of the HRQL questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and the Structured Clinical Interview for DSM-IV Axis Disorders (SCID-I) were administered to CIU patients who presented to the Allergy Department of the University of Istanbul (from January 1 to April 30, 2005). Healthy subjects matched sociodemographically with the study group were used as the control group.

Results

Eighty-four CIU patients and 75 controls were included in the study. The mean ± SD age of the study participants was 36.83 ± 10.26 years, and 84% were women. The mean ± SD duration of the disease was 6.34 ± 7.2 years, and symptoms were intermittent in 51%. The SCID-I revealed a psychiatric diagnosis in 60% of the patients. In terms of the distribution of psychiatric diagnoses, the most frequently occurring diagnosis was depressive disorders (40%). Most patients (81%) believed that their illnesses were due to stress. The subdomains on the SF-36 measurements were significantly lower than those of the control subjects (P ≤ .005). The physical function, vitality, and mental health subdomains of the SF-36 in the patients with a psychiatric diagnosis were significantly lower (P < .05).

Conclusion

These findings suggested that psychiatric morbidity is high among ICU patients and is detrimental to their quality of life.

Section snippets

INTRODUCTION

Chronic urticaria (CU) is a common skin disorder characterized by recurrent and spontaneously occurring wheal and flares associated with pruritus. The traditional definition of CU is daily or almost daily occurrence of hives for more than 6 weeks, in contrast to acute urticaria, which disappears within less than 6 weeks.1, 2 CU predominantly affects adults and is approximately twice as common in women as in men. It remains a major problem in terms of etiology, investigation, and management.³

Patient Selection

Patients with CIU who met selection criteria among the first attending 350 patients who had applied to the Allergy Department at the University of Istanbul between January 1 and April 30, 2005, were included in the study. The criteria for inclusion in the study were as follows: (1) a diagnosis of CIU, (2) age between 18 and 65 years, (3) lack of any apparent psychotic symptom or mental retardation, (4) provision of informed consent, (5) ability to sufficiently read, write, and comprehend the

RESULTS

Eighty-four CIU patients and 75 controls were included in the study. The sociodemographic characteristics of the patient and control groups are given in Table 1. The mean ± SD duration of the disease was 6.34 ± 7.2 years. Symptoms were intermittent in 51% and persistent in 49% of the patients. According to combined symptom score assessments, disease was severe in 21%, moderate in 63%, and mild in 15% of study participants, although in patient symptom ratings, disease severity was slightly

DISCUSSION

In this study, 60% of CIU patients obtained a psychiatric diagnosis according to the SCID-I. Taking into consideration that 7% of these patients had received such a diagnosis only in the past, it was found that the rate of new psychiatric diagnosis was 52%. The rate of psychiatric disorders among patients with chronic physical diseases has been shown to be 29% to 40%.15, 16 The prevalence of psychiatric disorder in the general population in Turkey has been reported to be between 10% to 20%.17,

