Psoriasis is a common condition, affecting 1.5-2% of the population of industrialized countries. It is important for clinicians to be aware that psoriasis can have a substantial emotional impact on an individual, which is not necessarily related to the extent of skin disease. This review examines current literature addressing the psychological and emotional aspects of psoriasis. A literature search of the MEDLINE (1966-2002) and PsycINFO (1984-2002) computer databases and bibliographies was carried out. Papers selected for the review included English language reviews and all original research relevant to the topic, in the form of randomized controlled trials, cohort studies, case-control studies, cross-over and uncontrolled clinical trials, patient surveys, quality-of-life studies, case series and case reports. Despite significant shortcomings, the available prevalence studies showed uniformly high rates of psychopathology among psoriasis sufferers. The few intervention studies available are summarized and critically discussed. Psoriasis is associated with a variety of psychological problems, including poor self esteem, sexual dysfunction, anxiety, depression and suicidal ideation. The clinical severity of the psoriasis may not reflect the degree of emotional impact of the disease. A number of psychological interventions have shown promise in recent trials. It is important that clinicians consider the psychosocial aspects of this illness.

Results are consistent with elevated rates of HCV in mentally ill populations elsewhere in the world, and provide support for selective screening.

Objective: The objective of this article is to set out consensus guidelines for the assessment and management of “suicidal patients” in the emergency department. Conclusions: Clinicians should be respectful and reassuring. They should review old notes, conduct a full history and examination, and talk to friends, family and any practitioners already involved in the patient’s care. Management should be guided, where possible, by the patient’s preferences, not by notions of risk. Every negotiated management plan and its rationale should be carefully documented.

This case illustrates one of the many clinical presentations of neuroleptic-induced dystonia. While suspected anaphylaxis needs to be vigorously treated, a history of neuroleptic use and particularly of a recent dosage increase should alert clinicians to the possibility of acute laryngeal dystonia.

Participants generally feel unprepared to care for patients with a life-limiting physical illness and have contrasting views on the role of psychiatry in this setting. Targeted education is required for psychiatry trainees in order to equip them to care for these patients.

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Consultation-liaison psychiatry is a fascinating and underresearched field. Important work remains to be done in service delivery, diagnosis, treatment and outcome, as well as medical ethics and systems research. Although our knowledge is progressing, many existing studies are underpowered and multisite collaborations are necessary. Our patients carry an enormous burden of ill health and require the services of skilled clinicians, advocates and treatment brokers.

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