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Dohm L, Saha S, Fronhoffs K, Gieler U. [Mental disorders from climate and environmental changes using the example of dermatology]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:704-710. [PMID: 39117980 DOI: 10.1007/s00105-024-05396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Global climate and environmental changes impose a significant impact on human health by increasing prevalences of chronic and acute skin diseases. Climate-associated environmental changes can also trigger or intensify mental illnesses independently of a skin disease. AIM Discussion of the effects of the climate and environmental changes on dermatological diseases applying the biopsychosocial model. MATERIALS AND METHODS A selective literature search in the PubMed database and other sources was conducted. RESULTS The biopsychosocial model considers complex interactions between biological, psychological, and social factors. In view of the consequences of climate and environmental changes, an extension of the model is proposed for the first time in order to address new challenges. The modified presentation supports the understanding of the dynamics and underscores that in dermatological care not only direct health effects of climate and environmental changes have to be dealt with, but also with an increasing number of mental illnesses, which in turn are to be regarded as direct and indirect health effects. CONCLUSION Coping with the predicted increase in the burden of disease and the decline in the available labor force associated with demographic change poses a major challenge. In order to maintain the functionality of the healthcare system, the prompt implementation of resource-efficient, sustainable measures in all areas of society is essential. The integrative consideration of dermatological and psychological complaints in the context of climate and environmental changes requires the adaptation of content for the education, training, and continuing education of specialists.
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Affiliation(s)
- Lea Dohm
- Deutsche Allianz Klimawandel und Gesundheit e. V. (KLUG e. V.), Cuvrystr. 1, 10997, Berlin, Deutschland.
| | - Susanne Saha
- Arbeitsgemeinschaft Nachhaltigkeit in der Dermatologie (AGN) e. V., Guntramstr. 8, 79106, Freiburg, Deutschland.
| | - Kristina Fronhoffs
- Arbeitskreis Psychosomatische Dermatologie e. V., Rheinbach, Deutschland
| | - Uwe Gieler
- Psychodermatologie Univ. Hautklinik Gießen, Ärztlicher Direktor der Vitos-Klinik für Psychosomatik Gießen, Gießen, Deutschland
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Bellinato F, Maurelli M, Geat D, Girolomoni G, Gisondi P. Managing the Patient with Psoriasis and Metabolic Comorbidities. Am J Clin Dermatol 2024; 25:527-540. [PMID: 38748391 PMCID: PMC11193697 DOI: 10.1007/s40257-024-00857-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 06/23/2024]
Abstract
Epidemiological data demonstrate strong associations between psoriasis and metabolic comorbidities, including obesity, hypertension, diabetes mellitus, dyslipidemia, and non-alcoholic fatty liver disease. The presence of metabolic comorbidities significantly influences the selection and effectiveness of pharmacological treatments. Some drugs should be prescribed with caution in patients with metabolic comorbidities because of an increased risk of adverse events, while others could have a reduced effectiveness. The aim of this narrative review is to highlight the challenges that healthcare professionals may face regarding the management of psoriasis in patients with metabolic comorbidities. In the first part of the article, the epidemiological association between psoriasis and metabolic comorbidities and their pathogenetic mechanisms is summarized. The second part describes the efficacy and safety profile of conventional and biologic drugs in patients with selected metabolic comorbidities including obesity, non-alcoholic fatty liver disease/hepatic steatosis, and diabetes. Finally, the role of pharmacological and non-pharmacological interventions, such as diet, alcohol abstinence, physical activity, and smoking avoidance is discussed. In conclusion, the choice of the best approach to manage patients with psoriasis with metabolic comorbidities should encompass both tailored pharmacological and individualized non-pharmacological interventions.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Davide Geat
- Department of Dermatology, Spedali Civili, Brescia, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
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Hepat A, Chakole S, Rannaware A. Psychological Well-Being of Adult Psoriasis Patients: A Narrative Review. Cureus 2023; 15:e37702. [PMID: 37206484 PMCID: PMC10191242 DOI: 10.7759/cureus.37702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Psoriasis is a chronic systemic inflammatory condition, and psychiatric comorbidities are common in this condition. It is a non-communicable, autoimmune, and incurable disease. Psoriasis causes an adverse effect and is connected with various psychological symptoms like social isolation, guilt, and embarrassment of a patient. They decrease self-esteem because of depression, anxiety, stress, and substance abuse adults. The prevalence rate of adults is gradually increasing. This study uses various scales to evaluate the level of psoriasis. This study aims to evaluate the level of depression, anxiety, stress, and substance abuse among adult psoriasis patients and to identify the factors affecting psoriasis patients. A detailed search was carried out using essential databases such as PubMed, Google Scholar, and the World Health Organization (WHO) database to search for articles elucidating the same. In total articles, 36 out of 160 are selected. All studies found that psoriasis is at a positive level in that the level of depression and anxiety is moderate to severe, the level of stress is moderate, the level of alcohol abuse is higher, and the level of smoking consumption is ever-increasing. A severe skin condition that impacts the quality of life and psychological health. It has become a public health issue. All the selected articles assessed patients who were highly affected by depression, anxiety, stress, and abuse. They also assessed the various comorbidities related to psoriasis.
