Psychiatric disorders in patients with systemic lupus erythematosus: association of anxiety disorder with shorter disease duration

Physicians’ awareness about neuropsychiatric syndromes in systemic lupus erythematosus (SLE) is not rarely limited to seizures and psychoses included in the American College of Rheumatology (ACR) classification. Involvement of the central nervous system (CNS) with its rich symptomatology still belongs to the faintly recognised and understood aspects of lupus. The objective was to investigate prevalence and clinical correlations of psychiatric disorders in SLE patients. Fifty-two SLE patients were included. Disease duration and current and cumulative corticosteroid doses were calculated. Disease activity was assessed with the Systemic Lupus Activity Measure (SLAM). All subjects were examined by a psychiatrist. Psychiatric disorders were classified according to ACR criteria for neuropsychiatric systemic lupus erythematosus (NPSLE). Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) were used to screen for cognitive impairments. Mental disorders were diagnosed in 16 (30.77%), depressive disorder in 6 (11.54%), cognitive dysfunction in 5 (9.62%), anxiety disorder in 4 (7.69%) and psychosis in one patient (1.92%). SLE duration was shorter in patients diagnosed with anxiety disorder (P < 0.05), and cumulative dose of corticosteroids was lower in patients with anxiety disorder (P < 0.01). There was high positive correlation between SLE duration and cumulative dose of corticosteroids (r = 0.684, P < 0.001). Shorter SLE duration in patients with anxiety disorder seems to reflect its adaptative nature

Folie à deux. Case report

Induced psychotic disorder is a seldom described syndrome of symptoms, defined as the occurrence of delusions shared by two or more people who are in close emotional relationship. One of them exhibits symptoms of primary psychotic disorder, whereas in the other the symptoms are induced and disappear in result of separation from the inducing person. The study was aimed at presentation of a case of a patient with induced psychotic disorders. The presented patient – a captain of a military unit, shared persecutory delusions which originally had occurred in his partner – a woman met through the Internet. She claimed that they were both embroiled in a “spy scandal” involving special services. She created a feeling of danger, claiming that they were all the time under surveillance. She manipulated information and situations so that the patient broke up with his family, lost his job, and suffered from medical and financial consequences. He considered the false image of reality created by his partner as true and he completely subordinated his behaviour to it. During a forensic psychiatric examination the expert psychiatrists presented a diagnosis of adjustment disorders and referred the patient to a medical board. For further diagnosis he was admitted to the Clinic of Affective and Psychotic Disorders, where finally he was diagnosed with induced psychotic disorders.Indukowane zaburzenia urojeniowe to rzadko opisywany zespół objawów, definiowany jako występowanie przekonań urojeniowych podzielanych przez dwie osoby (lub więcej osób) będące w bliskim związku emocjonalnym. Jedna z tych osób wykazuje objawy pierwotnego zaburzenia psychotycznego, u drugiej natomiast objawy są wzbudzane i przemijają na skutek oddzielenia od osoby indukującej. Celem pracy jest przedstawienie przypadku zaburzeń psychotycznych określanych jako indukowane zaburzenia urojeniowe. Opis dotyczy pacjenta (kapitana jednostki wojskowej), u którego, w trakcie trwającego kilka lat związku z partnerką poznaną przez Internet, doszło do wyindukowania urojeń prześladowczych prawdopodobnie występujących u partnerki. Poznana kobieta twierdziła, iż obydwoje zostali wplątani w „aferę szpiegowską” z udziałem służb specjalnych. Wprowadzała duże poczucie zagrożenia, twierdziła, że poddawani są inwigilacji. Manipulowała informacjami i sytuacjami, doprowadzając do zerwania kontaktów pacjenta z rodziną. Na skutek trwającego kilka lat silnego związku emocjonalnego pacjent całkowicie stracił kontakt z rodziną, także pracę na dotychczasowym stanowisku oraz poniósł konsekwencje finansowe i zdrowotne. Wykreowany przez partnerkę fałszywy obraz rzeczywistości pacjent uznał za realny i podporządkował mu całkowicie swoje postępowanie. W trakcie badania sądowo- psychiatrycznego biegli postawili diagnozę zaburzeń adaptacyjnych, a następnie skierowali badanego na komisję lekarską. W celu dalszej diagnostyki pacjent był hospitalizowany w Klinice Zaburzeń Afektywnych i psychotycznych UM w Łodzi, gdzie ostatecznie ustalono rozpoznanie indukowanych zaburzeń urojeniowych

Association of antiphospholipid antibodies with seizures.

<p>anti-β₂GPI—anti-β2-glycoprotein-I; aCL—anticardiolipin; IgG—immunoglobulin G; IgA—immunoglobulin A; LA—lupus anticoagulant; OR—odds ratio; CI—confidence interval</p><p>Association of antiphospholipid antibodies with seizures.</p

Association of antiphospholipid antibodies with ischemic stroke.

<p>anti-β₂GPI—anti-β2-glycoprotein-I; IgM—immunoglobulin M; OR—odds ratio; CI—confidence interval</p><p>Association of antiphospholipid antibodies with ischemic stroke.</p

Clinical and laboratory characteristics of NPSLE and non-NPSLE patients according to the American College of Rheumatology (ACR) classification criteria.

<p>NPSLE—neuropsychiatric systemic lupus erythematosus; ANA—antinuclear antibodies</p><p>Differences between NPSLE and non-NPSLE groups are statistically insignificant.</p><p>Clinical and laboratory characteristics of NPSLE and non-NPSLE patients according to the American College of Rheumatology (ACR) classification criteria.</p

Comparison of systemic lupus erythematosus (SLE) activity, as measured with the Systemic Lupus Activity Measure (SLAM), in patients with and without cerebrovascular diseases.

<p>Median values expressed as horizontal lines, interquartile ranges as boxes, and ranges as whiskers.</p

Relation of diagnosis of SLE and the onset of neuropsychiatric symptoms.

<p>Values are negative in those patients, who developed neuropsychiatric symptoms before they were diagnosed with SLE. Dotted lines show the median intervals between the onset of neuropsychiatric symptoms and diagnosis of SLE, i.e. 2 years in patients who developed neuropsychiatric symptoms before they were diagnosed with SLE and 10 years in patients who developed neuropsychiatric symptoms after they were diagnosed with SLE.</p

Association of antiphospholipid antibodies with grand mal seizures.

<p>anti-β₂GPI—anti-β2-glycoprotein-I; aCL—anticardiolipin; IgG—immunoglobulin G; IgA—immunoglobulin A; OR—odds ratio; CI—confidence interval</p><p>Association of antiphospholipid antibodies with grand mal seizures.</p