rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2008-531rsp-669Research ArticleСтатьиArticlesВарианты психических нарушений у больных системной красной волчанкойVariants of psychiatric disorders in patients with systemic lupus erythematosusЛисицынаТ. А.LisitsynaT A-VeltishevD YVeltishevD Y-SeravinaO FSeravinaO F-KovalevskayaO BKovalevskayaO B-MarchenkoA SMarchenkoA S-НасоновЕвгений ЛьвовичNasonovE. L.-200815082008464№4 (2008)2126Copyright © Лисицына Т.А., Veltishev D.Y., Seravina O.F., Kovalevskaya O.B., Marchenko A.S., Насонов Е.Л., 20082008Лисицына Т.А., Veltishev D.Y., Seravina O.F., Kovalevskaya O.B., Marchenko A.S., Насонов Е.Л.Lisitsyna T.A., Veltishev D.Y., Seravina O.F., Kovalevskaya O.B., Marchenko A.S., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/669

Резюме Цель. Анализ распространенности и структуры психических нарушений среди пациентов с системной красной волчанкой (СКВ), наблюдающихся в ГУ Институт ревматологии РАМН. Материал и методы. Включены 115 пациентов достоверной СКВ в возрасте 34 (2445) года (медиана и интерквартильный размах), продолжительность болезни — 8 (4-17) лет. Активность СКВ оценивали с помощью шкалы SLEDA1. Психические нарушения диагностировались психиатром в соответствии с МКБ-10 с использованием ряда психиатрических и психологических шкал. Результаты. Психические нарушения были выявлены у 76 из 115 (66 %) пациентов. Преобладали расстройства тревожно-депрессивного спектра (83 %): депрессивные эпизоды (40 %), расстройства адаптации (24 %), генерализованные тревожные расстройства (10 %) и дистимия (9 %). Выраженные когнитивные нарушения выявлены у 7 % пациентов. Не выявлено различий по возрасту, полу, длительности и степени активности СКВ, длительности и кумулятивной дозе ГК и цитотоксиков у пациентов с психическими нарушениями и без таковых. Заключение. Психические нарушения часты среди больных СКВ (66 %). В их спектре основное место занимают тревожно-депрессивные расстройства (83 %). Характер взаимосвязей между СКВ и психическими нарушениями требует дальнейшего изучения.

Objective. To analyze prevalence and structure of psychiatric disorders in pts with systemic lupus erythematosus (SLE) examining in the Institute of rheumatology of RAMS. Material and methods. 115 pts with SLE with median age 34 [24; 45] years and median disease duration 8 [4; 17] years were included. SLE activity was assessed with SLEDAI. Psychiatric disorders were diagnosed by a psychiatrist according to ICD-10 using some psychiatric and psychological scales. Results. Psychiatric disorders were revealed in 76 from 115 (66%) pts. Anxiety-depressive spectrum disorders prevailed (83%): depressive episode (40%), adjustment disorders (24%), generalized anxiety disorder (10%), dysthymia (9%). Severe cognitive dysfunction was revealed in 7% of pts. Pts with and without psychiatric disorders did not significantly differ in age, sex, duration and activity of the disease, duration of treatment and cumulative dose of prednisolone and cytotoxic drugs. Conclusion. Psychiatric disorders are frequent in pts with SLE (66%). Anxiety-depressive disorders prevail among them (83%). Relationship between SLE and psychiatric disorders requires further examination.

системная красная волчанкапсихические нарушенияsystemic lupus erythematosuspsychiatric disordersReferences<div><p>Purandare К. N., WagleA. С., ParkerS. R. Psychiatric morbidity in patients with systemic lupus erythematosus. Q. J. Med., 1999, 92, 283-286.</p><p>Hermosillo-Romo D., Brey R. L. Diagnosis and management of patients with neuropsychiatric systemic lupus erythematosus (NPSLE). Best Pract. &amp; Res. Clin. Rheumatol., 2002, 16 (2), 229-244.</p><p>Levenson J. L. Psychiatric issues in rheumatology. Primary’ Psychiatry, 2006, 13 (11), 23-27.</p><p>Nived 0., Stutfelt G., Liang М. H., De Pablo P. The ACR nomenclature for CNS lupus revisited. Lupus, 2003, 12, 872-876.</p><p>Hochberg М. C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematotosus. Arthr. Rheum., 1997, 40, 1725.</p><p>Bombardier C. Glad man D. D., Urowitz М. B. et al. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Ailhr. Rheum., 1992, 35(6), 630-640.</p><p>Gladman D., Ginzler E., Goldsmith С et al. Systemic Lupus International Collaborating Clinics: development of a damage index in systemic lupus erythematotosus. J. Rheumatology, 1992, 19, 1820-1821.</p><p>Denton F., Sharpe L., Schrieber L. Cognitive bias in systemic lupus erythematosus. Eur. J. Pain, 2005, 9, I, 5-14</p><p>Brey R. L., Holliday S. L., Saklad A. R. et al. Neuropsychiatric syndromes in lupus. Neurology, 2002, 58, 1214-1220.