Psychopathology in systemic lupus erythematosus. II. Relation to clinical observations, corticosteroid administration, and cerebrospinal fluid C4

Abstract

A consecutive series of 17 patients with SLE were studied psychiatrically in a prospective manner with semistructured interview techniques and mental status observation. Patients with and without psychiatric syndromes complicating their SLE were compared as to neurological observations, laboratory test findings, and corticosteroid administration. There was no correlation between psychopathology and either the severity of SLE (as judged by laboratory tests), the degree of renal impairment, or the associated nonpsychiatric central nervous system manifestations. Analysis of CSF C4 in four patients with psychiatric syndromes did not support the hypothesis that immunological mechanisms underlie the psychiatric manifestations of SLE. Eleven discrete episodes of significant psychopathology were noted in seven patients. This group did not differ significantly from those patients without psychiatric illness as regards the interval since corticosteroid therapy was initiated, the minimum and maximum dosages, whether it had ever been possible to terminate corticosteroid therapy, and the dosage of corticosteroids at the time of index admission. Detailed consideration of the events in corticosteroid therapy surrounding the episodes supports the contention that systemic lupus erythematosus itself is the cause of the large majority of the psychiatric manifestations. Therefore, in most individual patients, the dosage of corticosteroids should not be reduced because of the development of psychiatric symptomatology, especially in those patients who either develop psychiatric syndromes at a time other than immediately following an increase in steroid administration. © 1973.