title: The Pictorial Representation of Illness and Self Measure (PRISM) instrument reveals a high burden of suffering in patients with chronic urticaria.
abstract: BACKGROUND
  Chronic urticaria severely affects quality of life. To date, no gold standard has been established to measure the burden of suffering, which often correlates poorly with the skin symptoms observed in patients with chronic urticaria.
  
  
  OBJECTIVE
  To investigate the effect of psychological factors on the course of urticaria.
  
  
  METHODS
  Health-related quality of life was assessed in 95 patients with chronic urticaria using the following instruments: Pictorial Representation of Illness and Self Measure (PRISM), Dermatology Life Quality Index (DLQI), and Skindex-29. Correlations were calculated. Cognitive flexibility and its correlation with the course of urticaria were assessed. Two case reports are presented to further elucidate features of PRISM.
  
  
  RESULTS
  PRISM revealed a high burden of suffering that was consistent with considerably impaired quality of life as measured by DLQI and Skindex-29 in the same patients. However, no significant correlation was observed between PRISM and the 2 quality of life questionnaires. From the baseline visit to the follow-up visit, quality of life scores improved significantly (DLQI, P = .001; Skindex-29, P = .001), whereas the PRISM score remained unchanged (P = .085). Disease course was favorable more often in cognitively flexible patients (n=54) (91%) than cognitively inflexible patients (P = .007).
  
  
  CONCLUSIONS
  PRISM revealed a high burden of suffering in chronic urticaria and provided helpful additional information for the management of these patients. In our cohort, cognitive flexibility was a positive predictive marker for the course of chronic urticaria.
authors.affiliation: Allergy Unit, Department of Dermatology, University Hospital of Zurich, Switzerland. toendurybettina@hotmail.com
authors.forename: B
authors.initials: B
authors.lastname: Töndury
authors.forename: B
authors.initials: B
authors.lastname: Muehleisen
authors.forename: B K
authors.initials: BK
authors.lastname: Ballmer-Weber
authors.forename: G
authors.initials: G
authors.lastname: Hofbauer
authors.forename: P
authors.initials: P
authors.lastname: Schmid-Grendelmeier
authors.forename: L
authors.initials: L
authors.lastname: French
authors.forename: S
authors.initials: S
authors.lastname: Büchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012647:Self-Assessment; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014581:Urticaria / Q000175:diagnosis* / Q000523:psychology*; D055815:Young Adult