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Nikoloudaki M, Repa A, Pitsigavdaki S, Molla Ismail Sali A, Sidiropoulos P, Lionis C, Bertsias G. Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study. J Clin Med 2022; 11:jcm11154316. [PMID: 35893407 PMCID: PMC9329785 DOI: 10.3390/jcm11154316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Mental disorders such as anxiety and depression are prevalent in systemic lupus erythematosus (SLE) patients, yet their association with the underlying disease activity remains uncertain and has been mostly evaluated at a cross-sectional level. To examine longitudinal trends in anxiety, depression, and lupus activity, a prospective observational study was performed on 40 adult SLE outpatients with active disease (SLE Disease Activity Index [SLEDAI]-2K ≥ 3 [excluding serology]) who received standard-of-care. Anxiety and depression were determined at baseline and 6 months by the Hospital Anxiety and Depression Scale. Treatment adherence was assessed with the Morisky Medication Adherence Scale-4. Increased anxiety (median [interquartile range] HADS-A: 11.0 [7.8]) and depression (HADS-D: 8.0 [4.8]) were found at inclusion, which remained stable and non-improving during follow-up (difference: 0.0 [4.8] and −0.5 [4.0], respectively) despite reduced SLEDAI-2K by 2.0 (4.0) (p < 0.001). Among possible baseline predictors, paid employment—but not disease activity—correlated with reduced HADS-A and HADS-D with corresponding standardized beta-coefficients of −0.35 (p = 0.017) and −0.27 (p = 0.093). Higher anxiety and depression correlated with lower treatment adherence (p = 0.041 and p = 0.088, respectively). These results indicate a high-mental disease burden in active SLE that persists despite disease control and emphasize the need to consider socioeconomic factors as part of comprehensive patient assessment.
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Affiliation(s)
- Myrto Nikoloudaki
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Argyro Repa
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Sofia Pitsigavdaki
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Ainour Molla Ismail Sali
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
| | - Prodromos Sidiropoulos
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
- Institute of Molecular Biology and Biotechnology—FORTH, 71110 Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete Medical School, 71110 Heraklion, Greece;
| | - George Bertsias
- Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece; (M.N.); (A.R.); (S.P.); (A.M.I.S.); (P.S.)
- Institute of Molecular Biology and Biotechnology—FORTH, 71110 Heraklion, Greece
- Correspondence: ; Tel.: +30-2810-394635
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Parperis K, Psarelis S, Chatzittofis A, Michaelides M, Nikiforou D, Antoniade E, Bhattarai B. Association of clinical characteristics, disease activity and health-related quality of life in SLE patients with major depressive disorder. Rheumatology (Oxford) 2021; 60:5369-5378. [PMID: 33547787 DOI: 10.1093/rheumatology/keab123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the contributing factors associated with major depressive disorder (MDD) in SLE patients and examine the association between disease-specific health-related quality of life [lupus quality of life (LupusQoL)] domains and MDD. METHODS Depression was assessed by the patient health questionnaire (PHQ)-9, and scores ≥10 indicate MDD. Demographic data, LupusQoL domains, clinical and other features of the SLE patients were described and compared between MDD (PHQ-9 ≥10) and non-MDD (PHQ-9 <10) groups using χ2 tests for categorical variables and Wilcoxon rank sum tests for non-normal continuous variables. The risk of MDD was evaluated for the patient and physician-reported features individually using log-binomial models to estimate relative risks and 95% confidence limits. RESULTS Eighty-eight patients with SLE met eligibility criteria, with a mean (range) age of 48.6 (19-80), mostly female (80%) and with a mean disease duration of 13.2 years. Compared with the non-MDD group, patients with MDD (n = 32, 36%) were more likely to have the following SLE manifestations: mucocutaneous, vascular, ocular, pulmonary and musculoskeletal involvement. Self-rated health described as poor/fair was markedly associated with MDD (P < 0.001, relative risk = 0.48). Based on relative risks, higher pain visual analogue score, and patient and physician global assessment scores were also linked to MDD. The LupusQoL domain scores were notably lower in the MDD patients, with a statistically significant reduction in all LupusQoL domains. CONCLUSION Predictors of MDD in SLE patients include higher scores in pain and global assessment, poor or fair self-reported health, and specific organ involvement. These findings may help clinicians to recognize and manage MDD promptly.
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Affiliation(s)
- Konstantinos Parperis
- Department of Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus and University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | | | | | - Elpida Antoniade
- Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
| | - Bikash Bhattarai
- Department of Biostatistics, Valleywise Health and University of Arizona College of Medicine, Phoenix, Arizona, USA
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Eldeiry D, Zandy M, Tayer-Shifman OE, Kwan A, Marzouk S, Su J, Bingham K, Touma Z. Association between depression and anxiety with skin and musculoskeletal clinical phenotypes in systemic lupus erythematosus. Rheumatology (Oxford) 2020; 59:3211-3220. [DOI: 10.1093/rheumatology/keaa098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Abstract
Objectives
To study the clinical phenotypes, determined based on cumulative disease activity manifestations, and sociodemographic factors associated with depression and anxiety in SLE.
Methods
Patients attending a single centre were assessed for depression and anxiety. SLE clinical phenotypes were based on the organ systems of cumulative 10-year SLE Disease Activity Index 2000 (SLEDAI-2K), prior to visit. Multivariable logistic regression analyses for depression, anxiety, and coexisting anxiety and depression were performed to study associated SLE clinical phenotypes and other factors.
Results
Among 341 patients, the prevalence of anxiety and depression was 34% and 27%, respectively, while 21% had coexisting anxiety and depression. Patients with skin involvement had significantly higher likelihood of anxiety compared with patients with no skin involvement [adjusted odds ratio (aOR) = 1.8; 95% CI: 1.1, 3.0]. Patients with skin involvement also had higher likelihood of having coexisting anxiety and depression (aOR = 2.0, 95% CI: 1.2, 3.9). Patients with musculoskeletal (MSK) (aOR = 1.9; 95% CI: 1.1, 3.5) and skin system (aOR = 1.8; 95% CI: 1.04, 3.2) involvement had higher likelihood of depression compared with patients without skin or musculoskeletal involvement. Employment status and fibromyalgia at the time of the visit, and inception status were significantly associated with anxiety, depression, and coexisting anxiety and depression, respectively.
Conclusion
SLE clinical phenotypes, specifically skin or MSK systems, along with fibromyalgia, employment and shorter disease duration were associated with anxiety or depression. Routine patient screening, especially among patients with shorter disease duration, for these associations may facilitate the diagnosis of these mental health disorders, and allow for more timely diagnosis.
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Affiliation(s)
- David Eldeiry
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Moe Zandy
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Oshrat E Tayer-Shifman
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Andrew Kwan
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | | | - Jiandong Su
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
| | - Kathleen Bingham
- Centre for Mental Health, Psychiatry Department, University Health Network, Toronto General Hospital
| | - Zahi Touma
- Department of Medicine, Division of Rheumatology, University of Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital
- Institute of Health Policy, University of Toronto, Toronto, Ontario, Canada
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Qiang Seah BZ, Chua CG. A Proposed Aeromedical Disposition Flowchart for Systemic Lupus Erythematosus. Aerosp Med Hum Perform 2020; 91:826-832. [PMID: 33187571 DOI: 10.3357/amhp.5684.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement. Clinical management of this condition has unique aeromedical considerations and an impact on subsequent aeromedical disposition. A comprehensive decision matrix would greatly benefit aviation medicine practitioners in the management of aircrew and personnel in flying-related vocations who are diagnosed with SLE.CASE REPORT: We describe the aeromedical management of a military air traffic controller who was diagnosed with SLE after presenting with cutaneous lupus, nonscarring alopecia, symmetrical small joint polyarthropathy, leukopenia, and presence of SLE-specific antibody. She was treated with hydroxychloroquine and low-dose systemic glucocorticoids, and allowed to return to duties with a proximity restriction and a bar on field deployments and night duties.DISCUSSION: Several SLE manifestations may have either incapacitating or distracting effects on aircrew and personnel in flying-related vocations. Some medications used in the treatment of SLE may similarly impact on an individuals ability to safely execute flight or air traffic control duties. We propose an aeromedical disposition decision flowchart that would guide aviation medicine practitioners in the management of individuals diagnosed with SLE to ensure optimal and safe performance in their respective occupational settings.Seah BZQ, Chua CG. A proposed aeromedical disposition flowchart for systemic lupus erythematosus. Aerosp Med Hum Perform. 2020; 91(10):826832.
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Kwan A, Katz P, Touma Z. The Assessment of Anxiety and Depression and its Associated Factors in SLE. Curr Rheumatol Rev 2019; 15:90-98. [PMID: 30255761 DOI: 10.2174/1573397114666180926101513] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/13/2018] [Accepted: 09/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression and anxiety are common neuropsychiatric complaints in patients with Systemic Lupus Erythematosus (SLE). While numerous studies have been performed to investigate the prevalence, impact, and associated factors of depression and anxiety, current literature presents mixed results. In particular, the prevalence of anxiety and depression varies substantially between studies due to methodological limitations, and heterogeneity in defining anxiety and depression, patient selection, and metrics used. Moreover, there is a lack of studies evaluating the validity, reliability, and interpretability of commonly used screening tools for depression and anxiety in SLE patients. RESULT AND CONCLUSION Further investigations should aim to reach a consensus surrounding the role of controversial associated factors in depression and anxiety of SLE patients, while also focusing on the identification of novel factors that have not yet been highlighted in the literature.
