Nearly half of patients with systemic lupus erythematosus had at least one mood or anxiety disorder, and slightly more than one-third had at least one personality disorder, the results from a small cross-sectional study demonstrated.
"When our results, including the onset time of mood or anxiety disorders, are considered, these disorders seem to be secondary to the severity of lupus rather than play a primary role in the exacerbation of SLE," Turkish researchers led by Dr. Faruk Uguz wrote. "However, it is unclear whether there is a biological basis of this condition or psychological reaction to the severity of SLE."
Dr. Uguz, a psychiatrist with the University of Necmettin Erbakan, Konya, Turkey, and his associates evaluated 45 consecutive patients with SLE who were admitted to the university’s rheumatology outpatient clinic. They also included a control group of 60 hospital personnel and their relatives who were matched for the sociodemographic characteristics of the SLE patients.
Exclusion criteria included illiteracy, cognitive incompetence, a history of schizophrenia or related psychotic disorders, a history of neurologic diseases or severe neurologic manifestations of SLE, concomitant serious medical illnesses such as uncontrolled endocrine abnormalities, cardiovascular disease, movement disorder, and the use of psychotropic medication within the last 4 weeks.
The researchers used the American College of Rheumatology revised criteria for SLE to diagnose SLE, the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version to diagnose mood and anxiety disorders, and the Structured Clinical Interview for DSM, Revised Third Edition to diagnose personality disorders (Compr. Psychiatry 2013;54:341-5). Psychiatric interviews were conducted by psychiatrists with at least 4 years of experience with psychiatric disorders and diagnostic instruments.
The mean age of the study participants was 40 years. Most (91%) were female, married (85%), and unemployed (88%). The disease duration was a mean of 67 months in the patient group. Dr. Uguz and his colleagues reported that 21 people in the patient group (47%) had at least one mood or anxiety disorder and 16 (36%) had any personality disorder. By contrast, 10 people in the control group (17%) had at least one mood or anxiety disorder and 7 (12%) had any personality disorder.
Among SLE patients, the most common psychiatric disorders were major depression (22%) and generalized anxiety disorder (16%). The conditions affected 5% and 3% of control subjects, respectively.
"Being of a cross-sectional nature, the present study is limited by an insufficiency to indicate whether the evaluated Axis I or Axis II psychiatric disorders have causal relevance to SLE," the researchers wrote. "It is unclear whether Axis I disorders are a contributing factor that may exacerbate SLE, or are secondary to the development of a more active SLE."
Another limitation of the study is its small sample size, they said, as well as its failure to determine whether a patient had a family history of mental disorders. "Further controlled studies with larger sample sizes should be conducted to investigate long-term effects of psychiatric disorders and their treatments in the course of SLE," the investigators concluded.