Abstract
Psychiatric symptoms in association with S.L.E. have been reviewed, and their incidence, classification, pathology and psycho-dynamics have been discussed.
The most useful classification is into, a) functional illness, usually depression, and b) toxic-organic illness. The incidence of the ‘functional disorders’ varies widely; it has been reported in up to 50 per cent of patients with S.L.E. In contrast, ‘toxic-organic illness’ shows remarkable consistency from study to study (four authors report an incidence of 29 per cent) in patients with S.L.E. The few pathological studies suggest the underlying etiology in the toxic-organic group may be, a) cerebrovasclar disease or, b) toxic states secondary to complications of S.L.E. such as uremia or, c) steroid treatment.
This classification is of practical significance in that the natural history and prognosis differ in these two groups. The ‘toxic-organic’ group shows a higher incidence of cardiovascular and renal-vascular disease and increased morbidity.
The dynamics of the ‘functional’ group have been discussed, particularly with reference to ego psychology.
Finally, a case is presented which is one of the few reported of the presentation of psychiatric symptoms leading to the diagnosis of S.L.E. and demonstrating a response to empirical forms of treatment.