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Affiliation(s)
- Andrew Kwan
- Queen's University, Kingston, Ontario, Canada.,University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Patricia Katz
- Department of Medicine, UCSF, Philip R. Lee Institute for Health Policy Studies, St, San Francisco, CA 94117, United States
| | - Zahi Touma
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
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Moustafa AT, Moazzami M, Engel L, Bangert E, Hassanein M, Marzouk S, Kravtsenyuk M, Fung W, Eder L, Su J, Wither JE, Touma Z. Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 50:84-94. [PMID: 31303437 DOI: 10.1016/j.semarthrit.2019.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To systematically review and synthesize literature on 1) the overall prevalence of depression and anxiety in SLE patients in identified studies, and 2) the pooled prevalence per metrics of depression and anxiety in adult SLE patients. METHODS This review used (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines and in-depth searches in four databases (1954-2016; Ovid-based Medline, Embase, PsycINFO and CINAHL) to identify articles on the prevalence of depression and/or anxiety in adult SLE patients. Included studies were critically appraised and analyzed. The prevalence of depression and anxiety was studied for all included studies, and whenever possible, pooled prevalence (PP) was determined for more commonly used metrics. Statistical and publication bias was assessed using funnel plots. RESULT A total of 3103 references were identified, 226 were selected for detailed review and 72 were included in the final analysis. OVERALL PREVALENCE The depression PP, obtained from 69 studies representing 23,386 SLE patients, was 35.0% (95% CI: 29.9%-40.3%). The anxiety PP, obtained from 38 studies representing 4439 SLE patients, was 25.8% (95% CI: 19.2%-32.9%). PREVALENCE PER METRICS USED The more commonly used instruments included the Centre for Epidemiological Studies - Depression (CES-D), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scales (HADS-A/D), and Hamilton Rating Scales for Depression/Anxiety (HAM-D/A)]. The CES-D was utilized in 13 studies including 1856 SLE patients; depression PP was 41.5% (95% CI: 35.1%-48.1%). The BDI was utilized in 14 studies including 1355 SLE patients and the BAI in 3 studies including 489 patients; depression PP was 39.9% (95% CI: 31.1%-49.1) and anxiety PP was 38.4% (95% CI: 34.2%-42.8%). The HADS-D was utilized in 14 studies including 1238 SLE patients and the HADS-A in 12 studies including 1099 patients respectively; its depression PP was 24.4% (95% CI: 19.1%-30.1%) and anxiety PP was 38.3% (95% CI: 29.1%-47.9%). The HAM-D was utilized in 4 studies including 267 SLE patients and the HAM-A in 4 studies including 213 patients respectively; its depression PP was 40.0% (95% CI: 23.0%-59.0%) and anxiety PP was 39.0% (95% CI: 32.0%-45.0%). CONCLUSION There was high variability in the prevalence of depression and anxiety, ranging from 8.7%-78.6% and 1.1%-71.4%, respectively. This could be attributed to the lack of consistency in the metrics used and its definition for depression and anxiety in SLE. Studies that used a specific metric, such as the CES-D, BDI or HAM-D, yielded similar depression prevalence. The HADS-D had the lowest prevalence. All metrics of anxiety yielded similar anxiety prevalence.
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Affiliation(s)
- Ahmed T Moustafa
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Mitra Moazzami
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Lisa Engel
- University of Toronto SLE Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Elvira Bangert
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Mohamed Hassanein
- Michigan State University, College of Human Medicine, East Lansing, Michigan, United States.
| | - Sherief Marzouk
- Lecturer, Faculty of Medicine, Department of Psychiatry, Neuropsychiatry Division, University of Toronto, Toronto, Ontario, Canada.
| | - Maryana Kravtsenyuk
- Forensic Psychiatrist, Alberta Hospital Edmonton, Assistant Clinical Professor, Department of Psychiatry, University of Alberta, Alberta, Canada.
| | - William Fung
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Lihi Eder
- Assistant Professor of Medicine, University of Toronto, Women's College Research Institute, Toronto, Ontario, Canada.
| | - Jiandong Su
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Joan E Wither
- Departments of Medicine and Immunology, University of Toronto, Division of Rheumatology, Toronto Western Hospital, Senior Scientist, Krembil Research Institute, Toronto, Ontario, Canada.
| | - Zahi Touma
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, EW, 1-412, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
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Tisseverasinghe A, Peschken C, Hitchon C. Anxiety and Mood Disorders in Systemic Lupus Erythematosus: Current Insights and Future Directions. Curr Rheumatol Rep 2018; 20:85. [DOI: 10.1007/s11926-018-0797-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Arat S, Lenaerts JL, De Langhe E, Verschueren P, Moons P, Vandenberghe J, Taelman V, Westhovens R. Illness representations of systemic lupus erythematosus and systemic sclerosis: a comparison of patients, their rheumatologists and their general practitioners. Lupus Sci Med 2017; 4:e000232. [PMID: 29177061 PMCID: PMC5687554 DOI: 10.1136/lupus-2017-000232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/22/2017] [Accepted: 10/12/2017] [Indexed: 11/21/2022]
Abstract
Objective Discrepancies in illness representations between patients and physicians result in treatment difficulties, decreased well-being of patients and misunderstandings and disrupted communication. Hence, the objective of this study was to compare illness perceptions of individual patients with systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), their rheumatologists and their general practitioners (GPs) and explore potential differences. Methods This study has a cross-sectional design. Patients with SLE and SSc, who were followed at the rheumatology department of the University Hospitals Leuven (Belgium), completed the revised Illness Perception Questionnaire which measures patients’ perceptions of their condition and captures nine dimensions. Physicians completed the Revised Illness Perception Questionnaire for Healthcare Professionals which consists of seven dimensions and measures perceptions of the healthcare professional regarding the disease of their patients. Intraclass correlation was performed to examine relationships between pairs of respondents; Cohen’s d was used for estimating the magnitude of the difference. Results Questionnaires were sent to 284 patients of whom 241 (113 SSc and 128 SLE patients) were included. Five rheumatologists and 160 GPs participated. For both diseases, positive correlations were found for ‘consequences’, ‘illness coherence’ and ‘emotional representations’ among patients, rheumatologists and GPs. GPs scored higher on the ‘consequences’ of these diseases for the patient (d=0.71 for SLE; d=0.80 for SSc). Differences between rheumatologists and GPs were small for SSc and moderate to large for ‘consequences’ (d=0.56) and ‘timeline acute/chronic’ (d=0.95) in SLE with higher scores for GPs. Conclusions For both diseases and among the three groups, significant correlations are detected for the dimensions ‘consequences’, ‘illness coherence’ and ‘emotional representations’. Differences between rheumatologists and GPs were mainly detected in the case of SLE patients. This can have implications for the collaboration between these two groups of physicians in daily clinical practice. Clinical trial registration NCT02655640; Pre-results.
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Affiliation(s)
- Seher Arat
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Jan L Lenaerts
- Department of Rheumatology, Jessa Hospitals Hasselt, Hasselt, Belgium.,Department of Rheumatology, Reuma-Instituut Hasselt, Hasselt, Belgium.,Department of of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Ellen De Langhe
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Skeletal Biology and Engineering Research Center, Leuven, Belgium.,Department of of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Verschueren
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Skeletal Biology and Engineering Research Center, Leuven, Belgium.,Department of of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Goteborg, Sweden.,Instituteof Health and Care Sciences, University of Gothenburg, Leuven, Belgium
| | - Joris Vandenberghe
- Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of of Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Taelman
- Department of of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Rene Westhovens
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Skeletal Biology and Engineering Research Center, Leuven, Belgium.,Department of of Rheumatology, University Hospitals Leuven, Leuven, Belgium
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Alsowaida N, Alrasheed M, Mayet A, Alsuwaida A, Omair MA. Medication adherence, depression and disease activity among patients with systemic lupus erythematosus. Lupus 2017; 27:327-332. [PMID: 28825347 DOI: 10.1177/0961203317725585] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Medication non-adherence is an important cause of treatment failure among patients with systemic lupus erythematosus (SLE). Depression is a common neuropsychiatric disorder associated with SLE. The aims of this study are to assess the prevalence of both medication non-adherence and depressed mood among Saudi patients with SLE by using validated tools and to explore the impact of both depressive symptoms and disease activity on medication non-adherence. Methods A cross-sectional study was conducted in outpatients with SLE. Medication non-adherence was assessed by using the Morisky Medication Adherence Scale, and the severity of depressed mood was evaluated with the Beck's Depression Inventory. Disease activity was measured using the SLE Disease Activity Index (SLEDAI). Multiple logistic regression models were used to identify the multivariate predictors of medication non-adherence. Results Out of 140 patients, 134 (95.7%) were females with a mean (±SD) age of 35.6 (±11.3) years and a disease duration of 8.8 (±6.7) years. Medication non-adherence and depressed mood were detected in 62.1% and 35% of the patients, respectively. A moderate or severe depressed mood was significantly associated with medication non-adherence ( p = 0.04). There was a significant correlation between disease activity and the severity of depressed mood ( r = 0.31, p = 0.003). Disease activity did not correlate with medication non-adherence. Logistic regression demonstrated that moderate-to-severe depressed mood increased the probability of medication non-adherence (OR 2.62; 1.02-6.71). Conclusion Medication non-adherence and depressive symptoms are highly prevalent among Saudi SLE patients. Routine screening could facilitate the early detection and management of depression and medication adherence.
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Affiliation(s)
- N Alsowaida
- 1 Pharmacy Services, 37850 King Saud University Medical City, Riyadh, Saudi Arabia
| | - M Alrasheed
- 2 College of Pharmacy, 37850 King Saud University , Riyadh, Saudi Arabia
| | - A Mayet
- 3 Department of Clinical Pharmacy, College of Pharmacy, 37850 King Saud University , Riyadh, Saudi Arabia
| | - A Alsuwaida
- 4 Division of Nephrology, Department of Medicine, College of Medicine, 37850 King Saud University , Riyadh, Saudi Arabia
| | - M A Omair
- 5 Division of Rheumatology, Department of Medicine, College of Medicine, 37850 King Saud University , Riyadh, Saudi Arabia
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Macêdo EA, Appenzeller S, Costallat LTL. Depression in systemic lupus erythematosus: gender differences in the performance of the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). Lupus 2017; 27:179-189. [PMID: 28587586 DOI: 10.1177/0961203317713142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of depressive symptoms in patients with systemic lupus erythematosus (SLE) varies widely between different cohorts (17-75%), primarily due to factors such as the heterogeneity of the samples and the instruments used to detect depressive symptoms. Most of these instruments are self-administered questionnaires that have different characteristics and approaches to depressive symptoms. This study aimed to evaluate gender differences in the performance of three questionnaires used to assess depressive symptoms in patients with SLE: the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). This study included 54 male and 54 female SLE patients. Depressive symptoms were assessed using BDI (cutoffs 13 and 15), CES-D and HADS. The gold standard method used was the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Regarding the performance of the BDI questionnaire, no significant differences in sensitivity or specificity were found between the genders. The specificity of the CES-D questionnaire was significantly greater for the male group (83% vs. 62.5%, p = 0.0309), and its sensitivity was non-significantly higher for the female group (92.9% for women and 71.4% for men; p = 0.2474). Regarding the performance of the HADS, we found similar sensitivities between the genders (71.4%) but a higher specificity among the men (95.7% in men and 82.5% in women, p = 0.0741). In conclusion, our results suggest the presence of gender differences in the performance of the questionnaires in SLE patients. The BDI had the most similar performances between the male and female groups. In contrast, the CES-D and HADS-D showed considerable variation in performances between men and women with SLE.