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Affiliation(s)
- Ankita Hepat
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Asmita Rannaware
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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The Impact of Diet and Physical Activity on Psoriasis: A Narrative Review of the Current Evidence. Nutrients 2023; 15:nu15040840. [PMID: 36839198 PMCID: PMC9958594 DOI: 10.3390/nu15040840] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Psoriasis is an inflammatory disease with strong genetic links and numerous features of autoimmunity that are also influenced by environment and lifestyle, including nutritional factors and physical activity (PA), with regards to the condition of patients. Recent reports in the field of nutrigenomics indicate a significant impact of nutrients in modulating microRNAs. However, few studies have evaluated the effect of nutritional systems and PA on treating psoriasis. This narrative review updates information regarding the current dietary recommendations for individuals with psoriasis and discusses the role of diet and PA in psoriasis prevention and treatment. Application of nutrigenetics in psoriasis therapy is also discussed. The PubMed and Google Scholar databases were searched using the MeSH terms for "nutrigenomics", "dietetics", "diet therapy", "diet", "physical activity", and "exercise" in conjunction with the MeSH terms for "psoriasis" and "dermatology". Evidence has shown that patients with psoriasis should have a personalized anti-inflammatory diet. Psoriasis patients are less physically active; most performed exercises of low-to-moderate intensity and were less likely to undertake regular exercise. Identifying nutrigenomic discoveries and the current lifestyle interventions associated with psoriasis can help physicians and physical therapists develop educational programs to manage and protect against the disease.
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Zheng Q, Kuai L, Jiang W, Qiang Y, Wei L, Chen S, Li B, Wang R. Clinical Feature, Lifestyle Behavior and Non-Communicable Diseases Comorbidities Among Psoriasis Patients in Shanghai: Gender Disparity Analysis Based on a Cross-Sectional Study. Clin Cosmet Investig Dermatol 2022; 15:2751-2762. [PMID: 36545501 PMCID: PMC9762258 DOI: 10.2147/ccid.s393697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Background Gender difference is prevalent in clinical feature, disease severity for noncommunicable diseases (NCD), but studies on gender disparity in clinical feature, disease severity and NCD comorbidity among psoriasis patients are limited. This cross-sectional study explores gender differences in clinical feature, lifestyle behavior and NCD comorbidity among psoriasis patients. Methods Psoriasis patients were recruited through cluster survey method in two hospitals, and questionnaire interviews were applied to collect the demographic feature, lifestyle habits, clinical feature and NCD among patients. Results A total of 2102 psoriasis patients included 1332 males (63.4%), 70% were over 35 years old and approximately 50% of them were overweight or obesity. The median value for psoriasis initiation age and disease duration was 33 years old (34 for male and 32 for female) and 9 years (10 for male and 7 for female), respectively. The psoriasis recurrence was mainly in winter (73.4%) and autumn (34.2%) both for patients. The prevalence of tobacco smoking and alcohol drinking was 31.2% and 12.6%. Male patients had higher prevalence of tobacco smoking (odds ratio (OR) = 13.26, 95% confidence interval (CI): 9.54-18.44) and alcohol drinking (OR = 14.44, 95% CI: 7.90-26.40). The prevalence of diabetes, hypertension, hyperlipidemia, and metabolic syndrome were 13.2%, 28.5%, 23.4% and 21.5%, respectively. Male patients had higher prevalence of diabetes (OR = 1.53, 95% CI: 1.16-2.02), hypertension (OR = 1.87, 95% CI: 1.52-2.30), hyperlipidemia (OR = 2.34, 95% CI: 1.85-2.95) and metabolic syndrome (OR = 2.06, 95% CI: 1.63-2.62) than female patients. The proportions for 4 types of NCDs diagnosed after psoriasis onset were over 58%, which were also higher in males than females. Conclusion Female patients had shorter disease duration and with less NCD, and male patients had more body weight issue, with fewer sleep time and higher prevalence of tobacco smoking and alcohol drinking and NCDs. We recommend that dermatologist should notice the gender disparity in psoriasis patients, which is helpful for the disease diagnosis and treatment.
