Keywords :
Brief psychiatric rating scale, General health questionnaire, Hamilton anxiety rating scale, Hamilton depression rating scale, Neuropsychiatric systemic lupus erythematosus, Psychiatric manifestations, Psychosis, Systemic lupus activity measure, revised, Systemic lupus erythematosus, Systemic lupus erythematosus international collaboration committee
Citation Information :
Mondal S, Pradhan S, Ghosh S, Sinha A. Psychiatric Manifestations of Systemic Lupus Erythematosus Patients in a Tertiary Care Hospital: A Cross-sectional Study. Bengal Physician Journal 2025; 12 (1):12-18.
Aim and background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse neuropsychiatric manifestations which are classified and diagnosed under ACR 1999 guidelines and contribute significantly to overall disease morbidity and mortality. Data are scarce regarding neuropsychiatric manifestations of SLE in Eastern India as well as the utility of psychiatric rating scales for classifying, assessing disease severity, and prognostication. This study focuses on deriving the prevalence of psychiatric manifestations among SLE patients and their correlation with disease severity using several psychiatric rating scales and markers of disease severity.
Methods: This is a single center-based cross-sectional study involving 50 consented adult SLE patients fulfilling Systemic Lupus Erythematosus International Collaboration Committee (SLICC) criteria at NRS Medical College & Hospital over 18 months using a pretested questionnaire that includes psychiatric rating scales as well as disease severity assessment tools. Patients with drug abuse, pre-existing psychiatric disorders, dyselectrolytemia, and ongoing infection were excluded from the study.
Results: All the participants had anxiety disorder (100%) followed by depression (80%), psychosis (58%), mood disorders (54%), and cognitive dysfunction (8%). Systemic lupus activity measure, revised (SLAM-R) score had a positive correlation with General Health Questionnaire (GHQ) (r = 0.518, p < 0.05) and brief psychiatric rating scale (BPRS) (r = 0.589, p < 0.05). Brief psychiatric rating scale and GHQ had a positive correlation between them (r = 0.774, p < 0.05).
Conclusion: Psychiatric manifestations of SLE are quite prevalent in the study niche and their clinical severity is comparable to that estimated using screening questionnaires and disease severity tools used in this study.
Clinical significance: This study showed positive implications of implementing psychiatric rating scales as a screening tool in SLE patients for early diagnosis of psychiatric manifestations and use as corroborative measures of disease severity.
ACR Ad Hoc Committee on neuropsychiatric lupus nomenclature: The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999;42:599–608. DOI: 10.1002/1529-0131(199904)42:4<599::AID-ANR2>3.0.CO;2-F.
Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: Pathogenesis and biomarkers. Nat Rev Neurol 2014;10:579–596. DOI: 10.1038/nrneurol.2014.148
Zandman-Goddard G, Chapman J, Shoenfeld Y. Autoantibodies involved in neuropsychiatric SLE and antiphospholipid syndrome. Semin Arthritis Rheum 2007;36:297–315. DOI: 10.1016/j.semarthrit.2006.11.003.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50–55. DOI: 10.1111/j.2044-8341.1959.tb00467.x.
Liao J, Kang J, Li F, et al. A cross-sectional study on the association of anxiety and depression with the disease activity of systemic lupus erythematosus. BMC Psychiatry 2022;22(1):591. DOI: 10.1186/s12888-022-04236-z.
Lew D, Huang X, Kellahan SR, et al. Anxiety symptoms among patients with systemic lupus erythematosus persist over time and are independent of SLE disease activity. ACR Open Rheumatol 2022;4(5):432–440. DOI: 10.1002/acr2.11417.
Pangman VC, Sloan J, Guse L. An examination of psychometric properties of the mini-mental status examination and the standardized mini-mental status examination: Implications for clinical practice. Appl Nurs Res 2005;13(4):209–213. DOI: 10.1053/apnr.2000.9231.
Brey RL, Holliday SL, Saklad AR, et al. Neuropsychiatric syndromes in lupus: Prevalence using standardized definitions. Neurology 2002;58(8):1214–1220. DOI: 10.1212/wnl.58.8.1214.
Duca L, Roman N, Teodorescu A, et al. Association between inflammation and thrombotic pathway link with pathogenesis of depression and anxiety in SLE patients. Biomolecules 2023;13(3):567. DOI: 10.3390/biom13030567.
