Psychiatric Disorders In Patients With Different Phenotypes Of Neuropsychiatric Systemic Lupus Erythematosus (Npsle)

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). Disclosure of Interests: None declared