The Etiology of Psychiatric Symptoms in Patients with Systemic Lupus Erythematosus

Abstract

The purpose of this review was to explore the probable etiologies of psychiatric problems in patients with SLE. Although instances of psychosis generally are attributed to disease pathophysiology, the precise mechanism for this problem remains speculative. The etiology of non-psychotic psychiatric complaints is even less clear. Overall, it is likely that psychiatric complaints in patients with SLE are attributable to numerous factors including acquired brain dysfunction, organ system dysfunction, iatrogenic effects of corticosteroid treatment, learning history, psychosocial stressors, and current coping strategies. Additional research is needed to explore the bi-directional, synergistic, and dynamic interactions among diverse physiological and psychological variables as they impact an individual's psychiatric status.

Depression in Systemic Lupus Erythematosus: The Key Role of Illness Intrusiveness and Concealment of Symptoms

“…In contrast, we did not find the associations reported in several studies (Iverson & Anderson, 1994;Kozora, Ellison, & West, 2006;Ward, Marx, & Barry, 2004), between SLE activity (SLEDAI) or damage (SLICC) and depression. Our findings suggest that it is the impact of SLE on lived experience, rather than the illness per se, that carries a depressogenic effect.…”

“…However, the association found between physical illness markers and depression in several studies (Iverson & Anderson, 1994;Nery et al, 2007;Ward, Marx, & Barry, 2004) is not to be discounted, particularly as our data, which is derived from routine lab tests, do not include such depressionrelated measurements as C-reactive protein and cytokines. The inconsistent pattern of results regarding the associations between SLE activity or damage and depression may be accounted for by the mediating role of a subjective sense of distress, as evidenced by HRQol or illness intrusiveness.…”

“…On the one hand, it has often been assumed that the 35-85% comorbidity of SLE and depression (Kozora, Ellison, & West, 2006) is largely due to heightened illness activity (Iverson & Anderson, 1994;Ward, Marx, & Barry, 2004). Related hypotheses ascribe SLE depression to an underlying central nervous system disorder (Kozora, Ellison, & West, 2006) or to the pain symptoms which are known to be associated with depression (Banks & Kerns, 1996).…”

Behaviour sequelae following acute Kawasaki disease

“…Systemic lupus erythematous is also a multi-organ systemic vasculitis, which is known to affect the cerebral nervous system (CNS), causing various neuropsychiatric symptoms [18,19]. Multiple areas of hypoperfusion have been shown on SPECT studies of lupus patients positive for neuropsychiatric symptoms [20].…”

Research methods for investigating causal relations between SLE disease variables and psychiatric symptomatology

“…9 Despite the plethora of research articles, clear delineation of variables that are causally connected to psychiatric symptomatology in patients with SLE remains elusive. 10,11 People with SLE frequently experience psychiatric problems such as organic mental syndromes or disorders, psychotic disorders, mood disorders, anxiety disorders, sleep disturbances or sexual dysfunctions.l° There have been explicit assumptions in the literature that psychiatric disturbance in patients with SLE is a direct manifestation of the disease process,l2-'6 while others question this assumption. [17][18][19] In a methodological review of the literature on psychiatric disturbance associated with SLE, Iversonlo concluded that the available studies lacked the empirical rigor to estimate the prevalence of these problems or to assert that psychiatric symptoms are causally related to SLE pathophysiology.…”