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Affiliation(s)
- E A Macêdo
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
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11
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Macêdo EA, Appenzeller S, Costallat LTL. Gender differences in systemic lupus erythematosus concerning anxiety, depression and quality of life. Lupus 2016; 25:1315-27. [DOI: 10.1177/0961203316638934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Several studies have demonstrated a high prevalence of depression and anxiety in patients with systemic lupus erythematosus (SLE); however, few data address gender differences regarding these manifestations. This study aimed to investigate gender differences in the prevalence of depressive and anxiety symptoms, and their effect on the quality of life (QOL) of male and female SLE patients. This study included 54 male SLE patients, 54 female SLE patients, 54 male controls and 54 female controls. Depressive symptoms were assessed using the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Hospital Anxiety and Depression Scale (HADS); the anxiety symptoms were examined using HADS. We used the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to assess QOL. Depressive symptoms were found in 22.2% of BDI respondents, 24.1% of CES-D respondents and 13% of HADS-D respondents who were male SLE patients; while in the female SLE patient group, they were found in 38.9% of BDI respondents ( p = 0.063), 51.9% of CES-D respondents ( p = 0.653) and 31.5% of HADS-D respondents ( p = 0.003). Anxiety symptoms were found in 16.7% of the male SLE patients and 38.9% of the female SLE patients ( p = 0.024). Lower scores on the SF-36 (for QOL) were found in both male and female SLE patients with depression and anxiety symptoms. In conclusion, we observed significant gender differences regarding the prevalence of depressive and anxiety symptoms in patients with SLE, with significantly higher values in the female group. The presence of these symptoms appears to have a negative effect on the QOL of patients of both genders.
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Affiliation(s)
- E A Macêdo
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, State University of Campinas, Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, State University of Campinas, Campinas, Brazil
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12
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Neri F, Chimini L, Filippini E, Motta M, Faden D, Tincani A. Pregnancy in patients with rheumatic diseases: psychological implication of a chronic disease and neuropsychological evaluation of the children. Lupus 2016; 13:666-8. [PMID: 15485099 DOI: 10.1191/0961203303lu2003oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As a consequence of the general improvement in the diagnosis and management of rheumatic diseases, patients achieve a better quality of life, with the possibility of a normal family life including one or more pregnancies. It is important, therefore, to consider the psychological aspects of these mothers’ life and the influence of their chronic disease on their children is development. Several papers have reported the impact of systemic lupus erythematosus (SLE) on the quality of life. They found higher incidence of anxiety (from 15 to 45%) and depression (from 25 to 47%) compared to the general population. We have investigated the psychological influence of SLE on family planning, and we observed that it can interfere with physiological phenomena such as parenthood and the upbringing of children. The children of lupus mothers have a normal intelligence level for their age. What is emerging, however, is an increased incidence of learning disabilities compared to the general population. This observation suggests the importance of an early neuropsychological examination, in order to identify the children needing particular care. Therefore, psychological support seems to be an important help in the counseling of patients with rheumatic disease and in the future life of their children.
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Affiliation(s)
- F Neri
- Pediatric Neuropsychiatry Institute, University of Brescia, Italy.
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Eber T, Chapman J, Shoenfeld Y. Anti-ribosomal P-protein and its role in psychiatric manifestations of systemic lupus erythematosus: myth or reality? Lupus 2016; 14:571-5. [PMID: 16175927 DOI: 10.1191/0961203305lu2150rr] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that may involve the central nervous system (CNS) resulting in neuropsychiatric manifestations. The associated psychiatric disorders include depression, psychosis, mood disorders, anxiety, cognitive dysfunction, and delirium/encephalopathy. Several autoantibodies may play a role in the pathogenesis of psychiatric complications of SLE, particularly antibodies against ribosomal P-proteins (anti-P) and possibly antibodies against endothelial cells (AECA). The reported prevalence of anti-P is highly variable in SLE patients and is dependent on different ethnic backgrounds, sensitivity and specificity of the assays employed for autoantibody detection, and the time at which sera were analysed in relation to the clinical event. Controversial data exist on the association of anti-P with psychiatric manifestations of SLE. These autoantibodies have been suggested to be specific markers of the psychiatric manifestations of SLE, particularly of the psychosis and depression, and the antibody level varied with the clinical activity of the disease. Some studies have confirmed the hypothesis of an association of anti-P antibodies with psychiatric manifestations of neuropsychiatric SLE (NPSLE) while others have disputed this relationship. This review summarizes the recent studies about relationship between anti-P antibodies and psychiatric manifestation of SLE.
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Affiliation(s)
- T Eber
- Beer Yaakov Mental Health Center, Tel Aviv University, Tel-Aviv, Israel
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Abstract
This article is the first to review published research on psychosocial factors and behavioral interventions related to systemic lupus erythematosus (SLE). The first section presents descriptive studies, followed by studies that investigate psychosocial factors as predictor and outcome variables. These studies demonstrate that the consideration of psychosocial factors is critical to understanding the disease experience of persons with SLE. Next, studies of behavioral interventions are presented, leading to the conclusion that randomized controlled trials are essential yet rare. The final section highlights limitations of the extant literature and suggests directions for future research and recommendations for clinicians.
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Affiliation(s)
- A H Seawell
- Department of Psychology, University at Albany, State University of New York, New York 12222, USA.
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15
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Postal M, Lapa AT, Sinicato NA, de Oliveira Peliçari K, Peres FA, Costallat LTL, Fernandes PT, Marini R, Appenzeller S. Depressive symptoms are associated with tumor necrosis factor alpha in systemic lupus erythematosus. J Neuroinflammation 2016; 13:5. [PMID: 26732584 PMCID: PMC4702302 DOI: 10.1186/s12974-015-0471-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tumor necrosis factor alpha (TNF-α) is deeply related to pathogenesis of neurodevelopmental disorders, especially depression. The aim of this study was to explore potential relationships between sera TNF-α levels and mood and anxiety disorders in systemic lupus erythematosus (SLE) patients. METHODS We included 153 consecutive SLE patients (women 148; median age 30; range 10-62) and 40 (women 37; mean age 28.5; range 12-59) age- and sex-matched healthy controls. Mood and anxiety disorders were determined through Beck Depression and Beck Anxiety Inventory. SLE patients were further assessed for clinical and laboratory SLE manifestations. TNF-α levels were measured by enzyme-linked immunosorbent assay using commercial kits. RESULTS Depressive symptoms were identified in 70 (45.7 %) SLE patients and in 10 (25 %) healthy controls (p < 0.001). Anxiety symptoms were identified in 93 (60.7 %) SLE patients and in 16 controls (40 %) (p < 0.001). Sera TNF-α levels were increased in SLE patients with depressive symptoms (p < 0.001) and with anxiety symptoms (p = 0.014). A direct correlation between the severity of depressive symptoms and sera TNF-α levels (r = 0.22; p = 0.003) was observed. TNF-α levels were significantly increased in patients with active disease (p = 0.012). In addition, we observed a correlation between sera TNF-α levels and disease activity (r = 0.28; p = 0.008). In the multivariate analysis, sera TNF-α levels were independently associated with depressive symptoms (t = 3.28; 95 % CI 1.08-2.2; p = 0.002). CONCLUSIONS Sera TNF-α levels are increased in SLE patients with mood and anxiety disorders. In SLE, sera TNF-α levels are independently associated with mood disorders. The etiology of mood disorders is still debated in SLE, but our findings suggest the presence of immunological basis for depression in SLE.
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Affiliation(s)
- Mariana Postal
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Aline Tamires Lapa
- Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Nailú Angélica Sinicato
- Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Karina de Oliveira Peliçari
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Fernando Augusto Peres
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Lilian Tereza Lavras Costallat
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Paula Teixeira Fernandes
- Department of Sport Sciences, Faculty of Physical Education State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil
| | - Roberto Marini
- Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
| | - Simone Appenzeller
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil. .,Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science State University of Campinas, Campinas, São Paulo, CEP 13083-970, Brazil.
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Nishimura K, Omori M, Katsumata Y, Sato E, Kawaguchi Y, Harigai M, Yamanaka H, Ishigooka J. Psychological distress in corticosteroid-naive patients with systemic lupus erythematosus: A prospective cross-sectional study. Lupus 2015; 25:463-71. [PMID: 26527504 DOI: 10.1177/0961203315615223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Psychological distress, such as depression and anxiety, has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which might themselves induce mood disturbances. We investigated psychological distress in corticosteroid-naive patients with SLE who did not exhibit any overt neuropsychiatric manifestations. METHODS Forty-three SLE in-patients with no current or past abnormal neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic and personality characteristics were administered a comprehensive battery of psychological/neuropsychological tests. The Profile of Mood States (POMS) was used to assess depression and anxiety. Results of clinical, laboratory, and neurological tests were compared with regard to their presence. RESULTS Prevalence of depression was higher in patients (n = 11, 25.6%) than in controls (n = 2, 6.7%; p = 0.035), although prevalence of anxiety did not differ across groups (patients: 34.9%, n = 15; controls: 16.7%, n = 5; p = 0.147). Using multiple logistic regression analysis, we identified avoidance coping methods (OR, 1.3; 95% CI 1.030-1.644; p = 0.027) as an independent risk factor for depression. CONCLUSION Our results indicate that depression presents more frequently in corticosteroid-naive patients with early-stage, active SLE than in the normal population, but anxiety does not. Depression may be related to psychological reactions to suffering from the disease.