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Affiliation(s)
- Qi Zheng
- Department of Traditional Chinese Medicine, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Wencheng Jiang
- Department of Traditional Chinese Medicine, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Yan Qiang
- Clinical Research and Innovation Transformation Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Lei Wei
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Siting Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Bin Li
- Department of Traditional Chinese Medicine, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, People’s Republic of China,Correspondence: Bin Li; Ruiping Wang, Email ;
| | - Ruiping Wang
- Clinical Research and Innovation Transformation Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, People’s Republic of China,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Yeroushalmi S, Hakimi M, Chung M, Bartholomew E, Bhutani T, Liao W. Psoriasis and Exercise: A Review. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:189-197. [PMID: 35813078 PMCID: PMC9258800 DOI: 10.2147/ptt.s349791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/11/2022] [Indexed: 12/20/2022]
Abstract
Psoriasis is a prevalent inflammatory skin disorder that is associated with a number of comorbidities including cardiovascular disease and metabolic syndrome. Exercise can influence the outcomes of chronic inflammatory diseases, and the presence of these diseases can also influence physical activity in afflicted patients. We reviewed the available literature published on exercise in psoriasis patients and aimed to explore physical activity levels, barriers to exercise, physical fitness, exercise as a prevention strategy as well as a treatment modality. Overall, patients with moderate to severe psoriasis are more sedentary than the general population and experience barriers to exercise secondary to their skin disease. Moderate to vigorous exercise may be an independent preventative factor in reducing the incident risk of developing psoriasis and the utilization of exercise as a weight loss strategy may improve disease severity especially in overweight patients. Expert panels agree that exercise can be beneficial as an adjunct treatment in patients with psoriasis who are overweight; however, more randomized clinical trials are needed to establish these links.
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Affiliation(s)
- Samuel Yeroushalmi
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Mimi Chung
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Erin Bartholomew
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
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Saalbach A, Kunz M. Impact of Chronic Inflammation in Psoriasis on Bone Metabolism. Front Immunol 2022; 13:925503. [PMID: 35812457 PMCID: PMC9259794 DOI: 10.3389/fimmu.2022.925503] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Psoriasis is a chronic inflammatory disease of the skin and joints associated with several comorbidities such as arthritis, diabetes mellitus and metabolic syndrome, including obesity, hypertension and dyslipidaemia, Crohn's disease, uveitis and psychiatric and psychological diseases. Psoriasis has been described as an independent risk factor for cardiovascular diseases and thus patients with psoriasis should be monitored for the development of cardiovascular disease or metabolic syndrome. However, there is mounting evidence that psoriasis also affects the development of osteoporosis, an important metabolic disease with enormous clinical and socioeconomic impact. At present, there are still controversial opinions about the role of psoriasis in osteoporosis. A more in depth analysis of this phenomenon is of great importance for affected patients since, until now, bone metabolism is not routinely examined in psoriatic patients, which might have important long-term consequences for patients and the health system. In the present review, we summarize current knowledge on the impact of psoriatic inflammation on bone metabolism and osteoporosis.
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Affiliation(s)
- Anja Saalbach
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, Leipzig, Germany
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Bucur Ș, Savu AP, Stănescu AMA, Șerban ED, Nicolescu AC, Constantin T, Bobircă A, Constantin MM. Oversight and Management of Women with Psoriasis in Childbearing Age. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:780. [PMID: 35744043 PMCID: PMC9227010 DOI: 10.3390/medicina58060780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
Psoriasis is a complex disease with many associated comorbidities, all of which have a negative impact on a patient's personal, social, and sexual life. There are some unique considerations in the effects of this disease among women. The average age of diagnosis in women with psoriasis is 28 years, and this onset corresponds to the fertile life of women. There is conflicting information about the effects of psoriasis on female fertility. Some studies suggest that this condition's associated comorbidities, personal behaviors, and reduced ovarian reserve, especially due to chronic inflammation, affect women's fertility. Another possible reason women with psoriasis are less likely to become pregnant is that their sexual intercourse frequency decreases after the condition's onset. The available information on the effects of pregnancy on women with psoriasis is limited. According to current evidence, most women will experience an improvement in their skin condition. Studies show that patients with moderate-to-severe psoriasis are more prone to experience pregnancy complications. The management of pregnant and lactating women with psoriasis is also difficult, as the safety profile of commonly used drugs in patients with psoriasis is not entirely known.
