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Chloroquine is a prototype antimalarial drug, widely used in several branches of medicine. Antimalarial drugs are used in the treatment of various dermatological, immunological, rheumatological and infectious diseases. Examples of off-labelled indications for chloroquine analogues use include dermatomyositis, sarcoidosis, polymorphous light eruption, disseminated granuloma annulare and porfiria cutanea tarda. There is a relatively small number of adverse effects related to chloroquine analogues used in standard doses, such as gastrointestinal disturbances, headaches, skin reactions, hypotension, convulsions, extrapyramidal symptoms and visual disturbances. Psychiatric side effects of chloroquine seem to be rare, but may manifest in a wide range of symptoms, such as confusion, disorientation, ideas of persecution, agitation, outbursts of violence, loss of interest, feeling sad, suicidal ideas and impaired insight. There is also a report of a manic episode with psychotic features in the course of bipolar disorder, and another case report of persecutory delusions, anxiety, derealisation and visual illusions triggered by chloroquine. The duration of psychiatric symptoms usually ranges from one to two weeks and symptoms usually disappear within several days following cessation of chloroquine usage and starting psychiatric treatment where indicated. This article reviews the case studies of patients diagnosed with mental disorders resulting from the use of chloroquine, and discusses the management in such cases. [ABSTRACT FROM AUTHOR]

In the light of plurality of categorization of disorders in psychodermatology according to various authors, the use of the International Classification of Diseases and Related Health Problems (ICD-10) in clinical practice is helpful. The most common diagnoses found in dermatological patients referred to psychiatric consultation may be categorized as follows: dementia in other diseases classified elsewhere, other mental disorders caused by damage or dysfunction of the brain and somatic disease, mental illness and behavioral disorders due to alcohol use, persistent delusional disorder, mood disorders (affective) and anxiety disorders, hypochondriacal disorders, other disorders occurring in the form of somatic, psychological and behavioral factors associated with disorders or diseases classified in other chapters, abnormal habits and instincts (pulses), other personality and behavioral disorders in adults, mental impairment. This article outlines the spectrum of mental and behavioural disorders in dermatological practice. [ABSTRACT FROM AUTHOR]

Introduction: Biologics have already found an established position in dermatological treatments. Recent studies indicate their advantageous influence in relieving of depressive symptoms in patients with psoriasis. Aim of the study: To investigate the usage of biologics for symptoms of depression in patients with psoriasis. Material and methods: Randomized control trials (RCT) that investigated the usage of infliximab, etanercept, adalimumabu and ustekinumab for depressive symptoms in patients with psoriasis were to be found. A statistical analysis was performed using MetaEasy, version 1.0.4. Meta-analysis was carried out based on the mean difference (MD) and lower and upper contingency interval (95% CI), in a random effects model. Results: A metanalysis included 2 RCTs of biological therapy conducted in 864 patients with psoriasis. Adalimumab for the treatment of depressive symptoms in psoriasis was found to be statistically more effective in comparison with placebo (MD=-0.61 [lower 95% CI=-1.01, upper 95% CI=-0.21). In comparison with placebo, ustekinumab was found to be more effective in relieving depressive symptoms at the dose of 90 mg (MD=-0.74 [lower 95% CI=-0.88, upper 95% CI=-0.6]), as well as 45 mg (MD=-0.64 [lower 95% CI=-0.78, upper use 95% CI=-0.5]). Conclusions: In relieving of depressive symptoms in patients with psoriasis the usage of adalimumab and ustekinumamb is more effective in comparison to placebo and points out the new direction of the potential applying/application of biological treatments. [ABSTRACT FROM AUTHOR]