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Affiliation(s)
- K Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - M Omori
- Kanagawa Psychiatric Center, Yokohama, Japan
| | - Y Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - E Sato
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - M Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - J Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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17
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Schneider M, Haupt M. [Overcoming disease in systemic lupus erythematosus]. Z Rheumatol 2015; 74:591-6. [PMID: 26286190 DOI: 10.1007/s00393-014-1556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease affecting a broad range of different organ systems and, hence, presenting with multiple symptomatic domains, which considerably reduces the quality of life of patients. Within the last decade the prognosis of the disease has been significantly improved by novel therapies and intensive monitoring; however, non-pharmaceutical strategies for symptom control, self-efficacy and coping abilities for those affected are still insufficiently established. OBJECTIVE This article describes the possibilities and limitations of non-pharmaceutical strategies and makes suggestions for future treatment and research. RESULTS Preliminary interventional studies using psychoeducational, psychosocial and behavioral psychotherapeutic approaches, have consistently shown that the needs and expectations of patients related to help and support by doctors and professional care can be adequately and sustainably met. In addition, coping abilities and the quality of life can be increased.
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Affiliation(s)
- M Schneider
- Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland,
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18
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Tay SH, Cheung PPM, Mak A. Active disease is independently associated with more severe anxiety rather than depressive symptoms in patients with systemic lupus erythematosus. Lupus 2015; 24:1392-9. [DOI: 10.1177/0961203315591026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 05/21/2015] [Indexed: 01/14/2023]
Abstract
Objective The inter-correlation between and co-existence of depression and anxiety may engender inconsistency in addressing the relationship between the severity of depression and disease activity of systemic lupus erythematosus (SLE). We aimed at identifying whether lupus disease activity is independently associated with depression and anxiety in lupus patients. Methods Adult lupus patients were assessed for the severity of depressive and anxiety symptoms and lupus disease activity by using the Hospital Anxiety and Depression Scale (HADS) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), respectively. Age- and gender-matched healthy controls (HCs) were recruited for comparison. Prevalence and severity of depressive and anxiety symptoms were compared between lupus patients and HCs. Independent relationships between the severity of anxiety (HADS-Anxiety) and depressive (HADS-Depression) symptoms, and SLEDAI were studied with regression models. Results In total, 110 lupus patients and 110 HCs were studied. Lupus patients had significantly higher HADS scores than HCs (10.82 ± 6.5 vs 7.34 ± 4.9, p < 0.001). Significantly more lupus patients had anxiety (40.9 vs 21.8%, p = 0.002) and depressive symptoms (15.5 vs 6.4%, p = 0.025) than HCs. Multiple linear regression analyses revealed that SLEDAI (β = 0.160, p = 0.016), calcineurin inhibitor non-use (β = –1.929, p = 0.041) and past cyclophosphamide non-use (β = –1.603, p = 0.039) independently predicted HADS-Anxiety amongst lupus patients even after adjusting for HADS-Depression. Conversely, SLEDAI (β = 0.014, p = 0.834) lost its significant univariate correlation with HADS-Depression after controlling for HADS-Anxiety and other covariates. Conclusion Anxiety is more common in lupus patients than in HCs, and its severity is independently associated with more active SLE regardless of the presence or absence of concomitant depression.
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Affiliation(s)
- S H Tay
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P P M Cheung
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Mak
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Rutter S, Kiemle G. Exploring the social and interpersonal experiences of South Asian women with a diagnosis of Systemic Lupus Erythematosus. Psychol Health 2014; 30:318-35. [DOI: 10.1080/08870446.2014.972397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S.J. Rutter
- Department of Clinical Psychology, North Manchester General Hospital, Manchester, UK
| | - G. Kiemle
- Doctorate in Clinical Psychology, The University of Liverpool, Liverpool, UK
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20
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Knight A, Weiss P, Morales K, Gerdes M, Gutstein A, Vickery M, Keren R. Depression and anxiety and their association with healthcare utilization in pediatric lupus and mixed connective tissue disease patients: a cross-sectional study. Pediatr Rheumatol Online J 2014; 12:42. [PMID: 25242900 PMCID: PMC4169806 DOI: 10.1186/1546-0096-12-42] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety adversely affects outcomes in systemic lupus erythematosus (SLE) and healthcare utilization is high for pediatric SLE. We aimed to characterize the prevalence of depression and anxiety in pediatric SLE, and their association with healthcare utilization. METHODS We conducted a cross-sectional analysis of pediatric SLE and mixed connective tissue disease (MCTD) subjects and healthy controls aged 8 years and above. We used the Patient Health Questionnaire 9 (PHQ-9) and the Screen for Childhood Anxiety Related Disorders (SCARED) to identify depression, suicidal ideation and anxiety symptoms, respectively. We compared symptom prevalence in SLE/MCTD and healthy subjects using logistic regression. For SLE/MCTD subjects, we calculated the rate of annual outpatient visits [rheumatology/nephrology, primary care provider (PCP) and emergency department], hospitalizations and rheumatology/nephrology telephone consultations in the preceding year. We compared these outcomes in those with and without depression and anxiety using negative binomial regression. RESULTS We identified depression symptoms in 10 (20%) SLE/MCTD and 4 (8%) healthy subjects, representing a trend towards increased prevalence in unadjusted analysis (OR = 2.9, 95% CI 0.8-9.9, p = 0.09). Adjusted analysis did not show a significant difference; however, non-white race was a statistically significant independent risk factor for depression symptoms compared to white race (OR = 5.4, 95% CI 1.1-27.2, p = 0.04). We identified anxiety symptoms in 11 (22%) SLE/MCTD and 13 (26%) healthy subjects, which was not statistically different. Suicidal ideation was present in 7 (14%) SLE/MCTD and 2 (4%) healthy subjects, which was a statistically significant difference (OR = 5.4, 95% CI 1.02-28.3, p = 0.047). Of the 34% of SLE/MCTD subjects with any symptoms, only 24% had previous mental health care. Those with depression symptoms had a statistically significant lower rate of visits to the PCP (IRR = 0.38, 95% CI 0.19-0.76, p < 0.001). Anxiety symptoms were not associated with the healthcare utilization outcomes. CONCLUSIONS Depression and anxiety symptoms were prevalent, and suicidal ideation significantly more common in SLE/MCTD than in healthy subjects. Non-white race was an independent risk factor for depression. Despite prevalent symptoms, there were poor rates of prior mental health treatment, and less frequent PCP visits among those with depression symptoms. Further investigation of barriers to mental health care and interventional strategies for symptomatic youth with SLE/MCTD is needed.
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Affiliation(s)
- Andrea Knight
- Division of Rheumatology, Children’s Hospital of Philadelphia, 3405 Civic Center Blvd, Philadelphia, PA 19104 USA ,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 3535 Market St, 15th Flr, Philadelphia, PA 19104 USA ,Children’s Hospital of Philadelphia PolicyLab, Children’s Hospital of Philadelphia, 3535 Market St, 15th Flr, Philadelphia, PA 19104 USA ,Children’s Hospital of Philadelphia, 3535 Market St, Ste 1527, Philadelphia, PA 19104 USA
| | - Pamela Weiss
- Division of Rheumatology, Children’s Hospital of Philadelphia, 3405 Civic Center Blvd, Philadelphia, PA 19104 USA ,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 3535 Market St, 15th Flr, Philadelphia, PA 19104 USA ,Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, 8th Flr Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Knashawn Morales
- Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, 8th Flr Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Marsha Gerdes
- Children’s Hospital of Philadelphia PolicyLab, Children’s Hospital of Philadelphia, 3535 Market St, 15th Flr, Philadelphia, PA 19104 USA ,Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Allyson Gutstein
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL 33199 USA
| | - Michelle Vickery
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 3535 Market St, 15th Flr, Philadelphia, PA 19104 USA ,Children’s Hospital of Philadelphia PolicyLab, Children’s Hospital of Philadelphia, 3535 Market St, 15th Flr, Philadelphia, PA 19104 USA
| | - Ron Keren
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 3535 Market St, 15th Flr, Philadelphia, PA 19104 USA ,Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, 8th Flr Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA ,Division of General Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
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21
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Huang X, Magder LS, Petri M. Predictors of incident depression in systemic lupus erythematosus. J Rheumatol 2014; 41:1823-33. [PMID: 25128512 DOI: 10.3899/jrheum.140111] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Findings from previous studies of predictors of depression among patients with systemic lupus erythematosus (SLE) have been inconsistent. The aim of our study was to identify risk factors that preceded incident depression based on a large, closely followed longitudinal cohort. METHODS Data regarding 1609 patients with SLE in the Hopkins Lupus Cohort who had no history of depression prior to cohort entry were analyzed. Demographic variables, SLE manifestations, laboratory tests, physician's global assessment, Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), cumulative organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and onset of depression were recorded at enrollment and each quarterly visit. Rates of incident depression were calculated overall, and in subgroups defined by demographic and clinical variables. Adjusted estimates of association were derived using pooled logistic regression. RESULTS The incidence of depression was 29.7 episodes per 1000 person-years. In the multivariable analysis, these variables remained as independent predictors of incident depression: recent SLE diagnosis, non-Asian ethnicity, disability, cutaneous activity, longitudinal myelitis, and current prednisone use of 20 mg/day or higher. Global disease activity (SELENA-SLEDAI) was not a significant predictor after controlling for prednisone use. CONCLUSION Depression in SLE is multifactorial. Higher-dose prednisone (≥ 20 mg daily) is 1 important independent risk factor. Global disease activity is not a risk factor, but cutaneous activity and certain types of neurologic activity (myelitis) are predictive of depression. The independent effect of prednisone provides clinicians with an additional incentive to avoid and reduce high-dose prednisone exposure in SLE.
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Affiliation(s)
- Xiangyang Huang
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Laurence S Magder
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Sichuan University School of Medicine, West China Hospital, Chengdu, Sichuan, China; Department of Rheumatology, Johns Hopkins University School of Medicine; University of Maryland, Baltimore, Maryland, USA.X. Huang, MD, PhD, Associate Professor, Division of Rheumatology, Johns Hopkins University School of Medicine, and the Department of Rheumatology, Sichuan University School of Medicine, West China Hospital; L.S. Magder, MPH, PhD, Professor of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, MD, MPH, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine.