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Affiliation(s)
- Ștefana Bucur
- Department of Family Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (Ș.B.); (A.-C.N.); (T.C.); (A.B.); (M.-M.C.)
| | | | - Ana Maria Alexandra Stănescu
- Department of Family Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (Ș.B.); (A.-C.N.); (T.C.); (A.B.); (M.-M.C.)
| | - Elena-Daniela Șerban
- 2nd Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Alin-Codruț Nicolescu
- Department of Family Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (Ș.B.); (A.-C.N.); (T.C.); (A.B.); (M.-M.C.)
- Roma Medical Center for Diagnosis and Treatment, 011773 Bucharest, Romania
| | - Traian Constantin
- Department of Family Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (Ș.B.); (A.-C.N.); (T.C.); (A.B.); (M.-M.C.)
- Department of Urology, “Prof. Dr. Theodor Burghele” Hospital, 050659 Bucharest, Romania
| | - Anca Bobircă
- Department of Family Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (Ș.B.); (A.-C.N.); (T.C.); (A.B.); (M.-M.C.)
- Department of Internal Medicine and Rheumatology, “Dr. I. Cantacuzino” Hospital, 073206 Bucharest, Romania
| | - Maria-Magdalena Constantin
- Department of Family Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (Ș.B.); (A.-C.N.); (T.C.); (A.B.); (M.-M.C.)
- 2nd Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
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van Acht MR, van den Reek JMPA, de Jong EMGJ, Seyger MMB. The Effect of Lifestyle Changes on Disease Severity and Quality of Life in Patients with Plaque Psoriasis: A Narrative Review. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:35-51. [PMID: 35433402 PMCID: PMC9007593 DOI: 10.2147/ptt.s294189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/31/2022] [Indexed: 01/24/2023]
Abstract
Objective To evaluate the effect of lifestyle changes on the severity of psoriasis and the quality of life in patients with psoriasis. Methods For this narrative review, PubMed, Embase and ClinicalTrials.gov were searched for lifestyle intervention studies with an intervention duration of at least 12 weeks. Results Thirty-four intervention studies were included. Most studies performed interventions in the diet of patients with psoriasis (n=9), or added supplements to the diet (n=18). Three studies comprised relaxation techniques and four studies combined relaxation or stress-reducing techniques with an educational program or exercise. No interventional studies were carried out regarding smoking, alcohol and sleep. Especially dietary and relaxation interventions showed promising results with respect to psoriasis severity and dermatology-related QoL, respectively. Regarding dietary supplements, the three largest studies investigating fish oil or vitamin D did not show significant effects. Conclusion There is some evidence that dietary and relaxation interventions could be promising with respect to psoriasis severity and dermatology-related QoL, respectively. Furthermore, our review identified important gaps in psoriasis lifestyle research regarding study design and reporting of outcomes.
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Affiliation(s)
- Maartje R van Acht
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
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The Relationship between Alexithymia and Mental Health Is Fully Mediated by Anxiety and Depression in Patients with Psoriasis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063649. [PMID: 35329336 PMCID: PMC8950845 DOI: 10.3390/ijerph19063649] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023]
Abstract
Background: Psoriasis is a common skin disease that affects quality of life, especially mental health. Alexithymia has been considered a relevant feature in psoriasis patients. Moreover, psoriasis was found to be associated with negative psychological health, including anxiety and depression. As the pathways linking alexithymia and mental health remain unclear among patients with psoriasis, we aimed to examine the mediating role of anxiety and depression in the relationship between alexithymia and mental health in these patients. Methods: To explore our variables of interest, we used the Toronto Alexithymia Scale (TAS-20), the 12-Item Short Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS). Results: Forty-four percent of patients were alexithymic and reported higher anxiety and depression, and lower quality of life compared to non-alexithymic patients. Alexithymic patients also had lower educational attainment. A correlation analysis showed positive associations between alexithymia and both anxiety and depression, whereas mental and physical health were negatively associated with alexithymia. Moreover, anxiety and depression fully mediated the relationship between alexithymia and mental health. Conclusions: Our findings highlight the importance of assessing alexithymia and psychological distress in clinical practice to identify vulnerable patients and to implement interventions aimed at improving negative emotional states.
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