Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: a longitudinal study of active and inactive stages of the disease

Abstract

The objective was to analyze psychiatric disorders and psychosocial dysfunction in patients with systemic lupus erythematosus (SLE), studied longitudinally during active and subsequent inactive stage of their disease. During a 6 month period of study, we selected 20 consecutive patients with SLE who presented with a SLE flare. All patients fulfilled the 1982 revised criteria of the American College of Rheumatology for the classification of SLE. When patients entered the study, we performed psychiatric (CIS, RDC, STAI, HD, BDI, GHQ and MMS) psychosocial (GAS and VAS-P) scores assessment. One year later, we repeated the psychiatric and psychosocial assessment when patients showed inactive disease. The 20 patients evaluated were women, with a mean age of 34 y (SE 14.4, range 20-57). According to CIS evaluation, we diagnosed 8 (40%) psychiatric cases in the acute episode of SLE. The RDC diagnosis showed generalized anxiety in 5 patients, panic disorders in 2 patients and generalized anxiety plus depressive symptoms in one patient. One year later, when patients did not show disease activity, we diagnosed 2 (10%) psychiatric cases (P<0.05). When SLE patients were clinically inactive, they showed lower levels of psychological distress (GHQ scale, 1.8 vs 5.6, P<0.001), with a lower grade of anxiety measured by both HA (3.2 vs 8.2, P<0.01) and STAI-S (7.95 vs 20.90, P<0.001) scales. We also found a lower score in pain perception (VAS-P) (2.80 vs 4.25, P<0. 01) and higher occupational activity (VAS-P) (83.9 vs 66.2, P<0.01) and general functioning (GAS) (93.75 vs 83.50, P<0.05) during the inactive stage. No significant differences were found when we compared cognitive impairment, grade of depression and physical disability between inactive and active stages. We conclude that in SLE patients, psychiatric and psychosocial disorders during acute episodes are usually mild and seem to be related to the psychological impact of disease activity on patients. This type of psychiatric pathology is similar to that which would be expected in other groups coping with a stressful event, indicating that our patients did not react in a way specifically determined by their systemic disease.

Traços de personalidade e suas alterações em mulheres com lúpus

“…Most patients were married, similar to the studies of Segui et al 18 and Dobkin et al 23 The school level of the study patients (10.1 ± 2 years) was lower than that reported by international studies. 41,24 Approxi- mately 55% of our patients were housewives; this data also differs from that of most international studies like Segui et al,18 in which 25% of the patients were housewives.…”

“…This data is similar to that reported by Ishikura et al, 22 who also did not observe a relationship between the psychological characteristics of their patients and SLE activity. However, it differs from the results reported by Segui et al, 18 Ward et al, 24 and Yuko et al, 25 who observed a relationship between psychiatric symptoms (including personality disorders) and disease activity.…”

“…Other authors observed that personality changes can be secondary to the psychological stress imposed by SLE, the disease activity in the CNS, and/or the use of medications like immunosuppressors and corticosteroids. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Vertzman & Pinheiro, apud Lemle,29 are developing, at Universidade Federal do Rio de Janeiro (UFRJ), the Project "Narcissistic Pathologies and Autoimmune Diseases: a Psychoanalytic Comparative Study". According to those authors, based on clinical experience and some references in the literature, lupus patients would have a narcissistic psychological configuration (they would be selfish, arrogant, self-absorbed).…”

Efficacy of Cognitive Behavioural Therapy for the Treatment of Chronic Stress in Patients with Lupus Erythematosus: A Randomized Controlled Trial

“…Anxiety and depression, which are frequently caused by daily stress, are the most prevalent psychological disorders experienced by lupus patients, affecting up to 40% of patients in some series [26,27,28]. Furthermore, it is evident that lupus patients are dissatisfied with the treatment of both these disorders [29], indicating that lupus is currently being mismanaged and that patients’ concerns are not being dealt with adequately.…”

Outcomes and prognosis in systemic lupus erythematosus

“…По данным литературы наиболее частыми симп томами являются головная боль, психические нарушения (40-64%), судорожный синдром (7-50%). Отмечается до вольно высокий процент полинейропатии (12%), пораже ния черепно-мозговых нервов (10-15%) -глазодвигатель ных, тройничного, лицевого [8,15,30,51]. К числу редких проявлений, ассоциирующихся с неблагоприятным про гнозом, относят поперечный миелит и поражение зритель ного нерва [1,14,37].…”