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Depressive Symptoms and Associated Factors in Systemic Lupus Erythematosus. PSYCHOSOMATICS 2013; 54:443-50. [DOI: 10.1016/j.psym.2012.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 01/22/2023]
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Xu J, Cheng YQ, Chen B, Bai R, Li S, Xu XF, Xu L, Wen JF, Lu ZP, Zeng XF. Depression in systemic lupus erythematosus patients is associated with link-polymorphism but not methylation status of the 5HTT promoter region. Lupus 2013; 22:1001-10. [PMID: 23893825 DOI: 10.1177/0961203313498793] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A higher prevalence of depression in systemic lupus erythematosus (SLE) patients has been reported, though the mechanism underlying this phenomenon remains unclear. The present study was conducted to explore whether the polymorphism and methylation status of the serotonin transporter gene (5HTT) promoter region (PR-5HTT) contribute to depression in SLE patients from both genetic and epigenetic perspectives. In this study, 96 SLE patients and 96 healthy controls (HCs) were recruited. Depression levels of all subjects were evaluated using the Hamilton Depression Rating Scale (HDRS). The serotonin transporter-linked polymorphism (5HTTLPR) and the DNA methylation status of PR-5HTT were detected in peripheral lymphocytes of SLE patients and HCs. The differences in 5HTTLPR and DNA methylation of PR-5HTT between SLEs and HCs were compared. In SLE patients, the frequencies of short allele (S) and SS genotype of 5HTTLPR were higher in depressive SLE (SLE-D) patients than in non-depressive SLE (SLE-ND) patients. The mean HDRS score of SS homozygote patients was higher than that of patients with SL/LL genotypes. Conversely, PR-5HTT was hypomethylated in HCs as well as SLE patients. There was no difference in the methylation status between HCs and SLEs. Thus, the functional expression of PR-5HTT may be primarily regulated by gene polymorphism and not by DNA methylation. The risk allele of 5HTTLPR appears to be a major contributor to depression in SLE patients.
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Affiliation(s)
- J Xu
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - YQ Cheng
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - B Chen
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, PR China
| | - R Bai
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - S Li
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - XF Xu
- Department of Psychiatry, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - L Xu
- Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, PR China
| | - JF Wen
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, PR China
| | - ZP Lu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - XF Zeng
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
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Shapira-Lichter I, Vakil E, Litinsky I, Oren N, Glikmann-Johnston Y, Caspi D, Hendler T, Paran D. Learning and memory-related brain activity dynamics are altered in systemic lupus erythematosus: a functional magnetic resonance imaging study. Lupus 2013; 22:562-73. [DOI: 10.1177/0961203313480399] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Memory impairment is prevalent in systemic lupus erythematosus (SLE); however, the pathogenesis is unknown. Methods We studied 12 patients with SLE without clinically overt neuropsychiatric manifestations and 11 matched healthy controls, aiming to characterize neural correlates of memory impairment, using structural and functional magnetic resonance imaging (MRI). The paradigm consisted of three encoding and free-recall cycles, allowing characterization of dynamics along consecutive retrieval attempts. Results During learning, patients with SLE and healthy controls showed brain activity changes in two principal networks, the default mode network (DMN) and the task-positive network (TPN). Patients with SLE demonstrated significantly less deactivation in the DMN and greater activation in the TPN, reflecting greater recruitment of both networks. The anterior medial prefrontal cortex (amPFC) of the DMN emerged as the only region where brain activity dynamics were altered both over the learning process ( p < 0.006), and within free-recall period attempts ( p < 0.034). Patients showed significant positive correlations between learning efficiency and hippocampal activity, and greater hippocampal functional connectivity, with pronounced connectivity to DMN structures. Conclusions Increased brain activation in patients with SLE during learning may reflect compensatory mechanisms to overcome memory impairment. Our findings localize this impairment to the amPFC, consistent with the behavioral pattern seen in SLE. Altered networking of the hippocampal subsystem of the DMN is consistent with hippocampal neuronal damage seen in SLE, and may reflect compensatory cortical reorganization to cope with dysfunction in these regions pivotal to mnemonic functions.
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Affiliation(s)
- Irit Shapira-Lichter
- Functional Brain Center, Wohl Institute for Advanced Imaging
- Functional Neurosurgery Unit and the
| | - Eli Vakil
- Department of Psychology and Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Israel
| | - Ira Litinsky
- Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Israel
- Faculty of Medicine
| | - Noga Oren
- Functional Brain Center, Wohl Institute for Advanced Imaging
- Faculty of Medicine
| | - Yifat Glikmann-Johnston
- Functional Brain Center, Wohl Institute for Advanced Imaging
- School of Psychological Sciences
| | - Dan Caspi
- Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Israel
- Faculty of Medicine
| | - Talma Hendler
- Functional Brain Center, Wohl Institute for Advanced Imaging
- Faculty of Medicine
- School of Psychological Sciences
- Sagol School of Neuroscience; Tel-Aviv University, Israel
| | - Daphna Paran
- Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Israel
- Faculty of Medicine
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25
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Sehlo MG, Bahlas SM. Perceived illness stigma is associated with depression in female patients with systemic lupus erythematosus. J Psychosom Res 2013; 74:248-51. [PMID: 23438717 DOI: 10.1016/j.jpsychores.2012.09.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 09/22/2012] [Accepted: 09/24/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES 1) To assess the prevalence of depression in a sample of female patients with systemic lupus erythematosus (SLE) 2) To evaluate the association between perceived illness stigma and depression in those patients. METHODS In a cross-sectional study, 80 female SLE patients were evaluated for the presence of depression and perceived illness stigma. Depression was diagnosed using the Structured Clinical Interview for DSM-IV Axis Ι disorders, clinical version (SCID-I-CV), the severity of the depressive symptoms was evaluated using the Hospital Anxiety and Depression Scale-Depression Subscale (HADS-D), and the stigma of illness was assessed using the Stigma Impact Scale (SIS). RESULTS The prevalence of depression among female SLE patients was 18.75% (15/80). The perceived illness stigma was higher among the depressed group than among the non-depressed group (SIS mean scores were 43.87±7.87 and 26.62±3.79 respectively P<.001), there was a significant positive correlation between SIS and HAD-D scores (r=0.73, P=.002), and there was a significant association between perceived illness stigma and diagnosis of depression (R(2)=0.53, P=.002, odds ratio=3.2), which increased the severity of depressive symptoms (R(2)=0.64, P<.001). CONCLUSION This study demonstrates a significant association between illness stigma and depression in female SLE patients which may be important in promoting optimal coping for these women .
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Affiliation(s)
- Mohammad G Sehlo
- Department of Medicine, Psychiatry Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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26
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Palagini L, Mosca M, Tani C, Gemignani A, Mauri M, Bombardieri S. Depression and systemic lupus erythematosus: a systematic review. Lupus 2013; 22:409-16. [DOI: 10.1177/0961203313477227] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a chronic, relapsing–remitting autoimmune disorder that involves multiple organ systems including the central nervous system. Among the items included in the nomenclature for neuropsychiatric SLE, mood disorders have been identified. The aim of this paper is to review the clinical and psychobiological relationship between depression and SLE. Method We performed a systematic search of MEDLINE, EMBASE, PsychINFO, using MeSH headings and keywords for ‘depression’ and ‘SLE’. Results Seventeen studies reported depressive disorders, with prevalence rates in the range 17–75%. Three studies reported the most frequent symptoms, which may be represented by fatigue, weakness, somatic disorders and sleep disorders. Suicide ideation was much higher than in the general population. Nine studies analysed the relationship to SLE disease activity. The results of the available literature are contradictory. Psychobiological hypotheses have been considered in 13 studies. Among the psychobiological hypotheses which might underline the plausibility of their relationship, ‘psychosocial factors’ were the most frequently reported. Conclusions Differences in assessment techniques appear to be the main explanation for the variability in findings and important methodological limitations are present in the available literature to definitively point to the prevalence of depression, type of depression and most prevalent symptoms. To date, the relationship between depression and SLE disease activity also appears controversial. Methodological limitations are present in the available literature and it would be necessary to develop evidence-based guidelines to improve the diagnosis of depression in SLE. Identification of SLE-specific biomarkers of depression also has high priority.
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Affiliation(s)
- L Palagini
- Psychiatry Unit, Department of Neuroscience, University of Pisa, Italy
| | - M Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Italy
| | - C Tani
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Italy
| | - A Gemignani
- Department of Physiological Sciences, University of Pisa, Italy Extreme Centre, Italy
| | - M Mauri
- Psychiatry Unit, Department of Neuroscience, University of Pisa, Italy
| | - S Bombardieri
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Italy
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27
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Sciascia S, Bertolaccini ML, Baldovino S, Roccatello D, Khamashta MA, Sanna G. Central nervous system involvement in systemic lupus erythematosus: Overview on classification criteria. Autoimmun Rev 2013; 12:426-9. [DOI: 10.1016/j.autrev.2012.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 10/28/2022]
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28
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Zirkzee EJM, Steup-Beekman GM, van der Mast RC, Bollen ELEM, van der Wee NJA, Baptist E, Slee TM, Huisman MV, Middelkoop HAM, Luyendijk J, van Buchem MA, Huizinga TWJ. Prospective study of clinical phenotypes in neuropsychiatric systemic lupus erythematosus; multidisciplinary approach to diagnosis and therapy. J Rheumatol 2012; 39:2118-26. [PMID: 22984275 DOI: 10.3899/jrheum.120545] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe clinical phenotypes in neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS Data were prospectively collected in the Leiden NPSLE referral clinic, where patients suspected of having NPSLE are assessed in a standardized multidisciplinary manner. In consensus meetings, all medical specialists agreed on therapeutic strategy based on the suspected pathogenetic mechanism of NPSLE in the individual patient. An algorithm illustrates the process of decision-making during the consensus meeting. Clinical phenotypes are described, classified by pathogenetic mechanism. RESULTS One hundred consecutive patients were evaluated, of whom 71 had SLE (29 patients did not fulfill ≥ 4 American College of Rheumatology criteria) and 46 had NPSLE. Primary NPSLE was diagnosed in 38 patients (53%) and could be differentiated in 21 patients (55%) with inflammatory NPSLE who were advised on immunosuppressive therapy, 12 patients (32%) with ischemic NPSLE who were advised on anticoagulant therapy, and 5 patients (13%) with undefined NPSLE who were advised symptomatic treatment only. Cognitive dysfunction and higher level of disease activity were associated with inflammatory NPSLE. Although presence of immunoglobulin G anticardiolipin antibodies and abnormalities on magnetic resonance imaging (MRI) were associated with ischemic NPSLE, abnormalities on MRI lacked specificity to distinguish phenotypes. A history of renal disease and use of corticosteroids were associated with secondary NPSLE. CONCLUSION We describe multidisciplinary consensus as a standard for diagnosing and defining phenotypes in NPSLE. These phenotypes show specific characteristics, which can be used to support diagnosis and guide therapeutic decisions. Clinical phenotyping and selection of patients becomes increasingly important when advances in experimental science lead to new targets for therapy in NPSLE.