</p><p>McLaurin E. V, Holliday S. L., Williams P., Brey R. L. Predictors of cognitive dysfunction in patients with systemic lupus erythematosus. Neurology, 2005, 64 (2), 297-303.</p><p>Whitelaw D. A., Spangenberg J. J., Rickman R. et al. Association between the antiphospholipid antibody syndrome and neuropsychological impairment in SLE. Lupus, 1999, 8, 444-448.</p><p>MikdashiHandwerger B. Predictors of neumpsy- chiatric damage in systemic lupus erythematosus: data from the Maty land lupus cohort. Rheumatol., 2004. 43, 1555-1560.</p><p>Gerli R., Caponi L., Tincani A. et al. Clinical and serological associations of ribosomal P autoantibodies in systemic lupus erythematotosus: PROSPECTIVE evaluation in a large cohort of Italian patients. Rheumatol., 2002, 41, 1357-1366.</p><p>Segui J., Ramos-Casals М., Garcia-Carrasco M. et al. Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: a longitudinal study of active and inactive stages of the disease. Lupus, 2000, 9(8), 584-588.</p><p>Dentino A. N. PieperC. F., Rao К. М. K. et al. Association of interleukin-6 and other biologic variables with depression in older people living in the community. J. Am. Geriatric Soc., 1999, 47, 6-11.</p><p>LutgendorfS. K., Garand L., Buckwalter К. C. et al. Life stress, mood disturbance and elevated interleukin-6 in healthy older women. J. Gerontol. Biol. Sci., 1999, 54. M434-M439.</p><p>Pasic J., Levy W. C., Sullivan M. D. Cytokines in depression and heart failure. Psvchosom. Med., 2003, 65, 181-193.</p><p>Pollmacher Т., Haack М., Schuld A. et al. Low levels of circulating inflammatory cytokines — do they affect human brain functions? Brain Behav. Immun., 2002,16 (5), 525-532.</p><p>LicinioJ., WongM.L. The role of inflammatory mediators in the biology of major depression: central nervous system cytokines modulate the biological substrate of depressive symptoms, regulate stress-responsive systems and contribute to neurotoxicity and neuroprolection. Mol. Psychiatry, 1999, 4(4), 317-327.</p><p>Smith R. S. The macrophage theory of depression (published erratum appears in Med Hypotheses, 1991, 36, 178). Med. Hypotheses, 1991, 35, 298-306.</p><p>Feinglass E. J., Arnett F. C., Dorsch C. A. et al. Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum, and relationship to other features of the disease. Medicine (Baltimore), 1976, 55(4), 323 - 329.</p><p>Nery F. G., Borba E. F., Hatch J. P. etal. Major depressive disorder and disease activity in systemic lupus erythematosus. Compr. Psychiatry, 2007, 48 (1), 14-19.</p><p>Jump R., Robinson М., Armstrong A. etal. Fatigue in systemic lupus erythematosus: contributions of disease activity, pain, depression and perceived social support. J. Rheumatol., 2005, 32(9), 1699-1705.</p><p>Shortall Isenberg D., Newman S. P. Factors associated with mood and mood disorders in SLE. Lupus, 1995, 4, 272-279.</p><p>Lim L., Ron M. A., Ormerod I. E. et al. Psychiatric and neurological manifestatons in systemic lupus erythematosus. Q. J. М., 1988, 66(249), 27-38.</p><p>Onda K., Kato S. A clinical study of psychopathology in systemic lupus erythematosus. Seishin Shinkeigku Zasshi, 2000, 102(7), 616-639.</p><p>Wekking E. М., Vingerhoets A. J., Dam A. P., et al. Daily stressors and systemic lupus erythematosus: A longitudinal analysis — first findings. Psychother. Psychosom., 1991, 55, 108-113.</p><p>Peralta-Ramirez М. I. Alonso J. J., Godoy J. F. et al. The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus. Psychosom. Med., 2004, 66, 788-794.</p><p>Doha A., Rinaldi S., Ermani M. et al. Health-related quality of life in Italian patients with systemic lupus erythematosus. II. Role of clinical, immunological and psychological determinants. Rheumatol., 2004, 43, 12, 1580-1586.</p></div><br /><div><p>Purandare К. N., WagleA. С., ParkerS. R. Psychiatric morbidity in patients with systemic lupus erythematosus. Q. J. Med., 1999, 92, 283-286.</p><p>Hermosillo-Romo D., Brey R. L. Diagnosis and management of patients with neuropsychiatric systemic lupus erythematosus (NPSLE). Best Pract. &amp; Res. Clin. Rheumatol., 2002, 16 (2), 229-244.</p><p>Levenson J. L. Psychiatric issues in rheumatology. Primary’ Psychiatry, 2006, 13 (11), 23-27.</p><p>Nived 0., Stutfelt G., Liang М. H., De Pablo P. The ACR nomenclature for CNS lupus revisited. Lupus, 2003, 12, 872-876.