***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The present study examined the effects of emotional disclosure ( ED ) intervention on both disease severity and quality of life in patients with psoriasis . METHODS Fifty-nine patients were recruited ( mean age , 50 years ; 32 men and 27 women ; mean length of diagnosis , 22 years ) . Individuals were r and omly assigned to receive ED intervention or st and ard control writing intervention .  Disease severity , quality of life , and mood were assessed at baseline and at 2 , 8 , and 12 weeks postintervention . RESULTS Disease severity and quality of life improved in both groups over the follow-up period . Preliminary analysis suggested no differences in the magnitude of improvement between the groups . However , predictors of improvement were found to differ . Disease severity on Week 12 was predicted by changes in mood in intervention patients and seasonal variation in control patients . In contrast , quality of life on Week 12 was predicted by baseline quality of life in intervention patients , while seasonal variation approached significance for control patients . CONCLUSIONS Changes in mood following ED predicted improvements in disease severity in patients with psoriasis . However , the degree of improvement did not differ between intervention and control patients Objective : Patients with somatic conditions , such as psoriasis , frequently suffer from high burden of their disease in daily life and might benefit from internet-based cognitive behavioral therapy ( ICBT ) tailored to their adjustment problems . The aim of this multicenter r and omized controlled trial was to examine the effects of therapist-guided , individually tailored ICBT in a clinical sample of patients with psoriasis . Methods : A total of 131 patients with psoriasis , who were screened for a psychological risk profile , were r and omized to either care as usual ( CAU , n = 66 ) or ICBT in addition to CAU ( n = 65 ) . Participants filled out st and ardized self-report question naires assessing physical and psychological functioning and impact on daily activities at baseline , posttreatment assessment , and 6-month follow-up . Results : In covariate-controlled linear mixed-model analyses , significantly larger improvements in ICBT compared to CAU were found in the primary outcomes physical functioning ( p = 0.03 , d = 0.36 ) and impact on daily activities ( p = 0.04 , d = 0.35 ) , but not in psychological functioning ( p = 0.32 ) , up to 6 months after treatment compared to baseline . In explorative analyses , the working alliance measured at the beginning of ICBT treatment predicted improved physical ( p = 0.02 ) and psychological ( p < 0.001 ) outcomes . Conclusions : Results underline the promise of therapist-guided , individually tailored ICBT to improve physical functioning and reduce the impact of psoriasis on daily activities in patients with a psychological risk profile . Establishing a good therapeutic relationship early on may be an important factor that influences treatment outcomes in personalized ICBT interventions . Further research is needed to evaluate ICBT effectiveness in additional sample s and to explore its underlying mechanisms Background Data evaluating the impact of objective ly measured psoriasis severity on  type 2 diabetes mellitus ( T2DM ) risk are lacking . Objective To determine the risk for T2DM in patients with psoriasis compared with that in adults without psoriasis , stratified by categories of directly assessed body surface area ( BSA ) affected by psoriasis . Methods A prospect i ve , population ‐based , cohort study from the United Kingdom in which 8124 adults with psoriasis and 76,599 adults without psoriasis were followed prospect ively for approximately 4 years . Results There were 280 incident cases of diabetes in the psoriasis group ( 3.44 % ) and 1867 incident cases of diabetes in those without psoriasis ( 2.44 % ) . After adjustment for age , sex and body mass index , the hazard ratios for development of incident diabetes were 1.21 ( 95 % confidence interval [ CI ] , 1.01‐1.44 ) , 1.01 ( 95 % CI , 0.81‐1.26 ) , and 1.64 ( 95 % CI , 1.23‐2.18 ) in the groups with 2 % or less of their BSA affected , 3 % to 10 % of their BSA affected , and 10 % or more of their BSA affected compared with in the groups without psoriasis , respectively ( P = .004 for trend ) . Worldwide , we estimate an additional 125,650 new diagnoses of T2DM per year in patients with psoriasis as compared with in those without psoriasis . Limitations Relatively short‐term follow‐up and exclusion of prevalence cases , which may have masked associations in patients with