Introduction: Since pathogenesis of cholestatic pruritus is not fully elucidated, the treatment is a real challenge for the clinician. In case of the lack of efficiency, despite the treatment of the liver disease, one considers indications for the usage of drugs affecting the central nervous system, such as gabapentin; butorphanol, tetrahydrocannabinol, mirtazapine, naloxone, naltrexone, ondansetron and sertraline. Up to date, there has been a deficiency of randomized controlled trials (RCT) and meta-analyses concerning the usage of these medications. The aim of the study: To investigate efficiency of the usage of drugs affecting the central nervous system in the therapy of cholestatic pruritus based on a systematic review and meta-analysis of up-to-date studies. Material and methods: Randomized control trials (RCT) that investigated the usage of gabapentin; butorphanol, tetrahydrocannabinol, mirtazapine, naloxone, naltrexone, ondansetron and sertraline in the treatment of cholestatic pruritus were to be found. A statistical analysis was performed using MetaEasy, version 1.0.4. Meta-analysis was carried out based on the mean difference (MD) and lower and upper contingency interval (95% CI), in a random effects model. Results: The systematic review included 2 RCTs of naltrexone therapy conducted in 26 patients with cholestatic pruritus, 2 RCTs conducted in 22 patients undergoing naloxone therapy, 3 RTCs evaluating the usage of ondansetrone in 30 patients, 1 RCT assessing sertraline therapy in 12 patients, and 1 RCT assessing gabapentin therapy in 15 patients. Three case reports that concerned the usage of butorphanol, tetrahydrocannabinol and mirtazapine in cholestatic pruritus were not included in meta-analysis. Naltrexone for the treatment of cholestatic pruritus was statistically more effective in comparison with placebo in day time (MD=0.91 [95% CI=0.26-1.56]; MD=1.64 [95% CI=0.66-2.62]), and during the night (MD=0.85 [95% CI=0.2 -1.51]; MD=1.48 [95% CI=0.5-2.46]). In comparison with placebo naloxone was found to be more effective in relieving cholestatic pruritus (MD=0.74 [95% CI=0.22-1.26]; MD=0.06 [95% CI=-0.8-0.94). Two RCTs of ondansetrone showed no significant advantage over placebo and one RCT showing pruritus reduction (VAS decrease 1.34; 95%CI=0.12-2.56; p=0.033). In the group undergoing sertraline therapy (p<0.009), a significant reduction of pruritus was observed. In RCT assessing the usage of gabapentin no significant differences were found in reduction of the pruritus in comparison to the control group with placebo. Conclusions: Naltrexone, naloxone and sertraline are more effective than placebo for the treatment of cholestatic pruritus. There is a lack of convincing evidence of the advantage of the usage of gabapentin; butorphanol, tetrahydrocannabinol, mirtazapine and ondansetroneover placebo for cholestatic pruritus. [ABSTRACT FROM AUTHOR]

Introduction: The identification of psychological variables influencing coping with stress in patients with psoriasis is the basis for the usage of suitable psychological intervention targeting support of the healing process. The aim of the study: To analyze the influence of personality traits on coping with stress and quality of life in patients with psoriasis. Material and methods: The study comprised 22 patients with psoriasis (8 women and 14 men) who completed following questionnaires: NEO-Five Factor Inventory, Strategies of coping with stress (SRSS) and SKINDEX. Results: The personality profile of patients with psoriasis was similar to values observed in the general population. The mean result found in SRSS concerning problem oriented strategy (37.6±9.4) was higher than the median on the scale. The mean result in SRSS concerning emotionally oriented strategy (54.8±23.9) was lower than the median in the scale. The mean result in SKINDEX (95±23.9) was higher than the median on the scale, and indicates the occurrence of lowered quality of life in patients with psoriasis. In NEO-FFI, neuroticism negatively correlated with the problem oriented strategy in SRSS (r=-0.7; p<0.0001). The result in SRSS concerning emotion oriented strategy positively correlated with the result obtained in SKINDEX, i.e. this group of patients was characterized with the lower quality of life (r=0.32; p=0.02). Conclusions: The obtained results confirm a rational need for qualifying the patients with psoriasis for psychological interventions, aimed to modulate personality and enhance coping with stress, and may be helpful in patient's adjustment, and improvement of quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Since pathogenesis of uremic pruritus is not fully elucidated, the treatment is a real challenge for a clinician. In case of the lack of treatment efficiency, despite the usage of emollients and phototherapy UV, one considers indications to the usage of drugs affecting the central nervous system, such as gabapentin, nalfurafine, butorphanol, naltrexone, ondansetron, mirtazapine and doxepin. Up to date there is a deficiency of randomized controlled trials (RCT) and meta-analyses concerning the usage of these medications. The aim of the study: To investigate efficiency of the usage of drugs affecting the central nervous system in the therapy of uremic pruritus based on the systematic review and meta-analysis of up-to-date studies. Material and methods: Randomized control trials (RCT) that investigated the usage of gabapentin, nalfurafine, butorphanol, naltrexone, ondansetron, mirtazapine, and doxepin in the treatment of uremic pruritus were enclosed to systematic review. A statistical analysis was performed using MetaEasy, version 1.0.4. Meta-analysis was carried out based on the mean difference (MD) and lower, and upper contingency interval (95% Cl), in a random effects model. Results: The systematic review included 3 RCT of gabapentin therapy conducted in 84 patients with uremic pruritus, 1 meta-analysis and 1 RCT conducted in 268 patients undergoing nalfurafine therapy, 2 RTCs evaluating the usage of naltrexone in 31 patients, 1 RCT assessing ondansetron therapy in 16 patients, and 1 RCT assessing doxepin therapy in 24 patients. Gabapentin for the treatment of uremic pruritus was statistically more effective in comparison with placebo (MD=-2.32 [lower 95%CI=-2.97, upper 95%CI=-1.66]). In comparison with placebo nalfurafine was found to be more effective in relieving uremic pruritus (MD=-0.49 [lower 95%CI=-0.66, upper 95%CI=-0.32]). One RCT showed significant decrease of pruritus in the group undergoing naltrexone therapy (p<0.001), however this investigation did not contain results of pruritus reduction in the control group with placebo, therefore it was not included in meta-analysis. In RCTs assessing the usage of naltrexone and ondansetron no significant differences were found in reduction of the pruritus in comparison to the control group with placebo. Conclusions: Gabapentin and nalfurafine for the tratment of uremic pruritus are more effective than placebo. There is a lack of convincing evidence of advantage of the usage of butophanol, naltrexone, ondansetrone, mirtazapine and doxepin over placebo for uremic pruritus. [ABSTRACT FROM AUTHOR]