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Affiliation(s)
- Elisabeth J M Zirkzee
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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29
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Goodman D, Morrissey S, Graham D, Bossingham D. The Application of Cognitive—Behaviour Therapy in Altering Illness Representations of Systemic Lupus Erythematosus. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.2005.22.3.156] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThere is evidence to suggest that illness representations are associated with chronic illness outcomes. Accordingly, several authors have recommended that interventions aimed at improving illness outcomes should include an illness-representations component. While a few researchers have attempted to develop such interventions for chronic illness and chronic pain, no such intervention has been developed for individuals with systemic lupus erythematosus (SLE), a chronic auto-immune illness which results in a variety of negative physical and psychological symptoms. This article reports on a pilot program that investigated the feasibility of a cognitive and behavioural—based intervention for treating SLE which included an illness-representations-change component. The effectiveness of the intervention compared to usual treatment for SLE was evaluated. Also investigated was whether changed illness representations had a beneficial effect on physical health and psychological wellbeing. It was found that the intervention did change participants' treatment control and emotional representations, and that perceived stress was reduced following the intervention. The importance of these findings is discussed, two rival hypotheses for the findings obtained are explored and directions for future research are suggested.
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30
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Cleanthous S, Tyagi M, Isenberg DA, Newman SP. What do we know about self-reported fatigue in systemic lupus erythematosus? Lupus 2012; 21:465-76. [DOI: 10.1177/0961203312436863] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fatigue is one of the most complex and ill understood symptoms of chronic illness often reported as the number one complaint by patients with systemic lupus erythematosus (SLE). This paper aims to provide a comprehensive review of the literature on fatigue in SLE. A pool of 55 relevant articles was retrieved via electronic searches of six databases including MEDLINE, EMBASE, CINAHL, AMED, PsychINFO and PubMed. Fatigue in the studies reviewed was assessed by a range of self-report instruments, the content of which is varied. The results displayed a consensus on the high prevalence of fatigue in SLE, which is significantly higher when compared with controls. The aetiology of fatigue appears to be multifactorial. Disease activity is not always significantly associated with fatigue, in comparison with other secondary features of SLE and psychological variables. The literature is limited by the cross-sectional nature of most of the studies, which does not permit for any firm conclusion regarding the direction of causal relationships to be made. The high prevalence of fatigue in SLE emphasizes the need for further detailed prospective research to inform the understanding of its aetiology, course and management.
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Affiliation(s)
- S Cleanthous
- Centre for Rheumatology Research, University College London, UK
| | - M Tyagi
- Health Services Research, City University, London, UK
| | - DA Isenberg
- Centre for Rheumatology Research, University College London, UK
| | - SP Newman
- Health Services Research, City University, London, UK
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31
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Beckerman NL, Sarracco M. Listening to lupus patients and families: fine tuning the assessment. SOCIAL WORK IN HEALTH CARE 2012; 51:597-612. [PMID: 22905976 DOI: 10.1080/00981389.2012.683679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Given the chronicity and uncertainty of lupus, patients and their family members will face physical, financial, social, and emotional challenges that can be overwhelming. This article records the experiences of three different families affected by lupus. Although these patients and families are very different, their perspectives identify common emotional challenges. Understanding these experiences from their perspectives can help facilitate an assessment that is highly attuned to the potential psychosocial impact of lupus on the patient and the family.
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Affiliation(s)
- N L Beckerman
- Wurzweiler School of Social Work, Yeshiva University, New York, New York 10033, USA.
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32
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Auerbach C, Beckerman NL. Locus of control and lupus: patients' beliefs, perspectives, and disease activity. SOCIAL WORK IN HEALTH CARE 2012; 51:613-626. [PMID: 22905977 DOI: 10.1080/00981389.2012.683685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patients with lupus often experience a high degree of psychological symptoms such as anxiety, depression, and mood disorders that can influence their beliefs and perceptions of their illness. The purpose of the study was to examine how a patient's self-reported psychosocial needs (depression and anxiety) and beliefs about how much control they have over their health (health locus of control) influences their perception of disease chronicity and acuity. The study findings were based on a survey of 378 patients self-diagnosed with lupus.
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Affiliation(s)
- Charles Auerbach
- Wurzweiler School of Social Work, Yeshiva University, New York, New York 10033, USA.
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33
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Beckerman NL, Auerbach C, Blanco I. Psychosocial dimensions of SLE: implications for the health care team. J Multidiscip Healthc 2011; 4:63-72. [PMID: 21594059 PMCID: PMC3093952 DOI: 10.2147/jmdh.s19303] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this exploratory study was threefold, ie, to clarify the unique psychosocial challenges facing those living with systemic lupus erythematosus (SLE), to distinguish which sociodemographic variables impact the lives of SLE patients, and generate knowledge regarding the way patients perceive SLE medication regimens. Methods: This was a cross-sectional exploratory study in 378 patients diagnosed with SLE and receiving services from the SLE Lupus Foundation in New York City. In addition to sociodemographic variables, the instrument used consisted of two scales, ie, the Systemic Lupus Erythematosus Needs Questionnaire (SLENQ) and the Multidimensional Health Locus of Control Scale, as well as questions regarding subjective perceptions of side effects from SLE medication. Results: The highest general cause of self-reported depressive and anxious feelings was changes in appearance due to SLE, and limitations in physical abilities due to SLE (primarily from muscle and joint pain). The higher the sense of control over SLE, the less likely respondents were to report feeling depressed and anxious. African-American and Hispanic SLE patients reported a higher level of unmet psychological needs due to SLE than did their other ethnic counterparts. Weight gain and hair loss were the most likely medication side effects and also the most likely causes of SLE-related depression and anxiety. Conclusion: Those living with SLE are at risk for feelings of depression and anxiety. African-American and Hispanic women are at higher risk for these emotional states. Comprehensive assessment across the disciplines should screen this group of patients for depression and anxiety, and be prepared to refer them to patient education and social work counseling as indicated.
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34
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Damage accrual, cumulative glucocorticoid dose and depression predict anxiety in patients with systemic lupus erythematosus. Clin Rheumatol 2011; 30:795-803. [PMID: 21221690 DOI: 10.1007/s10067-010-1651-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 10/15/2010] [Accepted: 12/02/2010] [Indexed: 01/23/2023]
Abstract
The burden of anxiety in patients with systemic lupus erythematosus (SLE) compared to those with other inflammatory rheumatological conditions is unclear. We aimed to compare the frequency and level of anxiety between patients with SLE, rheumatoid arthritis (RA), and gout and healthy individuals and explore independent predictors for anxiety in SLE patients. Consecutive patients with SLE, RA and gout and healthy individuals who were age and sex matched with the SLE group were evaluated for anxiety using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic and disease-related variables were compared between all groups. Predictors for anxiety were studied by regression models, with construction of a prediction model for the presence of anxiety in SLE patients by the receiver operating characteristic (ROC) analysis. Amongst 271 subjects studied, 60 had lupus, 50 had gout, 100 had RA and 61 were healthy controls. The frequency and level of anxiety were significantly higher in SLE patients than patients with gout, RA and healthy controls. SLE per se was independently associated with higher HADS-anxiety score after controlling for potential confounders. Logistic regression model showed that higher damage accrual, higher cumulative glucocorticoid dose, depression and fewer regular medications predicted anxiety in SLE patients, with an accuracy of 90% by the ROC analysis.
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35
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Abstract
This article reports on the findings of a qualitative study based on three focus-groups of individuals (N = 32) living with Systemic Lupus Erythematosus (SLE). The themes that emerged indicated a high vulnerability for self-reported feelings of depression. The four key challenges included: (1) feeling depressed that they are not who they used to be, (2) feelings of depression and anxiety related to coping with the uncertainty of the illness, (3) physical and emotional fatigue of living with a chronic illness, and (4) coping with the financial strain of the illness. These psychosocial challenges should be considered in screening, assessment, and treatment planning for social work service with this population.
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Affiliation(s)
- Nancy L Beckerman
- Wurweiler School of Social Work, Yeshiva University, New York, New York, USA.
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36
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Hawro T, Krupińska-Kun M, Rabe-Jabłońska J, Sysa-Jędrzejowska A, Robak E, Bogaczewicz J, Woźniacka A. Psychiatric disorders in patients with systemic lupus erythematosus: association of anxiety disorder with shorter disease duration. Rheumatol Int 2010; 31:1387-91. [PMID: 21136258 PMCID: PMC3178030 DOI: 10.1007/s00296-010-1689-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 11/14/2010] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Tomasz Hawro
- Department of Dermatology and Venereology, Medical University of Lodz, 5 Krzemieniecka Street, 94-017, Lodz, Poland.
