I am a general practitioner in a government general hospital in Thailand. There was neither psychiatrist nor dermatologist in the hospital therefore cases which met the psychological or dermatological referral criteria would be referred to the specialists at a provincial hospital.
Despite an increase knowledge and understanding about psychological conditions, the existence of conventional beliefs has influenced many Thai people to judge and treat patients with mental illness as insane. Consequently, many patients refused to see the psychiatrists due to a fear of being judged by others and a long waiting time, resulting in failure to improve their conditions and a decrease in quality of life. My selected patient was a 22-year-old lady, Emma (pseudonym), who came to see me at the outpatient clinic for the follow-up appointment about her psoriasis. She had been diagnosed and treated as mild psoriasis for 10 years with a moderate response. Although her lesions were mainly limited to upper and lower limbs, her lesions often flared up, due to physical trauma and stress. Additionally, she was very self-conscious about her psoriasis and would like to discuss the referral to a dermatologist for further treatments. Emma was chosen for a discussion as a part of a monthly conference of the
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Leading to searches of published literature using databases, which were PubMed, ProQuest, Scopus , Cochrane, CINAHL Plus, and PsychINFO. Additionally, the Google Scholar search engine and NICE website were also included in the searching process. The keywords I used in my searches were Psoriasis, “Psychological interventions”, “Cognitive behavioural therapy”, “cognitive-behavioural therapy”, CBT, anxiety, stress, depression, depress, distress, “psychological assessments”, and “psychological