Suicidal ideation is observed in patients with systemic lupus erythematosus (SLE). No study on this notable phenomenon in neuropsychiatric SLE (NPSLE) is available so far.
Methods
Participants were 53 consecutive outpatients with NPSLE (48 women; mean age 43.8 years) diagnosed according to the American College of Rheumatology nomenclature for SLE neuropsychiatric syndromes. A Neuropsychiatric Questionnaire (NP-Q) concerning 45 neurological, cognitive and psychiatric symptoms was used to assess the prevalence of self-perceived neuropsychiatric symptoms. The Modified Hospital Anxiety and Depression Scale (HADS-M) was used to assess the level of anxiety, depression and irritability. Formal neuropsychological examination was performed. Clinical data were collected by means of medical charts review and structured interview.
Results
Suicidal thoughts were present in 25% of patients with NPSLE, irrespective of sex, age, education, work status, disease duration and steroid treatment. Suicidal ideation was connected with elevated levels of depression, anxiety and irritability. In patients with suicidal ideation the prevalence of cognitive, psychiatric and neurological self-perceived problems was significantly higher.
Conclusions
Suicidal thoughts are common in patients with NPSLE. Neuropsychiatric manifestation per se, depression, anxiety and patients’ subjective complaints can be risk factors for suicidal ideation. Screening for suicidal thoughts is vital in routine care of SLE patients.
SutantoBSingh-GrewalDMcNeilHP. Experiences and perspectives of adults living with systemic lupus erythematosus: Thematic synthesis of qualitative studies. Arthritis Rheum2013; 11: 1752–1765.
2.
AsanoNMJde Sales CoriolanoMAsanoBJ. Psychiatric comorbidities in patients with systemic lupus erythematosus: a systematic review of the last 10 years. Rev Bras Rheumatol2013; 53: 431–437.
3.
PalaginiLMoscaMTaniC. Depression and systemic lupus erythematosus: a systematic review. Lupus2013; 22: 409–416.
4.
WolfeFMichaudKLiT. Chronic conditions and health problems in rheumatic diseases: comparisons with rheumatoid arthritis, noninflammatory rheumatic disorders, systemic lupus erythematosus, and fibromyalgia. J Rheumatol2010; 37: 305–315.
5.
Nowicka-SauerKCzuszyńskaZMajkowiczM. Neuropsychological assessment in mixed connective tissue disease: comparison with systemic lupus erythematosus. Lupus2012; 21: 927–933.
6.
HawroTKrupińska-KunMRabe-JabłońksaJ. Psychiatric disorders in patients with systemic lupus erythematosus: association of anxiety disorder with sorter disease duration. Rheumatol Int2011; 31: 1387–1391.
7.
StollTKauerYBuchiS. Prediction of depression in systemic lupus erythematosus patients using SF-36 Mental Health scores. Rheumatology2001; 40: 695–698.
8.
ManeetonBManeetonNLouthrenooW. Prevalence and prediction of depression in patients with systemic lupus erythematosus: a cross sectional study. Neuropsych Dis Treatment2013; 9: 799–804.
9.
ZakeriZShakibaMNarouieB. Prevalence of depressive symptoms in patients with systemic lupus erythematosus: Iranian experience. Rheumatol Int2012; 32: 1179–1187.
10.
DhosscheDMUlusaracASyedW. A retrospective study of general hospital patients who commit suicide shortly after being discharged from the hospital. Arch Int Med2001; 161: 991–994.
11.
EvansDLCharneyDSLewisL. Mood disorders in the medically ill: Scientific review and recommendations. Biol Psychiatry2005; 58: 175–189.
12.
MokCCChanKLCheungEFC. Suicidal ideation in patients with systemic lupus erythematosus: incidence and risk factors. Rheumatol2014; 53: 714–721.
13.
XieLFChenPLPanHF. Prevalence and correlates of suicidal ideation in SLE inpatients: Chinese experience. Rheumatol Int2012; 32: 2707–2714.
14.
IversonG.L. Screening for depression in systemic lupus erythematosus with the British Columbia Major Depression Inventory. Psychol Rep2002; 90: 1091–1096.
15.
IshikuraRMorimotoNTanakaK. Factors associated with anxiety, depression and suicide ideation in female outpatients with SLE in Japan. Clin Rheumatol2001; 20: 394–400.
16.
The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42: 599–608.
17.
Nowicka-SauerKCzuszyńskaZSmoleńskaŻ. Neuropsychological assessment in systemic lupus erythematosus patients: clinical usefulness of first-choice diagnostic tests in detecting cognitive impairment and preliminary diagnosis of neuropsychiatric lupus. Clin Exp Rheumatol2011; 29: 299–306.