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37
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Jarpa E, Babul M, Calderón J, González M, Martínez ME, Bravo-Zehnder M, Henríquez C, Jacobelli S, González A, Massardo L. Common mental disorders and psychological distress in systemic lupus erythematosus are not associated with disease activity. Lupus 2010; 20:58-66. [DOI: 10.1177/0961203310381773] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychiatric diagnosis in patients with systemic lupus erythematosus (SLE) is controversial: variations have been reported in frequency, diagnostic assays, associations with disease activity, autoantibodies, and contributing social factors. Eighty-three consecutive non-selected Chilean patients with SLE were evaluated for: (i) 26 common mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the Mini-International Neuropsychiatric Interview (MINI-plus); (ii) psychological suffering measured by Hospital Anxiety and Depression Scale (HADS); (iii) ACR 1999 neuropsychiatric (NP)SLE criteria; (iv) SLE disease activity (SLEDAI-2K); (v) cumulative damage (SLICC/ACR); and (vi) anti-ribosomal P antibodies by enzyme-linked immunoassay and immunoblot. Psychiatric diagnoses occurred in 44.6% of patients; the most frequent (21.7%) was major depressive episode (MDE). No association with lupus activity was observed in patients with a DSM-IV diagnosis or MDE or psychological suffering. ACR 1999 NPSLE criteria were present in 42.2% of patients, the majority corresponding to mood (28.9%) or anxiety disorders (15.6%). Suicidal risk was present in 9.6% of patients. Anti-ribosomal P antibodies (13.3%) were not associated with DSM-IV diagnosis. Severe psychiatric disorders in SLE are common and not associated with disease activity.
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Affiliation(s)
- E Jarpa
- Department of Clinical Immunology and Rheumatology
| | - M Babul
- Department of Psychiatry, School of Medicine
| | - J Calderón
- Department of Psychiatry, School of Medicine
| | - M González
- Department of Psychiatry, School of Medicine
| | - ME Martínez
- Department of Clinical Immunology and Rheumatology
| | - M Bravo-Zehnder
- Department of Clinical Immunology and Rheumatology
- Center of Cell Regulation and Pathology, Center of Aging and Regeneration, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile
- Millennium Institute for Fundamental and Applied Biology, Santiago, Chile
| | - C Henríquez
- Department of Clinical Immunology and Rheumatology
| | - S Jacobelli
- Department of Clinical Immunology and Rheumatology
| | - A González
- Department of Clinical Immunology and Rheumatology
- Center of Cell Regulation and Pathology, Center of Aging and Regeneration, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile
- Millennium Institute for Fundamental and Applied Biology, Santiago, Chile
| | - L Massardo
- Department of Clinical Immunology and Rheumatology
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38
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Kellner ES, Lee PY, Li Y, Switanek J, Zhuang H, Segal MS, Sobel ES, Satoh M, Reeves WH. Endogenous type-I interferon activity is not associated with depression or fatigue in systemic lupus erythematosus. J Neuroimmunol 2010; 223:13-9. [PMID: 20416954 PMCID: PMC3580233 DOI: 10.1016/j.jneuroim.2010.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/25/2010] [Accepted: 03/26/2010] [Indexed: 11/27/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) often suffer from depression and fatigue in addition to the physical manifestations of the autoimmune disease. Elevated production of type-I interferons (IFN-I) has been found in lupus patients and IFN-I can precipitate a variety of neuropsychiatric side effects. This study was conducted to evaluate the relationship between dysregulated IFN-I production and the presence of depression or fatigue in lupus patients. Through cross-sectional and longitudinal analysis we found no significant correlation between abnormal IFN-I levels (as measured by peripheral blood expression of IFN-I-stimulated genes) and neuropsychiatric manifestations. Elevation of endogenous serum IFN-I levels is unlikely to account for the depression and fatigue associated with SLE.
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Affiliation(s)
- Erinn S. Kellner
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Pui Y. Lee
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610
| | - Yi Li
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Juliana Switanek
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Haoyang Zhuang
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
| | - Mark S. Segal
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610
| | - Eric S. Sobel
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610
| | - Minoru Satoh
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610
| | - Westley H. Reeves
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610
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39
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Bachen EA, Chesney MA, Criswell LA. Prevalence of mood and anxiety disorders in women with systemic lupus erythematosus. ACTA ACUST UNITED AC 2009; 61:822-9. [PMID: 19479699 DOI: 10.1002/art.24519] [Citation(s) in RCA: 182] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the lifetime prevalence of mood and anxiety disorders in patients with systemic lupus erythematosus (SLE). Demographic and disease-related variables were examined for association with lifetime major depressive disorder (MDD) and the presence of any mood or anxiety disorder. METHODS Three hundred twenty-six white women with SLE completed the Composite International Diagnostic Interview and the Systemic Lupus Activity Questionnaire, a self-report measure of SLE disease activity. The binomial test was used to compare the prevalence of psychiatric diagnoses in patients with SLE with a population sample of white women. RESULTS Sixty-five percent of the participants received a lifetime mood or anxiety diagnosis. MDD (47%), specific phobia (24%), panic disorder (16%), obsessive-compulsive disorder (9%), and bipolar I disorder (6%) were more common among patients with SLE than among other white women (P = 0.00009 for specific phobia; for all other values P = 0.00001). Although most patients with histories of mood disorders reported their psychiatric symptoms to a medical provider, a substantial number of patients with anxiety disorders did not. Self-reported disease activity was associated with a lifetime history of MDD (P = 0.001) and presence of a mood or anxiety disorder (P = 0.001), after controlling for demographic and clinical characteristics. CONCLUSION Several mood and anxiety disorders were more common in women with SLE compared with the general population, and disease activity may contribute to this higher risk. Brief self-report questionnaires may help providers identify patients with these conditions, particularly when patients are reluctant to disclose their symptoms.
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Bauernfeind B, Aringer M, Prodinger B, Kirchberger I, Machold K, Smolen J, Stamm T. Identification of relevant concepts of functioning in daily life in people with systemic lupus erythematosus: A patient Delphi exercise. ACTA ACUST UNITED AC 2009; 61:21-8. [PMID: 19116959 DOI: 10.1002/art.24165] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify the most important and relevant concepts of daily functioning from the perspective of patients with systemic lupus erythematosus (SLE). METHODS We conducted a consensus-building, 3-round, electronic mail survey with SLE patients using the Delphi technique. The Delphi technique is a structured communication process with 4 key characteristics: anonymity, iteration with controlled feedback, statistical group response, and informed input. The concepts contained in the answers of the patients were extracted and linked to the International Classification of Functioning, Disability and Health (ICF). RESULTS Of the total 225 participants, 194 (86.2%) completed the questionnaires from all 3 Delphi rounds. In total, after the third Delphi round, 307 concepts were identified. Ninety concepts (55 in the domain body functions and structures, 16 in activities and participation, and 19 in environmental factors) were considered relevant by at least 50% of the participants in the third round and linked to the ICF. Twelve concepts were considered important by at least 75% of the participants. CONCLUSION The high number of concepts resulting from this large-scale patient Delphi approach underlines the great variety of SLE patients' problems in daily functioning. The results of this patient Delphi project supplement the findings of our focus-group study in establishing a comprehensive overview of the patient perspective in SLE.
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Tomietto P, Annese V, D'agostini S, Venturini P, La Torre G, De Vita S, Ferraccioli GF. General and specific factors associated with severity of cognitive impairment in systemic lupus erythematosus. ACTA ACUST UNITED AC 2007; 57:1461-72. [DOI: 10.1002/art.23098] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Nery FG, Borba EF, Hatch JP, Soares JC, Bonfá E, Neto FL. Major depressive disorder and disease activity in systemic lupus erythematosus. Compr Psychiatry 2007; 48:14-9. [PMID: 17145276 DOI: 10.1016/j.comppsych.2006.04.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 02/27/2006] [Accepted: 04/17/2006] [Indexed: 11/22/2022] Open
Abstract
The association between psychosocial factors and systemic lupus erythematosus (SLE) is still a matter of discussion. Mood disorders may represent neuropsychiatric manifestations of SLE disease activity or may be a consequence of the stress of having a chronic major disease. We examined the hypothesis that SLE disease activity is related to the presence and severity of major depression in patients with SLE. Seventy-one patients with SLE were evaluated for the presence and intensity of major depressive disorder, psychosocial stressors, functional disability, SLE disease activity, and cumulative damage. Patients with major depression presented a trend toward having greater severity of SLE disease activity compared with those without major depression (P = .056). Major depression was also associated with life events (P = .017) and hassles (P < .001). Reinforcing these findings, depression severity was directly correlated with disease activity (r = 0.26, P = .026) and with functional disability (r = 0.46, P < .001). Moreover, multiple linear regression analysis, controlling for stressful life events and previous major depressive episodes, demonstrated that SLE disease activity still was associated with depression severity (P = .014). In conclusion, these results support the hypothesis that SLE disease activity is a potential risk factor for the presence and severity of major depression in patients with SLE. Whether major depression in active SLE is a central nervous system manifestation of the disease that is mediated by an autoimmune mechanism deserves further research.
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Affiliation(s)
- Fabiano G Nery
- Department of Psychiatry, University of São Paulo Medical School, São Paulo 01060-970 Brazil.
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Monaghan SM, Sharpe L, Denton F, Levy J, Schrieber L, Sensky T. Relationship between appearance and psychological distress in rheumatic diseases. ACTA ACUST UNITED AC 2007; 57:303-9. [PMID: 17330287 DOI: 10.1002/art.22553] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the relationship between physical appearance concerns and psychological distress in patients with rheumatic diseases. METHODS A total of 60 patients with systemic lupus erythematosus (SLE), 44 with chronic rheumatoid arthritis (RA), and 53 with recent-onset RA were evaluated for levels of appearance concern and a range of illness-specific measures to determine how these demographic and clinical variables were related to the dependent variable psychological distress. RESULTS Using hierarchical multiple regression analyses, we found that both appearance concerns and levels of disability were predictive of depression in patients with RA. In the SLE sample, physical disability was predictive of depression when appearance concerns were not included in the analysis. However, disability did not predict depression when appearance concerns were entered into the analysis. This indicates that appearance concerns mediated the relationship between disability and depression in SLE. There was no association between appearance concerns and anxiety in either sample. CONCLUSION The results suggest that appearance concerns are strongly related to depression in patients with rheumatic diseases and should be routinely assessed.