Zakeri Z, Shakiba M, Narouie B, et al. Prevalence of depression and depressive symptoms in patients with systemic lupus erythematosus: Iranian experience. Rheumatol Int 2012;32(5):1179–1187. DOI: 10.1007/s00296-010-1791-9.
Bertsa GK, Ioannidis JP, Aringer M, et al. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: Report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis 2010;69:2074–2082. DOI: 10.1136/ard.2010.130476.
Pinto C. Indian research on acute organic brain syndrome: Delirium. Indian J Psychiatry 2010;52(Suppl 1):S139–S147. DOI: 10.4103/0019-5545.69226.
Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012;64(8):2677–2686. DOI: 10.1002/art.34473.
World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992. Available from: https://iris.who.int/handle/10665/37958.
Sterling M. General health questionnaire-28 (GHQ-28). J Physiother 2011;57(4):259. DOI: 10.1016/S1836-9553(11)70060-1.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62. DOI: 10.1136/jnnp.23.1.56.
Leucht S, Kane JM, Kissling W, et al. Clinical implications of brief psychiatric rating scale scores. Br J Psychiatry 2005;187:366–371. DOI: 10.1192/bjp.187.4.366.
Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. Am J Psychiatry 2000;157(11):1873–1875. DOI: 10.1176/appi.ajp.157.11.1873.
Romero-Diaz J, Isenberg D, Ramsey-Goldman R. Measures of adult systemic lupus erythematosus: Updated version of British Isles Lupus Assessment Group (BILAG 2004), European Consensus Lupus Activity Measurements (ECLAM), Systemic Lupus Activity Measure, Revised (SLAM-R), Systemic Lupus Activity Questionnaire for Population Studies (SLAQ), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Arthritis Care Res (Hoboken) 2011;63(S11):S37–S46. DOI: 10.1002/acr.20572.
Saleem SM. Modified Kuppuswamy socioeconomic scale updated for the year 2020. Indian J Forensic Community Med 2020;7(1):2. DOI: 10.18231/j.ijfcm.2020.001
Hawro T, Maria KK, Jolanta RJ, et al. Psychiatric disorders in patients with systemic lupus erythematosus: Association of anxiety disorder with shorter disease duration. Rheumatol Int 2011;31:1387–1391. DOI: 10.1007/s00296-010-1689-6.
Muhammed H, Goyal M, Lal V, et al. Neuropsychiatric manifestations are not uncommon in Indian lupus patients and negatively affect quality of life. Lupus 2018;27(4):688–693. DOI: 10.1177/09612033177 47720.
Zhang Y, Han H, Chu L. Neuropsychiatric lupus erythematosus: Future directions and challenges: A Systematic Review and Survey. Clinics 2020;75:e1515. DOI: 10.6061/clinics/2020/e1515.
Ainiala H, Loukkola J, Peltola J, et al. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology 2001;57:496–500. DOI: 10.1212/wnl.57.3.496.
Philip EJ, Lindner H, Lederman L. Confidence in medical care linked to depression in lupus sufferers. J Allied Health 2009;38(2): 106–112.
Bai R, Liu S, Zhao Y, et al. Depressive and anxiety disorders in systemic lupus erythematosus patients without major neuropsychiatric manifestations. J Immunol Res 2016;2016(2829018):1–7. PMID: 19623792.
Bachen EA, Chesney MA, Criswell LA. Prevalence of mood and anxiety disorders in women with systemic lupus erythematosus. Arthritis Rheum 2009;61(6):822–829. DOI: 10.1002/art.24519.
Hanly JG, Su L, Urowitz MB, et al. Mood disorders in systemic lupus erythematosus: Results from an International Inception Cohort Study. Arthritis Rheumatol 2015;67(7):1837–1847. DOI: 10.1002/art. 39111.
Conti F, Alessandri C, Perricone C, et al. Neurocognitive dysfunction in systemic Lupus Erythematosus: Association with antiphospholipid antibodies, Disease activity and chronic damage. PLoS ONE 2012;7(3):e33824. DOI: 10.1371/journal.pone.0033824.
Raghunath S, Glikmann-Johnston Y, Golder V, et al. Clinical associations of cognitive dysfunction in systemic lupus erythematosus. Lupus Sci Med 2023;10(1):e00083. DOI: 10.1136/lupus-2022-00 0835.