A Clinical Study On The Effects Of Emotions And Sleep On Psoriasis Vulgaris Based On The Concept Of “heart Is On The Surface??

Objective:To explore the influence of emotion and sleep quality on skin lesions and quality of life in patients with psoriasis vulgaris.To explore the influencing factors of depression,anxiety and sleep disorder in patients with psoriasis vulgaris.To explore the feasibility of physician-oriented and patient-oriented comprehensive evaluation of psoriasis severity.And then,we seek a theoretical explanation of Traditional Chinese medicine about psoriasis vulgaris based on the statement "heart dominating exterior",hoping to provide a preliminary theoretical basis for the clinical application of treating psoriasis via "heart".Method:This study was a cross-sectional survey.We enrolled 266 outpatients diagnosed with psoriasis vulgaris in Beijing Traditional Chinese Medicine Hospital from February 2021 to February 2022.The electronic questionnaire was designed.Anxiety was evaluated by the Hospital Anxiety and Depression Scale(HADS).Sleep quality was assessed by Pittsburgh Sleep Quality Index(PSQI).The life quality of patients was evaluated by the Dermatology Life Quality Index(DLQI).Psoriasis Area and Severity Index(PASI)and Psoriasis Signs and Symptoms Diary(PSSD)were used to evaluate the lesions of patients by the physician and the patients,respectively.The average filling time of the scale was 25 minutes.Statistical analysis was performed to summarize the relationships between depression,anxiety and sleep quality and general conditions,quality of life,skin area and severity,symptoms and signs.Results:1.Influencing factors of abnormal emotions in patients with psoriasisAmong 266 patients finally enrolled in this study,patients with anxiety or depression(including suspected)accounted for 32.33%and 49.62%,respectively.In terms of demographic characteristics,anxiety state was significantly different from the job nature(P=0.008),but had no significant difference from age,gender,ethnicity,educational background.It can be inferred that the job nature will affect the emotions of patients,especially the painstaking work.In the relationship between anxiety,depression and sleep quality,there were significant differences between HADS-D score and PSQI score(P<0.0001),and positively correlated(r=0.448,P<0.01),that is,the severity of depression was positively correlated with sleep quality,and depression was positively correlated with sleep quality,time to fall asleep,sleep time,sleep efficiency,sleep disorder,hypnotic drug use,daytime dysfunction and other aspects.The results showed that sleep disorders were associated with abnormal emotions,especially depression,in patients with psoriasis.In the relationship between depression,anxiety and quality of life,the scores of anxiety,depression and quality of life were significantly different(P<0.0001),and were positively correlated(r=0.527,P<0.01;r=0.408,P<0.01).In the relationship between anxiety,depression and lesion area and severity,there was significant difference between depression and lesion area and severity score(PASI)(P<0.0001),but not anxiety(P=0.412).In the relationship between anxiety,depression and symptoms and signs,there was a significant difference between the scores of depression and the scores of patient symptoms and signs(PSSD),especially in itching,burning,stinging,pain and discomfort,dryness and exfoliation,but there was no significant difference between the scores of anxiety and symptoms and signs.Multiple linear regression analysis of anxiety and depression scores showed that HADS-D score had a negative effect on HADS-A score.HADS-A score,PASI score and PSQI score had a negative effect on HADS-D score.2.Influencing factors of sleep disorders in patients with psoriasisAmong 266 patients finally enrolled in this study,37.22%of them had poor sleep quality.No significant differences were found between age,gender,and job nature and sleep disorders.There were significant differences between sleep quality score(PSQI)and depression score(HADS-D)(P<0.0001)rather than HADS-A score(P=0.062).The items of sleep quality,time to fall asleep,length of sleep,sleep efficiency,sleep disturbance,hypnotic drug use and daytime dysfunction were significantly different from the depression score,but not from the anxiety score.Both anxiety and depression have an impact on sleep quality,and the impact of depression is more obvious and profound.Otherwise,PSQI was significantly different from PASI(P<0.0001).The more severe the skin lesions,the worse the sleep quality,and this phenomeon was more obvious in the difference between mild and severe skin lesions.PSQI was positively correlated with PSSD(r=0.410,P<0.01).3.Influencing factors of symptoms and signs recording in patients with psoriasisThe demographic characteristics of 266 patients were compared and analyzed.It was found that there was a significant difference between the burning and stinging scores and the educational background.Considering the actual situation,it is considered that this result has no obvious significance.The total score of PSSD was significantly different in different disease stages,among which the scores of itching,skin tightness,burning,dryness,cracking,scaling,peeling,redness,and bleeding were also significantly different from the disease stage.Among them,the average score of PSSD in the progressive stage was significantly higher than that in the stationary stage and regressive stage,which indicated that the self-perception of various symptoms and signs of patients was relatively serious in the progressive stage of psoriasis.For the relationship between PSSD and PASI score,there was a positive correlation between the PSSD score and the lesion area and severity score(PASI),suggesting that the more severe the symptoms and signs,the more severe the lesion area and severity.There was also a positive correlation between PASI score and PSSD score,indicating that there was a good correlation between PASI score and PSSD score,and the description of the severity of skin lesions was consistent.At the same time,there was a positive correlation between PSSD score and sleep quality score,indicating that symptoms and signs had a significant effect on sleep quality.However,there was no significant correlation between PSSD score and DLQI,HADS-D and HADS-A,but there were significant differences in the total score and some specific items of PSSD among patients with different HADS-D and DLQI scores,indicating that depression and quality of life had obvious effects on the symptoms and signs of patients.However,the effect of symptoms and signs on depression and quality of life was not obvious,and the relationship between anxiety and symptoms and signs was ambiguous.Conclusion:Anxiety,depression,sleep quality,quality of life,and severity of skin lesions in psoriasis vulgaris form a two-way relationship,and are widely related to itching,burning,stabbing,drying,exfoliation and other symptoms and signs.In clinical treatment,we should pay more attention to treat from the "heart",include patients’ feelings in the evaluation system of skin lesions,and cut off the vicious cycle in time.