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Axis I psychiatric disorders may be high in skin-restricted lupus.

The prevalence of psychiatric disorders is high among people with skin-restricted lupus, compared with the general population, yet most do not receive specialist mental health care or appropriate psychotropic treatment, researchers reported.

Investigators led by psychiatrist Isabelle Jalenques of the Clermont-Ferrand (France) University Hospital noted that psychiatric disorders had been extensively reported in patients with systemic lupus erythematosus (SLE), but no data existed on patients with skin-restricted disease (Br J Dermatol. 2016. doi: 10.1111/bjd.14392).

A previous exploratory study by the research group had shown that 60% of the 20 patients with subacute cutaneous lupus erythematosus and discoid lupus erythematosus studied had at least one psychiatric disorder. However, the study was limited by its size and lack of a control group.

In the current multicenter study, the researchers compared 75 outpatients with skin-restricted lupus (SRL) with 150 controls. The mean age of patients was 46 years, and the mean duration of disease was 10 years. The investigators discovered that almost 49% of the patients with SRL fulfilled criteria for at least one current Axis I psychiatric disorder, compared with 13% of controls (odds ratio, 5.0; P less than .001). Furthermore, 73% of patients fulfilled criteria for at least one lifetime Axis I psychiatric disorder, compared with 43% of controls (OR, 4.4; P less than .001).

The rates were close to those of patients with SLE for both current (42.2 and 46.7%) and lifetime psychiatric disorders (72%), the investigators noted.

Patients with SRL were at a particularly high risk of the following psychiatric disorders, compared with controls:

* Major depressive disorder. The current risk was 9% vs. 0% (P = .0007) and the lifetime risk was 44% vs. 26% (P = .01).

* Generalized anxiety disorder. The current risk was 23% vs. 3% (P less than .001) and the lifetime risk was 35% vs. 19% (P = .03).

* Panic disorder. Current was 7% vs. 0% (P = .004) and lifetime was 21 % vs. 3 % (P less than .001).

* Suicide risk. Current was 24% vs. 7% (P = .003).

* Alcohol dependence. Current was 7% vs. 0% (P = .004).

* Lifetime agoraphobia. Current risk was 20% vs. 9% (P = .01).

Many patients were not receiving specialist mental health care or appropriate psychotropic treatment despite psychiatric disorders being a well-known cause of psychological distress, excess mortality, impaired global functioning, and poor compliance with medical treatment, Dr. Jalenques and her associates noted.

"Clinicians should be aware of the high prevalence of these disorders among SRL patients and not hesitate to refer such patients for psychiatric evaluation," they concluded.

This study was supported by a grant from the French Ministry of Health and from Societe Francaise de Dermatologie. The authors said they have no conflicts of interest.



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Author:Garrett, Nicola
Publication:Clinical Psychiatry News
Date:May 1, 2016
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