</p><p>Hochberg М. C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematotosus. Arthr. Rheum., 1997, 40, 1725.</p><p>Bombardier C. Glad man D. D., Urowitz М. B. et al. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Ailhr. Rheum., 1992, 35(6), 630-640.</p><p>Gladman D., Ginzler E., Goldsmith С et al. Systemic Lupus International Collaborating Clinics: development of a damage index in systemic lupus erythematotosus. J. Rheumatology, 1992, 19, 1820-1821.</p><p>Denton F., Sharpe L., Schrieber L. Cognitive bias in systemic lupus erythematosus. Eur. J. Pain, 2005, 9, I, 5-14</p><p>Brey R. L., Holliday S. L., Saklad A. R. et al. Neuropsychiatric syndromes in lupus. Neurology, 2002, 58, 1214-1220.</p><p>McLaurin E. V, Holliday S. L., Williams P., Brey R. L. Predictors of cognitive dysfunction in patients with systemic lupus erythematosus. Neurology, 2005, 64 (2), 297-303.</p><p>Whitelaw D. A., Spangenberg J. J., Rickman R. et al. Association between the antiphospholipid antibody syndrome and neuropsychological impairment in SLE. Lupus, 1999, 8, 444-448.</p><p>MikdashiHandwerger B. Predictors of neumpsy- chiatric damage in systemic lupus erythematosus: data from the Maty land lupus cohort. Rheumatol., 2004. 43, 1555-1560.</p><p>Gerli R., Caponi L., Tincani A. et al. Clinical and serological associations of ribosomal P autoantibodies in systemic lupus erythematotosus: PROSPECTIVE evaluation in a large cohort of Italian patients. Rheumatol., 2002, 41, 1357-1366.</p><p>Segui J., Ramos-Casals М., Garcia-Carrasco M. et al. Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: a longitudinal study of active and inactive stages of the disease. Lupus, 2000, 9(8), 584-588.</p><p>Dentino A. N. PieperC. F., Rao К. М. K. et al. Association of interleukin-6 and other biologic variables with depression in older people living in the community. J. Am. Geriatric Soc., 1999, 47, 6-11.</p><p>LutgendorfS. K., Garand L., Buckwalter К. C. et al. Life stress, mood disturbance and elevated interleukin-6 in healthy older women. J. Gerontol. Biol. Sci., 1999, 54. M434-M439.</p><p>Pasic J., Levy W. C., Sullivan M. D. Cytokines in depression and heart failure. Psvchosom. Med., 2003, 65, 181-193.</p><p>Pollmacher Т., Haack М., Schuld A. et al. Low levels of circulating inflammatory cytokines — do they affect human brain functions? Brain Behav. Immun., 2002,16 (5), 525-532.</p><p>LicinioJ., WongM.L. The role of inflammatory mediators in the biology of major depression: central nervous system cytokines modulate the biological substrate of depressive symptoms, regulate stress-responsive systems and contribute to neurotoxicity and neuroprolection. Mol. Psychiatry, 1999, 4(4), 317-327.</p><p>Smith R. S. The macrophage theory of depression (published erratum appears in Med Hypotheses, 1991, 36, 178). Med. Hypotheses, 1991, 35, 298-306.</p><p>Feinglass E. J., Arnett F. C., Dorsch C. A. et al. Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum, and relationship to other features of the disease. Medicine (Baltimore), 1976, 55(4), 323 - 329.</p><p>Nery F. G., Borba E. F., Hatch J. P. etal. Major depressive disorder and disease activity in systemic lupus erythematosus. Compr. Psychiatry, 2007, 48 (1), 14-19.</p><p>Jump R., Robinson М., Armstrong A. etal. Fatigue in systemic lupus erythematosus: contributions of disease activity, pain, depression and perceived social support. J. Rheumatol., 2005, 32(9), 1699-1705.</p><p>Shortall Isenberg D., Newman S. P. Factors associated with mood and mood disorders in SLE. Lupus, 1995, 4, 272-279.</p><p>Lim L., Ron M. A., Ormerod I. E. et al. Psychiatric and neurological manifestatons in systemic lupus erythematosus. Q. J. М., 1988, 66(249), 27-38.</p><p>Onda K., Kato S. A clinical study of psychopathology in systemic lupus erythematosus. Seishin Shinkeigku Zasshi, 2000, 102(7), 616-639.</p><p>Wekking E. М., Vingerhoets A. J., Dam A. P., et al. Daily stressors and systemic lupus erythematosus: A longitudinal analysis — first findings. Psychother. Psychosom., 1991, 55, 108-113.</p><p>Peralta-Ramirez М. I. Alonso J. J., Godoy J. F. et al. The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus. Psychosom. Med., 2004, 66, 788-794.</p><p>Doha A., Rinaldi S., Ermani M. et al. Health-related quality of life in Italian patients with systemic lupus erythematosus. II. Role of clinical, immunological and psychological determinants. Rheumatol., 2004, 43, 12, 1580-1586.</p></div><br />

The authors declare that there are no conflicts of interest present.