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Chronic Urticaria
2022, Comprehensive Pharmacology
Chronic urticaria (CU) is defined by the recurrence of wheals and/or angioedema for more than 6 weeks. It is divided into chronic inducible urticarias (CIndU) and chronic spontaneous urticaria (CSU), previously termed chronic idiopathic urticaria. In CIndU, signs and symptoms are provoked by a specific and definite trigger such as exercise, friction or cold. Patients with CSU display symptoms independently of definite triggers. Most patients with CSU experience recurrent wheals angioedema, some only have wheals and a few patients have only angioedema. In most cases, CU is a self-limiting disorder. CSU, on average, persists for several years, whereas CIndU tends to be of longer duration. Type I and IIb autoimmunity, i.e., IgE and IgG/IgM autoantibodies to autoallergens and IgE receptor, respectively, have been implicated in the pathogenesis of CSU in most patients. Treatment of patients with CU is aimed at complete control. Guideline-recommended treatment options are limited to second-generation H₁-antihistamines, at standard or up to fourfold times the standard doses, omalizumab and cyclosporine. CU activity, impact and control should be assessed in all patients with CU as this helps to guide effective treatment.
How to Measure Disease Activity, Impact, and Control in Patients with Recurrent Wheals, Angioedema, or Both
2021, Journal of Allergy and Clinical Immunology: In Practice
Chronic spontaneous urticaria and chronic inducible urticaria are characterized by wheals, angioedema, or both, whereas other conditions such as hereditary angioedema present only with angioedema. The unpredictability of outbreaks, disfigurement, pruritus, and associated sleep and work disturbance can cause a significant impact on quality of life (QoL). Significant breakthroughs in the understanding of these conditions in recent years have led to the development of novel therapies. Assessment of patients with these conditions not only focuses on the clinical activity of the condition, but also on the impact on QoL and disease control with treatment. Patient-reported outcome measures, especially if sufficiently validated, give due prominence to the patient's perspective regarding disease impact and treatment outcomes. This article will review the tools readily available to assess activity, impact, and control in patients with recurrent wheals, angioedema, or both.
The Diagnostic Workup in Chronic Spontaneous Urticaria—What to Test and Why
2021, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
Nevertheless, existing comorbid allergies should be treated in accordance with the respective guidelines. Between 5% and 60% of patients with CSU exhibit psychiatric comorbidities,64,66,68,88,91-93 and a recent meta-analysis found sleep-wake disorders, anxiety, and mood disorders to be the most prevalent.94 Although mental disorders are frequent in the general population (12%-49%),95 there are data suggesting that CSU is associated with a significantly increased risk of psychiatric conditions,96,97 especially depression and anxiety,91,93,98-104 which contribute to decreased patient quality of life (QoL).
In chronic spontaneous urticaria (CSU), the guidelines recommend very limited diagnostic procedures during the routine workup, although additional investigations might be indicated in some patients with CSU. For physicians treating patients with CSU, it is often difficult to decide which diagnostic tests are useful.
To provide recommendations on what diagnostic tests should be performed on which patients with CSU.
We performed an extensive literature search on the respective topics and identified relevant questions that should prompt diagnostic procedures based on the published evidence and expert consensus among all authors.
We provide questions, diagnostic testing, where appropriate, and recommendation that should be included when assessing the history of a patient with CSU, to explore and rule out differential diagnoses, to assess patients for underlying causes and modifying conditions, to explore patients for comorbid diseases and consequences of having CSU, and to assess patients for CSU components that can help to predict their disease course and response to treatment.
Here, we provide physicians treating patients with CSU with information about which clues should lead to which tests and why.
A Patient Charter for Chronic Urticaria
2024, Advances in Therapy
Psychosocial factors and chronic spontaneous urticaria: a systematic review
2023, BMC Psychology
Practical update for the diagnosis and treatment of chronic urticaria
2023, Medicina (Argentina)

View all citing articles on Scopus

: Authors have nothing to disclose.

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Original Articles: Systemic Allergic DisordersPsychiatric morbidity and quality of life in patients with chronic idiopathic urticaria

Background

Objectives

Methods

Results

Conclusion

Section snippets

INTRODUCTION

Patient Selection

RESULTS

DISCUSSION

J Dermatol Sci

Ann Allergy Asthma Immunol

Gen Hosp Psychiatry

J Psychosom Res

J Dermatol Sci

Gen Hosp Psychiatry

Ann Allergy Asthma Immunol

The natural history of chronic urticaria and angioedema in patients visiting a tertiary referral centre

Br J Dermatol

Urticaria

Dermatol Psychosom

Chronic urticaria: evaluation of the role of physical, immunologic, and other contributory factors

Int J Dermatol

Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity

Br J Dermatol

EAACI/GA2LEN/EDF guideline: definition, classification and diagnosis of urticaria

Allergy

Sick role and psychoimmunologic parameters during the course of treatment: a quantitative single case analysis of urticaria

Psychother Psychosom Med Psychol

Quality of life and patients' satisfaction in chronic urticaria and respiratory allergy

Allergy

Structured Clinical Interview for DSM-IV Clinical Version (SCID-I/CD)

Adaptation to Turkish and reliability study of Structured Clinical Interview for Axial I disorders

Ilaç ve Tedavi Dergisi

SF-36 Health Survey Manual and Interpretation Guide

Kısa Form-36 (KF-36)'nın Türkçe versiyonunun Güvenilirliği ve Geçerliliği

İlaç ve Tedavi Dergisi

Psychiatric disorder in a sample of the general population with and without chronic medical conditions

Am J Psychiatry

Psychiatric morbidity in terminally ill cancer patients

Cancer

A study that examine the epidemiology of psychiatric disorders in Turkey

Toplum ve Hekim

Original Articles: Systemic Allergic Disorders
Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria

EAACI/GA²LEN/EDF guideline: definition, classification and diagnosis of urticaria