Mental disorders often underdiagnosed in dermatology

January 1, 2008

Dermatologic disease has a proven detrimental effect on the psyche of patients and according to one expert, the resulting mental disorders are grossly under-diagnosed.

Key Points

Vienna, Austria - For patients who suffer from chronic dermatological disorders, chances are high that they concomitantly suffer from a mental disorder such as depression or anxiety as a direct result of their skin disease.

According to one expert in the field, dermatologic patients suffer significant mental distress from their dermatologic diseases, and dermatologists should be much more aware of their plight.

"Usually, patients suffering from depression are relatively quiet and reserved, and they do not openly speak about their symptoms. This is no different in patients with dermatologic disease and their resulting mental suffering incurred from their skin disease," says Michael Musalek, M.D., professor of psychiatry at the Anton Proksch Institute.

Dr. Musalek recently finished a novel two-year study in which 600 randomly chosen patients with dermatologic disease were investigated for concomitant mental disorders. Study sites included the departments of dermatology at the Medical University of Vienna and a general hospital in Vienna, in order to avoid selection bias. The study population was divided into 300 out-patients and 300 in-patients. The selection criteria for study participants were "dermatological disorders," which includes the full gamut of the specialty.

These patients were subsequently questioned by fully trained psychiatrists, and examined as mental disorder patients would be. Physicians did not know if there was any history of mental disorder.

Study results showed that more than 40 percent of the patients with dermatological disorders suffer from mental disorders. Of this 40 percent population, nearly 80 percent suffer from anxiety or depression disorders, or both. The remaining 20 percent suffered from schizophrenia, dementia (in elderly patients) and dependence on psychotropic drugs.

"The major result of the study was the stunning 40 percent of the 600 randomly chosen dermatologic patients who suffer from a mental disorder, and nearly 80 percent of them are suffering from anxiety disorders and depression," Dr. Musalek tells Dermatology Times.

Study endpoints were to discover if mental disorders do occur in dermatologic patients and, if so, how often such patients are diagnosed by dermatologists as having a mental disorder. Other endpoints were to unveil the most common mental disorders in dermatologic patients and to determine if there are any mental disorders in association with a dermatologic disease that are commonly overlooked by dermatologists.

"This is a novel study because past studies have always dealt with patients filling out questionnaires and have not been designed that psychiatrists interview patients directly, as is the case in this study," Dr. Musalek says.

Dermatologists reviewed the same study population. Dr. Musalek says that the results were quite different. Dermatologists were only able to diagnose 20 percent of anxiety and depression disorders in the same patients. This means that only one-fifth of the patients who suffer mental disorders as a result of their dermatologic disease are diagnosed by dermatologists.

"Both of the clinics that were used in this study had psychodermatological units, which means that the physicians working there are exquisitely sensitized to such mental disorders in conjunction with dermatologic disease, and still the patients were not properly diagnosed.

"I am quite sure that if the same study were carried out in other hospitals, we would see even lower rates of mental disorder recognition/diagnosis," Dr. Musalek says.

He says most of the patients who are suffering from depression and anxiety disorders are not diagnosed and are not treated adequately.

"In patients with mental disorders, episodes are more severe, longer-lasting, and the physician will likely need to prescribe more medication to the patient to achieve a clearance of the disease.

"I believe that it behooves dermatologists to pay closer attention to the psyche of their patients in respect to the impact of their dermatologic disease and to work closer together with psychiatrists for the benefit of their patients," Dr. Musalek says.