less extensive psoriasis . Conclusion Clinicians may measure BSA affected by psoriasis to target diabetes prevention efforts for patients with psoriasis BACKGROUND AND OBJECTIVES The treatment of negative symptoms in schizophrenia is a major challenge for mental health care . One r and omized controlled trial found that cognitive therapy for low-functioning patients reduced avolition and improved functioning , using an average of 50.5 treatment sessions over the course of 18 months . The aim of our current pilot study was to evaluate whether 20 sessions of Cognitive Behavioral Therapy for negative symptoms ( CBT-n ) would reduce negative symptoms within 6 months . Also , we wanted to test the cognitive model of negative symptoms by analyzing whether a reduction in dysfunctional beliefs mediated the effects on negative symptoms . METHOD In an open trial 21 adult out patients with a schizophrenia spectrum disorder with negative symptoms received an average of 17.5 sessions of CBT-n . At baseline and end-of-treatment , we assessed negative symptoms ( PANSS ) and dysfunctional beliefs about cognitive abilities , performance , emotional experience , and social exclusion . Bootstrap analysis tested mediation . RESULTS The dropout rate was 14 % ( three participants ) . Intention-to-treat analyses showed a within group effect size of 1.26 on negative symptoms ( t = 6.16 , | Sig = 0.000 ) . Bootstrap analysis showed that dysfunctional beliefs partially mediated the change . LIMITATIONS The uncontrolled design induced efficacy biases . Also , the sample was relatively small , and there were no follow-up assessment s. CONCLUSIONS CBT-n may be effective in reducing negative symptoms . Also , patients reported fewer dysfunctional beliefs about their cognitive abilities , performance , emotional experience , and social exclusion , and this reduction partially mediated the change in negative symptoms . The reductions were clinical ly important . However , larger and controlled trials are needed OBJECTIVE Patient advocacy groups such as the National Psoriasis Foundation ( NPF ) serve as representatives of those affected by disease and provide information about the condition . Our objective was to assess the extent to which NPF members differ from nonmember patients with psoriasis in their knowledge and use of therapies . PARTICIPANTS Using r and om-digit dialing , we identified and interviewed patients with psoriasis in the general US population . R and omly selected NPF members were also interviewed . MAIN OUTCOME MEASURES Multivariate logistic regression models were used to estimate differences ( odds ratios and 95 % confidence intervals ) in demographic and clinical characteristics and in awareness and use of therapies between members and others diagnosed as having psoriasis . RESULTS Of 601 individuals with psoriasis identified from the general population survey , 185 provided a second interview and were defined as nonmembers . We interviewed 289 r and omly selected members of the NPF . Although members were significantly older and wealthier and had more extensive disease , they reported the disease to be significantly less of a burden and were more satisfied with therapy than others affected . Compared with nonmembers , members were significantly more likely to have heard of and used most of the 10 therapies assessed . However , the proportion of respondents who were aware of a therapy and who also used it did not differ between groups . CONCLUSION Members of the NPF are better informed and more satisfied with available treatment options than nonmember affected patients Increasing data suggests that there is a connection between stress and the appearance of psoriasis symptoms . We therefore performed a clinical trial enrolling 40 participants who were r and omly allocated to either an 8-week  cognitive-behavioural therapy ( CBT ) ( treatment group ) plus narrow-b and UVB phototherapy or to an 8-week course of only narrow-b and UVB phototherapy ( control group ) . We evaluated the clinical severity of psoriasis ( PASI ) , General Health Question naire (GHQ)-12 , Skindex-29 and State-Trait Anxiety Inventory ( STAI ) at baseline and by the end of the study . Sixty-five percent of patients in the treatment group achieved PASI75 compared with 15 % of st and ard UVB patients ( p = 0.007 ) . GHQ-12 cases were reduced from 45 % to 10 % in the treatment group and from 30 % to 20 % in the control group ( p = 0.05 ) . The Skindex-29 emotional domain showed a significant improvement in the CBT/biofeedback group compared with control patients ( -2.8 points , p = 0.04 ) . This study shows that an adjunctive 8-week intervention