Cognitive behavior therapy represent supportive factor in the treatment of patients with skin diseases. Cognitive therapy contributes to the change of the habit of mind about themselves and convictions about the disease and its results, what can turn out unusually helpful in the full commitment of the patient into the treatment such as compliance with medical recommendations. In turn behavior therapy make possible the acquisition of the skill of coping with psychological factors (e.g. the stress) that may exacerbate or aggravate symptoms of some diseases. The article outlines cognitive behavior therapy and possibilities of using it in the treatment of patients with skin diseases. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a chronic, recurrent, noncontagious skin disease, characterized by hyperproliferation of keratinocytes, that leads to physical impairment and decreased quality of life. Objective: To answer the question, which of psychological variables influence quality of life in patients with psoriasis. Material and methods: The study comprised 51 patients with psoriasis (27 females, 24 males) who completed Schalock's Quality of Life Questionnaire (QOL) (that enables assessment of overall quality of life, Satisfaction, Competence/Productivity, Empowerment/Independence, Social belonging/Community integration), NEO Five Factor Inventory (NEO-FFI) (that enables assessment of Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness), Appraisal of the Disease Scale (Threat, Profit, Obstacle/Loss, Challenge, Harm, Value) and Disease-Related Social Support Scale (Informative and Emotional Support). Results: Overall quality of life was negatively correlated with neuroticism (r=-0.59, p=0.003) in patients with psoriasis, and positively correlated with extraversion (r=0.59, p=0.003). Satisfaction correlated negatively with neuroticism (r=-0.53, p=0.01). Competence, Empowerment and Social Belonging were positively correlated with extraversion (r=0.49, p=0.017; r=0.45, p=0.03 i r=0.44, p=0.03 respectively). Empowerment was correlated with Threat and Obstacle/Loss and Meaning (r=-0.56, p=0.01; r=-0.58, p=0.01; r=-0.48, p=0.04 respectively). Overall quality of life was correlated with Emotional Support (r=0.57 , p=0.01). Satisfaction correlated with Instrumental, Informative, Emotional and Overall Social Support (r=0.47 , p=0.04; r=0.56, p=0.01; r=0.69, p=0.001; r=0.57 , p=0.01 respectively). Empowerment was correlated with Informative, Emotional and Overall Social Support (r=0.47 , p=0.04; r=0.64, p=0.003; r=0.50, p=0.03 respectively). Conclusions: The obtained results confirm a rational need for qualifying the patients with psoriasis into psychological interventions, aimed to modulate personality, that could enhance motivation, coping with negative emotions and be helpful in patient's adjustment, and improvement of quality of life. [ABSTRACT FROM AUTHOR]