18.
MatsukawaYSawadaSHayamaT. Suicide in patients with systemic lupus erythematosus: A clinical analysis of seven suicidal patients. Lupus1994; 3: 31–35.
19.
KarassaFBMaglianoMIsenbergDA. Suicide attempts in patients with systemic lupus erythematosus. Ann Rheum Dis2003; 62: 58–60.
20.
Tang KT, Hsieh CW, Hsieh TY, et al. Suicidal attempts in patients with systemic lupus erythematosus: A single-centre experience and literature review. Psychosomatics 2015; 56: 190–195. doi:10.1016/j.psym.2014.05.020.
21.
HochbergMC. Updating the American College of Rheumatology revised criteria for classification of systemic lupus erythematosus. Arthritis Rheum1997; 40: 1725–1725.
22.
DenburgSDStewartKHartLA. How “soft” are soft neurological signs? The relationship of subjective neuropsychiatric complaints to cognitive function in systemic lupus erythematosus. J Rheum2003; 30: 1006–1010.
23.
ZigmondASSnaithRP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand1983; 67: 361–370.
24.
MajkowiczMPraktyczna ocena efektywności opieki paliatywnej – wybrane techniki badawcze. In: de Walden-GałuszkoKMajkowiczM (eds). Ocena jakości opieki paliatywnej w teorii i praktyce, Gdańsk: Medical University of Gdańsk, 2000, pp. 21–42.
25.
JarpaEBabulMCalderonJ. Common mental disorders and psychological distress in systemic lupus erythematosus are not associated with disease activity. Lupus2011; 20: 58–66.
26.
BrittonPCDubersteinPRConnerKRHeiselMJHirschJKConwellY. Reasons for living, hopelessness, and suicide ideation among depressed adults 50 years or older. Am J Geriatr Psychiatry2008; 16: 736–741.
27.
BeckABrownGBerchickRStewartBSteerB. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry1990; 147: 190–195.
28.
SabbadiniMGManfrediAABozzoloE. Central nervous system involvement in systemic lupus erythematosus patients without overt neuropsychiatric manifestations. Lupus1999; 8: 11–19.
29.
MonasteroRBettiniPDel ZottoE. Prevalence and pattern of cognitive impairment in systyemic lupu erythematosus patients with and without overt neuropsychiatric manifestations. J Neurol Sci2001; 184: 33–39.
30.
FutrellNSchultzLRMillikanC. Central nervous system disease in patients with systemic lupus erythematosus. Neurology1992; 42: 1649–1657.
31.
MoralesMGCallejas RubioJLPeralta-RamírezMI. Impaired sexual function in women with systemic lupus erythematosus: a cross-sectional study. Lupus2013; 22: 987–995.
32.
VogelABhattacharyaSLarsenJL. Do subjective complaints correlate with cognitive impairment in systemic lupus erythematosus. Lupus2011; 20: 35–43.
33.
DenburgSDCarbotteRMDenburgJA. Psychological aspects of systemic lupus erythematosus: cognitive function, mood, and self-report. J Rheum1997; 24: 998–1003.
34.
HarrisonMIMorrisKAHortonR. Results of intervention for lupus patients with self-perceived cognitive difficulties. Neurology2005; 65: 1325–1327.
35.
KennaHAPoonAWde los AngelesCP. Psychiatric complications of treatment with corticosteroids: review with case report. Psychiatry Clin Neurosci2011; 65: 549–560.
36.
Lamore IIIRParmarSPatelKHilasO. Belimumab (Benlysta): a breakthrough therapy for systemic lupus erythematosus. P T2012; 37: 212–214. 217, 226.
37.
MacejováŽZárikováMOetterováM. Systemic lupus erythematosus – disease impact on patients. Cent Eur J Public Health2013; 21: 171–173.
38.
Al DhanhaniAMGignacMAMBeatonDE. Work factors are associated with workplace activity limitations in systemic lupus erythematosus. Rheumatology2014; 11: 2044–2052.
39.
van ExelEJacobsJKorswagenL-A. Depression in systemic lupus erythematosus, dependent on or independent of severity of disease. Lupus2013; 22: 1462–1469.
40.
RathbunAHaHaHH HarroldLReedG. A description of patient- and rheumatologist-reported depression symptoms in a American rheumatoid arthritis registry population. Clin Exp Rheumatol2014; 32: 523–532.
41.
MoscaMTaniChAringerM. EULAR recommendations for monitoring systemic lupus erythematosus patients in clinical practice and in observational studies. Ann Rheum Dis2010; 69: 1269–1274.
