Nearly half of all patients with chronic idiopathic urticaria have Axis I psychiatric diagnoses and 45% have Axis II diagnoses, a new study shows..
Obsessive-compulsive disorder (OCD) and major depression were the most common Axis I diagnoses among 89 consecutive patients with chronic idiopathic urticaria (CIU), and both psychiatric illnesses were significantly more common in the patients than in a control group.
Among the patients, 26% had OCD, compared with 2% of the controls, and 13% had major depression, compared with 3% of the controls, reported Dr. Faruk Uguz and his colleagues at Selcuk University, Konya, Turkey (J. Psychosom. Res. 2008;64:225–9).
Obsessive-compulsive personality disorder and avoidant personality disorder were the most common Axis II diagnoses among the CIU patients, and both were significantly more prevalent in the patients than in the controls. Thirty percent of the patients had obsessive-compulsive personality disorder, compared with 3% of the controls, and 18% of the patients had avoidant personality disorder, compared with 5% of the controls.
Characterized by the rapid appearance of itchy wheals, urticaria is considered chronic when it is recurrent for at least 6 weeks. Few chronic urticaria cases have identifiable physical causes, such as infections, reactions to drugs or foods, or vasculitic diseases. But 75% of all cases have no known cause, and these are referred to as chronic idiopathic urticaria.
The study involved 89 consecutive patients with CIU who were seen at an outpatient clinic in Turkey and a control group of 64 hospital employees and their relatives who were matched to the patients' sociodemographic characteristics. The investigators excluded from both groups individuals who were illiterate, and those who had accompanying severe medical illnesses, or had used corticosteroid or psychotropic medications within the prior 4 weeks.
Psychiatrists made Axis I diagnoses using the Structured Clinical Interview for DSM-IV and the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders.
In all, 44 of the CIU patients (49%) and 8 of the individuals in the control group (12%) had an Axis I disorder. Forty of the CIU patients (45%) and nine of the controls (14%) had Axis II disorders. Both differences were statistically significant.
The investigators acknowledged that their study could not establish a causal relationship between psychiatric disorders and CIU because of its cross-sectional design. Psychiatric disorders could either be a cause or a consequence of CIU.
“We think that obsessive-compulsive and avoidant personality disorders may constitute a predisposition for occurrence of both urticarial symptoms and Axis I psychiatric disorders, negatively impacting patients' coping mechanisms with stressful life events or leading to cognitive misinterpretations of various life events, which are actually not stressful,” the authors wrote.
They concluded that all patients with CIU should be screened for Axis I psychiatric disorders, particularly patients with OCD.
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