Background: Patients suffering from severe psoriasis report high levels of personal distress and disability as a result of their disease. Objective: The purpose of this study was to examine the relationship between disease severity, personal distress and disability. Methods: Twenty-two patients provided a self-rating of disease severity and completed the Psoriasis Disability Index (PDI) and the General Health Questionnaire (GHQ). A dermatologist provided a clinical assessment from the case notes. Results: Although the clinical assessment was not related to patient ratings, patientrated severity scores, GHQ and PDI were correlated with each other. GHQ could only be predicted by disease severity when it was mediated by PDI scores. Conclusions: These results indicated that psoriasis affects psychological distress through its effects on the patients’ everyday lives.

The timeliness of reporting four nationally notifiable diseases was examined using data reported via the National Electronic Telecommunications System for Surveillance. Timeliness of reporting varied by disease (bacterial meningitis: median 20 days; salmonellosis: median 22 days; shigellosis: median 23 days; and hepatitis A: median 33 days) and by state. These findings indicate a need to standardize surveillance definitions and to account for reporting differences between states in interpreting regional disease trends or detecting multistate disease outbreaks.

Patients who seek care for foot problems may present to the podiatrist with concurrent problems, such as anxiety, depression, phobias, personality disorders, and psychoses. These may or may not have any direct relationship to the pathogenesis of the foot problem. The podiatrist may learn of the presence of an emotional problem directly from the patient or from a family member. In many cases, the patient may be unaware or deny the presence of an emotional problem, leaving the podiatric physician in the dark about the patient's mental health state or its implications for the management of the skin problem. In a review of the psychosomatic aspects of dermatology, Koblenzer offered a working classification of the psychodermatoses. This is helpful to the podiatrist in recognizing those dermatologic disease states in which the various aspects of the individual participate in the disease, signs and symptoms of the disease, and the potential psychological value of the disease for the patient. It is also helpful to the podiatrist for recognizing those dermatoses in which psychiatric consultation may be useful so that recognition, treatment, improvement, and perhaps cure may be effected quickly.

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