POS0708 PSYCHIATRIC DISORDERS IN PATIENTS WITH DIFFERENT PHENOTYPES OF NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS (NPSLE)
Authors: R. Monahan, A. Blonk, H. Middelkoop, M. Kloppenburg, T. Huizinga, N. Van der Wee, G. M. Steup-Beekman
Journal: Annals of the Rheumatic Diseases (2021)

Background: Patients with systemic lupus erythematosus (SLE) may present with psychiatric disorders. These are important to recognize, as they influence quality of life and treatment outcomes and strategies. Objectives: We aimed to study the frequency of psychiatric morbidity as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in patients with SLE and neuropsychiatric symptoms of different origins. Methods: In the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center, patients undergo a standardized multidisciplinary assessment by a neurologist, neuropsychologist, vascular internal medicine, rheumatologist, physician assistant and psychiatrist. After two weeks, a multidisciplinary consensus meeting takes place, in which the symptoms are attributed to SLE requiring treatment (major NPSLE) or to minor involvement of SLE or other causes (minor/non-NPSLE). Consecutive patients visiting the NPSLE clinic between 2007-2019 were included. Data of psychiatric evaluation and current medication use were extracted from medical records. The presence of cognitive dysfunction was established during formal neuropsychological assessment. Results: 371 consecutive SLE patients were included, of which 110 patients had major NPSLE (30%). Mean age was 44 ± 14 years and 87% was female. The most frequently diagnosed psychiatric disorders in the total group were cognitive dysfunction (42%) and depression (23%), as shown in Table 1. Furthermore, anxiety was present in 5% and psychotic disorders in 4% of patients. In patients with minor/non-NPSLE, especially depression (26% vs 15%) and anxiety (6% vs 2%) were more common than in major NPSLE. Cognitive dysfunction (54% vs 36%) and psychotic disorders (6% vs 4%) were more common in patients with major NPSLE than minor/non-NPSLE. Psychiatric medication was used in 33% of patients, of which antidepressants and benzodiazepines the most frequently (both: 18% in both subgroups). Antipsychotics were more often used in patients with NPSLE (10% vs 7%) and benzodiazepines more often in minor/non-NPSLE (20% vs 14%). In addition, 17 patients (5%) had a history of suicide attempt, which was more common in patients with minor/non-NPSLE than major NPSLE (6% vs 2%). Conclusion: Psychiatric morbidity, especially cognitive dysfunction and depression, are common in patients with lupus and differ between underlying cause of the neuropsychiatric symptoms (minor/non-NPSLE vs major NPSLE). Table 1. Presence of psychiatric diagnoses in patients with SLE and neuropsychiatric symptoms All patients (n = 371 ) Minor/non-NPSLE (n = 261 ) Major NPSLE (n = 110 ) DSM V diagnosis, n (% ) Neurodevelopmental disorder 5 (1) 2 (1) 3 (2) Schizophrenia Spectrum and Other Psychotic Disorders 16 (4) 10 (4) 6 (6) Bipolar and related disorders 7 (2) 5 (2) 2 (2) Depressive disorders 84 (23) 68 (26) 16 (15) Anxiety disorders 17 (5) 15 (6) 2 (2) Obsessive-Compulsive and Related Disorders 1 (0) 1 (0) 0 (0) Trauma- and Stressor-Related Disorders 16 (4) 12 (5) 4 (3) Dissociative Disorders 2 (1) 2 (1) 0 (0) Somatic Symptom and Related Disorders 1 (0) 1 (0) 0 (0) Feeding and Eating Disorders 0 (0) 1 (0) 0 (0) Elimination Disorders 0 (0) 0 (0) 0 (0) Sleep-wake disorders 2 (1) 2 (1) 0 (0) Sexual dysfunctions 0 (0) 0 (0) 0 (0) Gender dysphoria 0 (0) 0 (0) 0 (0) Disruptive, Impulse-Control, and Conduct Disorder 0 (0) 0 (0) 0 (0) Substance-related and addictive disorders 9 (2) 8 (3) 1 (1) Cognitive dysfunction 154 (42) 95 (36) 59 (54) Personality disorders 10 (3) 9 (3) 1 (1) Paraphilic disorders 0 (0) 0 (0) 0 (0) Other mental disorders 12 (3) 7 (3) 5 (5) Medication-Induced Movement Disorders and Other Adverse Effects of Medication 0 (0) 0 (0) 0 (0) Unknown 3 (1) 3 (1) 0 (0) NPSLE = neuropsychiatric systemic lupus erythematosus. Disclosure of Interests: None declared