with CBT combined with biofeedback increases the beneficial effect of UVB therapy in the overall management of psoriasis , reduces the clinical severity of psoriasis , improving quality of life and decreases the number of minor psychiatric disorders Background : The evidence for efficacy of psychoeducational interventions in psoriasis is not well research ed . Objective : The objective of this study was to assess the benefits of a group , multi-professional , psychoeducational training in psoriasis . Material s and Methods : Adults with moderate-to-severe psoriasis were r and omized into psychoeducational intervention plus treatment ( intervention arm [ IA ] ) and treatment as usual alone ( control arm [ CA ] ) groups using r and om number tables . The primary efficacy measures were mean changes in Psoriasis Area Severity Index ( PASI ) and Dermatology Life Quality Index ( DLQI ) at 6months from the end of intervention . The secondary efficacy measures were the mean changes in the WHO-5 well-being index ( WHO-5 ) and the subsets of the patient health question naire ( PHQ ) , namely , PHQ-9 , generalized anxiety disorder (GAD)-7 , and PHQ-15 . Data were analyzed by intention-to-treat analysis . Results : One-hundred and three participants were r and omized into IA ( n = 54 ) and CA ( n = 49 ) . The prevalence of  psychiatric disorders  in the entire population was 26.2 % and was similar in both groups . Following intervention , there was statistically significant improvement in the mean scores in PASI , DLQI , and WHO-5 in the IA unlike that seen in the CA . There was statistically significant improvement in PHQ-9 scores in IA and CA . The scores on PHQ-15 and GAD-7 did not show any change . Intergroup comparisons showed that PASI was reduced significantly in IA as compared to CA . More participants in CA dropped out of the study than in the IA . Limitations : Modest sample size and lack of blinding of the participants and the administrators were the limitations of this study . Conclusion : Group psychoeducational intervention result ed in overall improvement in both clinical and psychological outcome measures in psoriasis patients BACKGROUND Case reports have indicated that psychologic treatments may have a beneficial effect on psoriasis activity . OBJECTIVE Our purpose was to further investigate the hypothesis that psychologic intervention has a beneficial effect on psoriasis activity in a blinded , controlled manner . METHODS Fifty-one patients with psoriasis vulgaris were r and omly assigned to a treatment or a control group . Patients in the treatment group participated in seven individual psychotherapy sessions in 12 weeks . Intervention techniques included stress management , guided imagery , and relaxation . The Psoriasis Area Severity Index ( PASI ) , Total Sign Score ( TSS ) , and Laser Doppler Skin Blood Flow ( LDBF ) of a selected reference plaque was measured in a blinded fashion at baseline ( week 0 ) , week 4 , week 8 , and after treatment ( week 12 ) . RESULTS Slight , but significant , changes in TSS and LDBF were found in the treatment group but not in the control group . When analyses were performed for both groups separately , the treatment group displayed significant reductions for all three psoriasis activity measures , whereas no changes were seen in the control group . CONCLUSION Our preliminary results suggest that psychologic intervention may have a moderate beneficial effect on psoriasis activity BACKGROUND Depression is a common mental health condition that has been associated with psoriasis . In the absence of prospect i ve data , it remains unclear whether depression precedes psoriasis as a risk factor . OBJECTIVES To examine the association between depression and the risk of new-onset psoriasis . METHODS A prospect i ve cohort of 86 880 US female nurses , The Nurses ' Health Study II , was followed up from 1993 to 2005 . Participants reported anti-depressant use and completed the  Mental Health Index ( MHI ) , a subscale of the Short-Form 36 in 1993 . The MHI assessed for depression and scores was categorized into four strata : 0 - 52 , 53 - 75 , 76 - 85 and 86 - 100 , with lower scores associated with increasing depressive symptoms . We excluded participants with a history of psoriasis prior to 1993 . A self-report of incident physician-diagnosed psoriasis constituted the main outcome 
    Output:
    
Conclusion CBT is effective in the treatment of psoriasis in terms of area and severity reduction .
Systemic treatment does not further enhance the  efficacy of CBT .
The effect of the psychological intervention is stronger in patients with moderate-to-severe psoriasis