The prevalence of psychiatric disorders is high among people with skin-restricted lupus (SRL), compared with the general population, yet most do not receive specialist mental health care or appropriate psychotropic treatment, researchers report.
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 SRL with 150 controls. Mean age of patients was 46 years and mean duration of disease was 10 years. They 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 (OR, 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 that of patients with SLE for both current (42.2 and 46.7%) and lifetime psychiatric disorders (72%), Dr. Jalenques and her associates noted.
Patients with SRL were at a particularly high risk of the following psychiatric disorders, compared with controls:
• Major depressive disorder: current (9% vs. 0%; P = .0007) and lifetime (44% vs. 26%; P = .01).
• Generalized anxiety disorder: current (23% vs. 3%; P less than .001) and lifetime (35% vs. 19%; P = .03).
• Panic disorder: current (7% vs. 0%; P = .004) and lifetime (21 % vs. 3 %; P less than .001).
• Suicide risk: current (24% vs. 7%; P = .003).
• Alcohol dependence: current (7% vs. 0%; P = .004).
• Lifetime agoraphobia: (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 Société Française de Dermatologie. The authors declared they have no conflicts of interest.