What are the most common psychiatric manifestations of psoriasis?

Common Psychiatric Manifestations of Psoriasis

Depression and anxiety are the most common psychiatric manifestations in patients with psoriasis, with depression affecting up to 60% of patients and anxiety symptoms occurring in 20-50% of individuals with the condition. 1, 2

Major Psychiatric Manifestations

Depression

• Depression is the most prevalent psychiatric comorbidity in psoriasis patients, with prevalence rates as high as 60% 1
• Depressive symptoms are more common in patients with moderate-to-severe psoriasis (PASI≥10) 3
• Women with psoriasis have higher rates of depression than men 3
• There is a bidirectional causal relationship between psoriasis and depression, with each condition increasing the risk of developing the other 4

Anxiety

• Anxiety affects approximately 20-50% of psoriasis patients 2
• Anxiety disorders commonly co-occur with depression in psoriasis patients 1
• Generalized anxiety disorder specifically affects about 9.6% of psoriasis patients 5

Suicidality

• Suicidal ideation affects approximately 12.7% of psoriasis patients 2
• In one study, 10% of psoriasis patients reported a wish to be dead and 5% reported active suicidal ideation 1
• Younger patients and those with more severe psoriasis are at significantly higher risk for suicidality 6
• Female patients show higher suicide risk than males 3

Other Psychiatric Manifestations

• Post-traumatic stress disorder (17.8% of psoriasis patients) 5
• Alcohol use disorder (16.4% of psoriasis patients) 5
• Adaptation disorder (15.1% of psoriasis patients) 5
• Mixed anxiety-depressive disorders (13.7% of psoriasis patients) 5
• Schizophrenia (2.82% prevalence, higher than general population) 2

Impact of Disease Severity on Mental Health

• Patients with moderate-to-severe psoriasis have significantly higher rates of depression 3
• Quality of life impairment correlates with increased psychiatric symptoms 3
• The psychological impact of psoriasis may be substantial even when the physical manifestations affect only a small body surface area 1

Screening and Management Recommendations

• All psoriasis patients should be informed about the association between psoriasis and mental health conditions, particularly anxiety and depression 1
• Dermatologists or primary care providers should routinely screen psoriasis patients for signs and symptoms of anxiety and depression 1
• Patients showing signs of anxiety, depression, or suicidal ideation should be promptly referred to appropriate mental health professionals 1
• Treating the underlying psoriasis can help improve associated psychiatric symptoms, particularly anxiety and depression 1

Pathophysiological Connections

• Pro-inflammatory markers involved in psoriasis pathophysiology are also elevated in patients with depression, anxiety, and schizophrenia, suggesting shared inflammatory pathways 2
• The bidirectional relationship between psoriasis and depression suggests common underlying mechanisms 4

Clinical Implications

• A multidisciplinary approach involving dermatologists, psychiatrists, and psychologists is recommended for optimal management of psoriasis patients 5
• Effective treatment of psoriasis may improve psychiatric symptoms, particularly depression and anxiety 1
• Biologic treatments for psoriasis appear to help decrease rates of depression, though their impact specifically on suicidality is less well established 6