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Background: Patients with systemic lupus erythematosus (SLE) may present with psychiatric disorders. These are important to recognize, as they influence quality of life and treatment outcomes and strategies.
Objectives: We aimed to study the frequency of psychiatric morbidity as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in patients with SLE and neuropsychiatric symptoms of different origins.
Methods: In the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center, patients undergo a standardized multidisciplinary assessment by a neurologist, neuropsychologist, vascular internal medicine, rheumatologist, physician assistant and psychiatrist. After two weeks, a multidisciplinary consensus meeting takes place, in which the symptoms are attributed to SLE requiring treatment (major NPSLE) or to minor involvement of SLE or other causes (minor/non-NPSLE). Consecutive patients visiting the NPSLE clinic between 2007-2019 were included. Data of psychiatric evaluation and current medication use were extracted from medical records. The presence of cognitive dysfunction was established during formal neuropsychological assessment.
Results: 371 consecutive SLE patients were included, of which 110 patients had major NPSLE (30%). Mean age was 44 ± 14 years and 87% was female.
The most frequently diagnosed psychiatric disorders in the total group were cognitive dysfunction (42%) and depression (23%), as shown in
Psychiatric medication was used in 33% of patients, of which antidepressants and benzodiazepines the most frequently (both: 18% in both subgroups). Antipsychotics were more often used in patients with NPSLE (10% vs 7%) and benzodiazepines more often in minor/non-NPSLE (20% vs 14%).
In addition, 17 patients (5%) had a history of suicide attempt, which was more common in patients with minor/non-NPSLE than major NPSLE (6% vs 2%).
Conclusion: Psychiatric morbidity, especially cognitive dysfunction and depression, are common in patients with lupus and differ between underlying cause of the neuropsychiatric symptoms (minor/non-NPSLE vs major NPSLE).
Presence of psychiatric diagnoses in patients with SLE andneuropsychiatric symptoms
|
All patients
|
Minor/non-NPSLE
| Major NPSLE (n = 110 ) | |
| DSM V diagnosis, n (% ) | |||
| Neurodevelopmental disorder | 5 (1) | 2 (1) | 3 (2) |
| Schizophrenia Spectrum and Other Psychotic Disorders | 16 (4) | 10 (4) | 6 (6) |
| Bipolar and related disorders | 7 (2) | 5 (2) | 2 (2) |
| Depressive disorders | 84 (23) | 68 (26) | 16 (15) |
| Anxiety disorders | 17 (5) | 15 (6) | 2 (2) |
| Obsessive-Compulsive and Related Disorders | 1 (0) | 1 (0) | 0 (0) |
| Trauma- and Stressor-Related Disorders | 16 (4) | 12 (5) | 4 (3) |
| Dissociative Disorders | 2 (1) | 2 (1) | 0 (0) |
| Somatic Symptom and Related Disorders | 1 (0) | 1 (0) | 0 (0) |
| Feeding and Eating Disorders | 0 (0) | 1 (0) | 0 (0) |
| Elimination Disorders | 0 (0) | 0 (0) | 0 (0) |
| Sleep-wake disorders | 2 (1) | 2 (1) | 0 (0) |
| Sexual dysfunctions | 0 (0) | 0 (0) | 0 (0) |
| Gender dysphoria | 0 (0) | 0 (0) | 0 (0) |
| Disruptive, Impulse-Control, and Conduct Disorder | 0 (0) | 0 (0) | 0 (0) |
| Substance-related and addictive disorders | 9 (2) | 8 (3) | 1 (1) |
| Cognitive dysfunction | 154 (42) | 95 (36) | 59 (54) |
| Personality disorders | 10 (3) | 9 (3) | 1 (1) |
| Paraphilic disorders | 0 (0) | 0 (0) | 0 (0) |
| Other mental disorders | 12 (3) | 7 (3) | 5 (5) |
| Medication-Induced Movement Disorders and Other Adverse Effects of Medication | 0 (0) | 0 (0) | 0 (0) |
| Unknown | 3 (1) | 3 (1) | 0 (0) |
NPSLE = neuropsychiatric systemic lupus erythematosus.
Disclosure of Interests: None declared