1 Psychiatric Disorders in Children with Chronic Idiopathic UrticariaTablo 1: Sosyodemografik Veriler Psychiatric Disorders in Children with Chronic Idiopathic Urticaria Ayşe Süleyman*, Funda Süleyman**, İlyas Kaya**, Murat Coşkun** *Erzurum Training and Research Hospital, Pediatric Immunology and Allergy Department **Istanbul Universty, Istanbul Faculty of Medicine, Child and Adolescent Psychiatry Department AİMS: The aim of this study was to define the types and frequencies of psychiatric comorbidities in children and adolescents with chronic idiopathic urticaria (CIU) and compare these findings with normal population. DISCUSSION : Chronic idiopathic urticaria (CIU) is defined as the daily or almost daily occurence of transitory and itchy weals lasting more than 6 weeks in which a possible cause such as physical factors, infections and allergies cannot be determined.1 Recent studies show that both adults and children with CIU frequently exhibit psychiatric comorbidity, most commonly depression and anxiety disorders,2-6 consistent with our findings. Psychiatric comorbidities were registered in 60% of the CIU adult population and 70% of CIU pediatric population (versus 30% of controls) ; while depression was the most common diagnosis in adults, anxiety disorders were more frequent in children.4,6 It was also shown that children with CIU also had higher internalizing, somatic and anxious ⁄depressed scores. The most common diagnoses included social anxiety disorder, separation anxiety disorder, and specific phobias.6 Similarly the most common psychiatric disorders were anxiety disorders in our sample and social phobia was the most common anxiety disorder. There are some reports showing that subjects with CIU are susceptible to manifesting psychiatric symptoms such as anxiety and depression and that psychiatric symptoms may precipitate the emergence of urticarial symptoms.2,3 This could be one of the underlying reasons of high anxiety comorbidity in patients with CIU. Attention deficit and hyperctivity disorder was also common in our group which makes harder for the patient and the parents to carry out with appropriate treatment adherence. These psychiatric disorders also effects the patient negatively while coping normal life stresses which could be the trigger of urticaria. Urticaria is considered as one of the psychosomatic disorders in which life stressors play a major role both in the onset and exacerbations.7-9 There are some studies showing the link between CIU and psychological stress as a provoking factor.10 Since patients with psychiatric comorbidity are more prone to psychological stress, CIU might be more frequent in individuals with psychiatric disorder. Further studies are required to confirm these findindgs. The limitations of our results must be considered. The small sample size is one of its limitations. Secondly, the study group consisted of cases from an outpatient setting (not based on the general population). The psychological functioning of children with CIU should be studied in further research. Further studies are required to determine the effects of appropriate psychiatric interventions including pharmacotherapy or psychotherapy in the course of CIU. CONCLUSİON: CIU is a psychosomatic disorder and usually accompanied by a psychiatric disorder. The high frequency of psychiatric comorbidity must be kept in mind while evaluating these patients. Our results suggest that the psychological status of children with CIU should be screened by clinicians and that an interdisciplinary approach combining dermatological and psychiatric evaluation is necessary for the management of CIU. METHOD: Fifty-six patients (25 girls and 31 boys, between the ages of 6 and 17 years) participated in the study. All of them were being followed up at the outpatient clinic for at least 6 months and diagnosed as having CIU after excluding any possible causes of urticaria. To investigate the other causes of chronic urticaria, patients underwent additional laboratory examinations including the following: Blood tests for complete blood count, erythrocyte sedimentation rate, blood chemistry, liver function tests, urine analysis and culture, throat swab culture, Helicobacter pylori stool antigen, microscopic investigation of stool for parasite ova, serum levels of complement C3, C4 and C1 inhibitor, free thyroxine, thyroid stimulation hormone, total serum Immunoglobulin (Ig) E, IgM, IgA, IgG; an auto-immune screening (antinuclear antibody, antithyroid peroxidase antibodies, antithyroglobulin antibodies, rheumatoid factor, tissue transglutaminase antibody, antiglaidin antibody, an autologous serum skin test). Since these measurements revealed no abnormalities , the diagnosis of CIU was confirmed. Psychiatric assessment was done by using the Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL). RESULTS: The mean age of the patients was ± 2.75 years. There were 31 boys (55.4%) and 25 girls (44.6%). The frequency of any psychiatric disorder was 69.6%, and 17.9 % of the patients had more than one psychiatric disorder. Psychiatric comorbidity was higher in girls then boys (76% vs 35.4%). The psychiatric comorbidities were as follows: social phobia (30.4%), attention deficit hyperactivity disorder (19.6%) , seperation anxiety, (10.7 %), anxiety disorder not otherwise specified (10.7%), major depressive disorder (7.1%), generalized anxiety disorder (5.4%), obsessive compulsive disorder (%1,8), oppositional defiant disorder (1.8%). The psychiatric comorbidities are summarized in Table 1. Psychiatric history was higher in the mothers than fathers (32.6% vs 20.9%, p=0.04). The most common psychiatric disorder in parents was anxiety disorder, according to the self report of parents. Table 1: The most common psychiatric comorbidities of patients diagnosed with CIU Psychiatric disorders Number of cases (n,%) Social phobia 10 (17.9%) Seperation anxiety 1 (1.8%) Attention deficit and hyperactivity disorder 4 (7.1%) Attention deficit and hyperactivity disorder, social phobia 3 (5.4%) Major depressive disorder Attention deficit and hyperactivity disorder, seperation anxiety 2 (3.6%) Attention deficit and hyperactivity disorder, oppositional defiant disorder Generalized anxiety disorder 3 (5. 4%) Attention deficit and hyperactivity disorder, major depressive disorder Social phobia, seperation anxiety Anxiety disorder not otherwise specified 6 (10.7%) Obsessive compulsive disorder References 1. Greaves MW. Chronic urticaria in childhood. Allergy. 2000;55:309–320. 2. Chung MC, Symons C, Gilliam J et al. Stress, psychiatric co-morbidity and coping in patients with chronic idiopathic urticaria. Psychol Health. 2010;25:477–490. 3. Uguz F, Engin B, Yilmaz E. 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