Neurocognitive Responses in Psoriasis Patients

Craig A. Elmets, MD


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In This Article

Abstract and Introduction


Imaging in patients with psoriasis shows brain changes that blunt responses to expressions of disgust in others.


Psoriasis can have profound emotional effects. Patients have a disproportionately high prevalence of depression and report a greater emotional impact of their disease on quality of life than patients with cancer, heart disease, or diabetes. In this study, investigators examined neurocognitive responses to facial expressions of disgust in patients with psoriasis.

Reactions of 13 men with mild-to-moderate chronic plaque-type psoriasis (mean PASI score, 5.3 ± 3.6) were compared with reactions of 13 age- and sex-matched controls. Rates of anxiety and depression did not differ between groups. The subjects were presented with neutral, disgusted, and fearful facial expressions during functional magnetic resonance imaging (fMRI). Compared with controls, the patients had blunted reactions in the insula cortex, the area of the brain that controls response to expressions of disgust. Moreover, patients were less able than controls to identify different intensities of disgust on the FERT facial expression recognition task. Patients, however, did not react significantly differently from controls on fMRI in response to fearful faces or to fear and sadness in the FERT. The authors speculate that psoriasis patients develop a subdued response to expressions of disgust as a means of coping with their disease.


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