Psychopathological parameters and dexamethasone
Evangelos Karanikas, Faidon Harsoulis, Ioannis Giouzepas, Ioannis Griveas, Fotis Chrysomallis
Departments of Dermatology, Psychiatry and Endocrinology of Medical School of Aristotelian University of Thessaloniki, Greece
logical development.1 Numerous studies have attempted toidentify a specific personality profile of a representative psori-
Introduction
atic patient but it remains unclear whether different psycho-
The literature dealing either with the psychological impact of
logical features precede and precipitate psoriatic flare-ups, or
psoriasis on the patients or the vulnerability of psoriatics to
they are a consequence of having a chronic, symptomatic, dis-
stressful life events is extensive whereas, so far, only few stud-
ies have actually tried to investigate the role of neuroendocrine
Furthermore, many studies have focused on the relationship
parameters within the aforementioned setting.
between stressful life events and the exacerbation of psoriaticdisease.7-14 According to one of them, psoriatic patients whose
Objective
the cutaneous condition is closely connected to their exposure
To investigate the correlation between psychopathological
to stressful life events, were reported to be up to 80%.9 On the
parameters and the neuroendocrine functional test of
contrary, the research output dealing with the psychopatholo-
Dexamethasone Suppression Test (DST) in psoriatic patients.
gy of psoriasis especially within the neuroendocrine frame-work, is minimal. In particular, the research into the literature
about studies involving the application of the Dexamethasone
24 mostly outpatient psoriatics and the same number of
Suppression Test (DST) in psoriatic patients, demonstrated
matched controls underwent psychiatric evaluation for detec-
only 2 studies.15,16 In no study has there been an attempt to track
tion of psychopathological traits. All participants underwent
down and investigate a possible interaction between psy-
chopathological parameters and DST in psoriatic patients. This has been our main motive for carrying out the present
Psoriatic patients showed significantly higher levels of depres-sive and anxiety mood, with the latter being mostly related to
recent stressful life events. In the DST, psoriatics exhibitedhigher mean cortisol serum levels although both groups pre-
PATIENTS
sented suppressed cortisol levels under 5 ìg/dl. Hormonal
The study involved (the participation) of 24 patients that visit-
parameters did not correlate with psychopathological features,
ed the A’ Clinic of Dermatological and Venereological
the extent of cutaneous psoriatic lesions and the duration of
Diseases of Aristotelian University of Thessaloniki on a pri-
marily outpatient basis. They suffered from psoriasis which hadbeen diagnosed either on a clinical basis (the diagnosis had
Conclusions
been made by two clinicians) or by histopathological findings.
Psoriasis is related to significant psychosocial morbidity
The patient sample consisted of 24 subjects, 11 men(46%) and
although no clear correlation with the DST has been replicat-
13 women(54%), with mean age 51.29 +- 3.59 years.
From the above mentioned patients 3 were admitted in the
hospital (2 males and one female). The mean duration of the
Key Words: Psoriasis, Stress, Psychopathology, Dexamethasone
disease was 6.29 1.90 years and according to the reports of the
Suppression Test, Cortisol, Life Changes
patients, the mean duration of the current psoriatic episodewas estimated in 6.28 1.61 months (n=18, 6 gave insufficient
INTRODUCTION
Psoriasis serves as perhaps the most illustrative example, In the study, 24 healthy volunteers participated as control
compared to any other psychocutaneous disorder, of the
group. Eleven (46%) were males and 13 (54%) were females
subtle interactions between genetic predisposition, envi-
with mean age, 43.42 2.35 years. The groups under study were
ronmental influences and psychosocial factors that take place
before the disease manifests itself. Ïn the other hand, because
The protocol of the study has been approved by the ethical
the 60% of the patients suffering from psoriasis start having the
committee of both the Aristotelian University and the Hospital
first symptoms prior to the age of 30 years, the nature of the
of Dermatological and Venereological Diseases of
skin disease becomes a crucial factor in these persons' psycho-
Thessaloniki. All the participants gave their written consentafter having been told the exact procedure.
The inclusion and exclusion criteria for both healthy volun-
teers and psoriatics were 1) age between 18-60 years 2) partic-
Address correspondence to: Evangelos Karanikas MD, PhD
ipation in at least 10-year federal educational system, 3)
10 Kleanthous st, 54642, Thessaloniki,GreeceTEL: 0030 6977313243, FAX: 0030 2310 381010
absense of severe concomitant diseases ( cardiopulmonary,
renal failure, cancer, cerebrovascular episode etc), 4) absence
Excerpt from “Hanna Pavilion, Cleveland, Autumn 1983” Suicide ward’s a strange place to make friends; never know how long they’ll last. Past the bend in the narrow hallway, an institutional sage-green elbow fixed at a right angle, past the plexiglassed glaze of the nurses’ station, we took turns lighting our cigarettes, our one means left: no butter knives, no nail files, no
The Journal of Political Philosophy: Volume 10, Number 2, 2002, pp. 153±174THEORIES of deliberative democracy consist of a set of principles thatare intended to establish fair terms of political cooperation in ademocratic society. Some theorists believe that the principles should refer onlyto the process of making political decisions in government or civil society.1The principles of deliberat