To treat or not to treat with immunosuppressive therapy: psychiatric disorders in patients with systemic lupus erythematosus

• Published in: Lupus science & medicine 2022-01, Vol.9 (1), p.e000629
• Main Authors: Monahan, Rory C, Blonk, Anne M E, Huizinga, Tom WJ, Kloppenburg, Margreet, Middelkoop, Huub A M, van der Wee, Nic J A, Steup-Beekman, Gerda M
• Format: Article
• Language: English
• Subjects: Anxiety disorders; Emotional disorders; Genotype & phenotype; Humans; Immunosuppression Therapy; Laboratories; Letter; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - psychology; Mental depression; Mental disorders; Mental Disorders - complications; Mental Disorders - drug therapy; Mental health; Mood disorders; Patients; psychology; Psychosis; systemic lupus erythematosus; therapeutics
• ISSN: 2053-8790; 2053-8790
• DOI: 10.1136/lupus-2021-000629

Psychiatric disorders are important to recognise as they influence quality of life and treatment outcomes. The prevalence of depression is strongly increased compared with the general population: in Dutch women, mood disorders were estimated to be present in 4.3% in 2019.7 Psychiatric medication was frequently used: antidepressants and benzodiazepines were both used in 18% of all patients and antipsychotics in 8% of patients.Table 1 Presence of psychiatric diagnoses (n=275)* in patients with SLE visiting the Leiden NPSLE clinic (N=371) with neuropsychiatric symptoms of an inflammatory or a non-inflammatory origin All patients (n=371) Non-inflammatory phenotype (n=291) Inflammatory phenotype† (n=80) DSM-5 diagnosis at presentation, number of patients (%)  Neurodevelopmental Disorders 5 (1) 2 (1) 3 (4) (0/3)‡  Schizophrenia Spectrum and Other Psychotic Disorders 16 (4) 11 (4) 5 (6) (5/5)  Bipolar and Related Disorders 7 (2) 5 (2) 2 (3)  Depressive Disorders 84 (23) 74 (25) 10 (13) (9/10)  Anxiety Disorders 17 (5) 16 (6) 1 (1) (0/1)  Obsessive-Compulsive and Related Disorders 1 (0) 1 (0) 0 (0)  Trauma- and Stressor-Related Disorders 16 (4) 13 (4) 3 (4) (0/3)  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) 0 (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 Disorders 0 (0) 0 (0) 0 (0)  Substance-Related and Addictive Disorders 9 (2) 8 (3) 1 (1) (0/1)  Cognitive Disorders§ 93 (25) 60 (21) 33 (41) (16/33)  Personality Disorders 10 (3) 9 (3) 1 (1) (0/1)  Paraphilic Disorders 0 (0) 0 (0) 0 (0)  Other Mental Disorders 12 (3) 7 (2) 5 (6) (0/5)  Medication-Induced Movement Disorders and Other Adverse Effects of Medication 0 (0) 0 (0) 0 (0)  None 131 (35) 107 (37) 24 (30)  Unknown 3 (1) 2 (1) 1 (1) *240 of 371 patients received a psychiatric diagnosis, of whom 208 received one diagnosis and 32 patients received two or more diagnoses. †An inflammatory phenotype indicates that neuropsychiatric symptoms were attributed to lupus activity in the multidisciplinary assessment based on clinical, radiological and laboratory assessment. The burden of mental health disorders on psychological, social and occupational functioning was assessed by the psychiatrist during the clinic visit using the Global Assessment of Functioning (GAF) as prop