Case Presentation: Psoriasis and Depression | Mio Nakamura, MD, MS, FAAD | United States

Summary

This presentation explores the case of a 20-year-old male with severe psoriasis and depression. The speaker highlights the impact of psoriasis on quality of life, including physical pain and emotional distress, which can lead to depression. The case study reveals the effectiveness of biologic treatments in improving both psoriasis and depression symptoms. The speaker emphasizes the need for depression screening in psoriasis patients, given the shared inflammatory pathways between the two conditions. Multidisciplinary care, including mental health referrals, is crucial for comprehensive patient management, with a focus on improving both physical and mental well-being.

Takeaways

• 😀 Psoriasis is linked to depression, with about 20% of psoriasis patients experiencing depression and suicidal ideation, far higher than the general population's 4%.
• 😀 Severe psoriasis increases the risk of depression, particularly in patients with more extensive skin involvement like genital and nail psoriasis, as well as comorbid conditions like psoriatic arthritis.
• 😀 Stress can worsen psoriasis, while the physical and psychological impact of psoriasis can lead to further stress, creating a vicious cycle that negatively affects the patient's quality of life.
• 😀 Systemic inflammation, especially involving markers like IL6, plays a key role in both psoriasis and depression, highlighting the importance of targeting inflammation in treatment.
• 😀 Treatment with biologic agents, like resinismab, can significantly improve both psoriasis and depression symptoms by reducing inflammation and improving quality of life.
• 😀 Multidisciplinary care, including referrals to mental health professionals, is important for psoriasis patients, especially those with depression or suicidal ideation.
• 😀 Early screening for depression, especially in high-risk patients (e.g., young age, severe symptoms, psoriatic arthritis), is crucial for identifying and addressing mental health issues.
• 😀 Tools like the PHQ9 questionnaire, which screens for depression, are helpful in primary care settings for early detection and intervention.
• 😀 Depression symptoms may improve alongside psoriasis treatment, and if psoriasis clears but depression persists, further mental health support is needed.
• 😀 Effective management of psoriasis should include not only biologic therapy but also monitoring and addressing associated mental health comorbidities, such as depression, through integrated care.

Q & A

What is the main condition being discussed in the presentation?

The presentation discusses a case of psoriasis and its impact on depression.

How severe was the patient's psoriasis?

The patient’s psoriasis was severe, with a Body Surface Area (BSA) of 30% and a Psoriasis Area and Severity Index (PASI) of 15.3.

What mental health tool was used to assess the patient's depression?

The PHQ-9 questionnaire was used to assess the patient's depression, scoring 14, which is considered moderate depression.

What are some of the risk factors for developing depression in patients with psoriasis?

Risk factors include female gender, younger age, more severe psoriasis, pain, itchiness, involvement of sensitive areas (like genitals or nails), and the presence of psoriatic arthritis.

What percentage of psoriasis patients are at risk for depression and suicidal ideation?

Approximately 20% of patients with psoriasis experience depression, and up to 50% may have suicidal ideation or behavior.

How does psoriasis lead to a cycle of worsening symptoms?

Psoriasis causes stress, which flares the condition, affecting social life, work, and mental health, which in turn leads to more stress, perpetuating the cycle.

What is the relationship between systemic inflammation and both psoriasis and depression?

Systemic inflammation, particularly involving cytokines like IL-6, is implicated in both psoriasis and depression, contributing to the severity of both conditions.

What treatments were considered for the patient in this case?

The patient was started on a biologic agent, resinismab, and offered a referral to mental health services, although he declined it initially.

How did the patient’s condition improve after treatment?

After four months, the patient showed significant improvement, with his PASI dropping to 1.7, BSA to 3%, and PHQ-9 score reducing to 2, indicating minimal depression.

What is the clinical recommendation for treating psoriasis patients who show signs of depression?

The recommendation is to screen for depression, especially in patients with risk factors, and to provide multidisciplinary care, including mental health referrals when necessary.