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Valesini G, Alessandri C, Celestino D, Conti F. Anti-endothelial antibodies and neuropsychiatric systemic lupus erythematosus. Ann N Y Acad Sci 2006; 1069:118-28. [PMID: 16855139 DOI: 10.1196/annals.1351.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE) has been attributed to autoantibody-mediated neural dysfunction, vasculopathy, and coagulopathy. Several autoantibodies specificities have been reported in serum and cerebrospinal fluid of NPSLE patients (i.e., antineuronal, antiribosomal P proteins, antiglial fibrillary acidic proteins, antiphospholipid, and anti-endothelial antibodies). We have recently demonstrated an association between serum anti-endothelial antibodies and psychosis or depression in patients with SLE. Subsequently, by screening a cDNA library from human umbilical artery endothelial cells with serum from a SLE patient with psychosis, one positive strongly reactive clone was identified encoding the C-terminal region (C-ter) of Nedd5, an intracytoplasmatic protein of the septin family. Anti-Nedd5 antibodies have been found significantly associated with psychiatric manifestations in SLE patients, strengthening the view of a possible implication of autoantibodies in the development of psychiatric disorders.
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Affiliation(s)
- Guido Valesini
- Dipartimento di Clinica e Terapia Medica Applicata, Cattedra e Divisione di Reumatologia, Università La Sapienza, V.le del Policlinico 155, 00161 Rome, Italy.
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Roebuck-Spencer TM, Yarboro C, Nowak M, Takada K, Jacobs G, Lapteva L, Weickert T, Volpe B, Diamond B, Illei G, Bleiberg J. Use of computerized assessment to predict neuropsychological functioning and emotional distress in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2006; 55:434-41. [PMID: 16739211 DOI: 10.1002/art.21992] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive dysfunction and neuropsychiatric disturbance are common in systemic lupus erythematosus (SLE). This study addressed the ability of the Automated Neuropsychological Assessment Metrics (ANAM), a computerized cognitive testing battery consisting of cognitive subtests, a sleepiness rating scale, and a mood scale, to predict neuropsychological status in patients with SLE. METHODS Sixty individuals with SLE and no overt neuropsychiatric symptoms were administered ANAM to determine its validity as a screening measure of cognitive dysfunction and emotional distress in SLE. RESULTS Performance on ANAM was compared with results of a consecutively administered, 2-hour battery of traditional neuropsychological tests and the Beck Depression Inventory II (BDI-II). Individual ANAM cognitive test scores were significantly correlated with most neuropsychological tests, particularly those measuring psychomotor processing speed and executive functioning. Using logistic regression, ANAM cognitive subtests successfully predicted individuals with SLE who had probable versus no impairment after controlling for premorbid levels of cognitive ability. Sensitivity of group classification was 76.2% and specificity was 82.8%, with 80% correct classification overall. ANAM's ability to predict neuropsychological functioning remained even after controlling for subjective reports of depressed mood and current sleepiness. Further, the ANAM mood scale was significantly correlated with the BDI-II (r = 0.67, P < 0.001), indicating its potential future use as a screening tool for emotional distress. CONCLUSION ANAM shows promise as a time- and cost-efficient tool for screening and monitoring cognitive and emotional functioning in SLE, and can indicate when a more thorough neuropsychological investigation is warranted.
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Affiliation(s)
- Tresa M Roebuck-Spencer
- Center for Cognitive Neuroscience, National Rehabilitation Hospital, Washington, DC 20010, USA.
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Rinaldi S, Ghisi M, Iaccarino L, Zampieri S, Ghirardello A, Sarzi-Puttini P, Ronconi L, Perini G, Todesco S, Sanavio E, Doria A. Influence of coping skills on health-related quality of life in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2006; 55:427-33. [PMID: 16739209 DOI: 10.1002/art.21993] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify coping strategies used by patients with systemic lupus erythematosus (SLE), and to assess the influence of main clinical and coping variables on health-related quality of life (HRQOL). METHODS We administered the Coping Orientation to Problems Experienced and the Short Form 36 questionnaire to a group of 144 patients with SLE and a group of 129 healthy controls. At the time of the psychological assessment, all patients underwent a complete clinical and laboratory evaluation. RESULTS SLE patients had higher scores in acceptance (P < 0.001) and turning to religion (P = 0.05) and lower scores in planning (P = 0.001), suppression of competing activities (P = 0.010), restraint coping (P = 0.031), focusing on and venting of emotion (P = 0.009), and strategies focused on problem (P = 0.012) compared with controls. By means of linear regression analysis, HRQOL in SLE patients seemed to be influenced positively by restraint coping and positive reinterpretation and growth, and negatively by focusing on and venting of emotion, behavioral disengagement, and mental disengagement. When clinical variables were added to the multivariate analysis for coping strategies, more significant regression models that included joint pain were obtained. CONCLUSION In facing stressful situations, patients with SLE tend to use coping skills that are generally adopted for events perceived as nonmodifiable. Strategies that show a passive attitude and joint pain seem to impair these patients' HRQOL.
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Haupt M, Millen S, Jänner M, Falagan D, Fischer-Betz R, Schneider M. Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis 2005; 64:1618-23. [PMID: 15829575 PMCID: PMC1755287 DOI: 10.1136/ard.2004.029926] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate a novel specific psychological intervention aimed at improving coping in patients with systemic lupus erythematosus (SLE). METHODS 34 community living SLE patients were recruited for the study. Intervention was undertaken in groups of up to eight patients and in two blocks over six months each. Eight patients were enrolled as a waiting list group. The 18 group sessions focused on information about the disease and specific problems of SLE patients, combining psychoeducative and psychotherapeutic elements. Psychological and medical evaluations were conducted at baseline and after three, six, and 12 months, using validated instruments. RESULTS The 34 SLE patients (91% female, mean age 42 years) improved significantly over a six month period on most of the psychological measuring instruments applied, such as depression, anxiety, and overall mental burden. The waiting list group showed no significant changes. CONCLUSIONS Conceptualised psychoeducational support may produce a significant and sustained improvement in coping skills of SLE patients and hence in their quality of life.
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Affiliation(s)
- M Haupt
- Centre of Rheumatology, Heinrich-Heine-University Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
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Autoantibody profile in systemic lupus erythematosus with psychiatric manifestations: a role for anti-endothelial-cell antibodies. Arthritis Res Ther 2004; 6:R366-72. [PMID: 15225372 PMCID: PMC464907 DOI: 10.1186/ar1198] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Revised: 05/07/2004] [Accepted: 05/18/2004] [Indexed: 01/27/2023] Open
Abstract
This study was performed to determine the correlation between psychiatric manifestations and several autoantibodies that might participate in the pathogenesis of psychiatric disorders in the course of systemic lupus erythematosus (SLE). Fifty-one unselected outpatients with SLE were enrolled. Psychiatric evaluation was performed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The prevalence of antibodies against endothelial cells (AECA), cardiolipin, β2 glycoprotein I, Ro, Ro52, La, glial fibrillary acidic protein, ribosomal P protein, dsDNA, and nucleosomes was assessed by experimental and commercial enzyme-linked immunosorbent assays. According to the cutoff value, AECA were present in 11 of 17 (64.7%) SLE patients with psychosis and mood disorders and in 10 of 34 (29.4%) patients without psychiatric manifestations other than anxiety (P = 0.03). Moreover, the AECA binding index was significantly higher in the first group (P = 0.03). Conversely, no significant correlation was found between the presence of the other autoantibodies studied and psychiatric involvement. The results of this study suggest a relationship between AECA and psychosis and mood disorders in SLE, supporting the hypothesis of a biological origin of these disturbances.
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Seguí J, Ramos-Casals M, García-Carrasco M, de Flores T, Cervera R, Valdés M, Font J, Ingelmo M. Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: a longitudinal study of active and inactive stages of the disease. Lupus 2001; 9:584-8. [PMID: 11035432 DOI: 10.1191/096120300678828730] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective was to analyze psychiatric disorders and psychosocial dysfunction in patients with systemic lupus erythematosus (SLE), studied longitudinally during active and subsequent inactive stage of their disease. During a 6 month period of study, we selected 20 consecutive patients with SLE who presented with a SLE flare. All patients fulfilled the 1982 revised criteria of the American College of Rheumatology for the classification of SLE. When patients entered the study, we performed psychiatric (CIS, RDC, STAI, HD, BDI, GHQ and MMS) psychosocial (GAS and VAS-P) scores assessment. One year later, we repeated the psychiatric and psychosocial assessment when patients showed inactive disease. The 20 patients evaluated were women, with a mean age of 34 y (SE 14.4, range 20-57). According to CIS evaluation, we diagnosed 8 (40%) psychiatric cases in the acute episode of SLE. The RDC diagnosis showed generalized anxiety in 5 patients, panic disorders in 2 patients and generalized anxiety plus depressive symptoms in one patient. One year later, when patients did not show disease activity, we diagnosed 2 (10%) psychiatric cases (P<0.05). When SLE patients were clinically inactive, they showed lower levels of psychological distress (GHQ scale, 1.8 vs 5.6, P<0.001), with a lower grade of anxiety measured by both HA (3.2 vs 8.2, P<0.01) and STAI-S (7.95 vs 20.90, P<0.001) scales. We also found a lower score in pain perception (VAS-P) (2.80 vs 4.25, P<0. 01) and higher occupational activity (VAS-P) (83.9 vs 66.2, P<0.01) and general functioning (GAS) (93.75 vs 83.50, P<0.05) during the inactive stage. No significant differences were found when we compared cognitive impairment, grade of depression and physical disability between inactive and active stages. We conclude that in SLE patients, psychiatric and psychosocial disorders during acute episodes are usually mild and seem to be related to the psychological impact of disease activity on patients. This type of psychiatric pathology is similar to that which would be expected in other groups coping with a stressful event, indicating that our patients did not react in a way specifically determined by their systemic disease.
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Affiliation(s)
- J Seguí
- Department of Psychiatry and Clinical Psychology, Department of Medicine, IDIBAPS (Institut d' Investigacions, Biomédiques August Pi i Sunyer), Hospital Clinic, School of Medicine, University of Barcelona, Barcelona, Spain
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