Psihosocijalni čimbenici u bolesnice sa psorijazom i psorijatičnim artritisom

Cilj: Danas važeća teorija svrstava psorijazu u psihokutane psihofiziološke bolesti. Traumatska iskustva u djetinjstvu povezuju se s pojavom artritisa i nekih kožnih bolesti te se smatra da u kombinaciji s genetskim faktorima predstavljaju rizične faktore za pojavu psorijaze i psorijatičnog artritisa. Prikaz slučaja: Psorijaza i psorijatični artritis su imunološki posredovane bolesti, a rana traumatska iskustva uzrok su poremećene kompetencije imunološkog sustava s regulatornim problemima u sustavima koji reguliraju odgovor na psihički stres. U radu je prikazana bolesnica sa psorijazom i psorijatičnim artritisom koja je od najranijeg djetinjstva bila izložena mnogobrojnim negativnim traumama u djetinjstvu. Rasprava: Emocionalno zanemarivanje, alkoholizam oca, izostanak osjećaja sigurnosti i kompetentnosti tijekom djetinjstva doveli su do negativnih i bolnih emocija sa stvaranjem obrasca za rasterećenje koji ide putem kože, odnosno zglobova. Dinamika obiteljskih odnosa diktirala je uvelike i tijek njene bolesti i načine nošenja s teškoćama koje je bolest donosila. Uobičajene ili standardne metode liječenja nisu dale zadovoljavajuće rezultate, no interdisciplinarnim pristupom i dugotrajnim psihoterapijskim liječenjem postignuti su značajni i dugoročni terapijskih rezultati. Tijekom psihoterapijskog liječenja razmatrani su njeni disfunkcionalni obrasci ponašanja i razlozi za njih. Bolesnica je u grupi dobila emocionalnu podršku, proradila dio svojih ranijih iskustava i uspjela ojačati ego snage za nošenje sa svakodnevnim obavezama i relacijama. Njen promijenjen odnos prema sebi i okolini omogućio joj je da gratifikaciju nađe u svojoj okolini i relaciji s bliskim osobama iz svog okruženja. Zaključak: Samo kombinirana i individualno prilagođena terapija, uz psihoterapijski pristup, može dovesti do dugotrajnijeg uspjeha u liječenju ovih bolesti
Aim: According to the new classification of psycho-dermatological disorders, psoriasis is classified as a psychophysiological disease. Recent studies have associated childhood exposure to trauma to same skin and joint diseases. Traumatic experiences in childhood combined with genetic predisposition are considered to be important risk factors in the development of psoriasis and psoriatic arthritis. Case report: Psoriasis and psoriatic arthritis are immunologically triggered diseases and early traumatic experiences are the reason of altered competence of the immune system with the regulatory problems in systems that control the response to psychologic stress. We showed a female patient with psoriasis and psoriatic arthritis with increased childhood negative traumatic experiences. Discussion: Emotional neglect, alcoholism of the father, the lack of sense of security and competence during childhood led to negative and painful emotions with creating a pattern of discharge that leads through the skin and joints. The dinamics of family relations formed in an important manner the ongoing of the disease and the ways of dealing with the difficulties that the desease caused.The common or standardized methods for treating of psoriasis and psoriatic arthritis that have been used since the beginning of the treatment, did not show satisfactory results. However, interdisciplinary approach and longterm pshichotherapy resulted in significant and lasting positve treatment results. During a psychotherapy the disfunctional patterns of behaviour and their reasons were analysed. The patient received emotional support of the group, she worked through a part of her former experiences and succeded in improving her ego for the strength for coping with the everyday dutys and relations. The changed relationship for herself and the surrounding enabled her to find thankfulness in her milieu and the relationship with close people from her surroundings. Conclusion: Thus, only a combined and individually adjusted therapy, together with a psychoterapic approach can lead to a long lasting success in treating this deseases.