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LETTER TO THE EDITOR
Year : 2011  |  Volume : 14  |  Issue : 2  |  Page : 141
 

Neuropsychiatric complications of SLE: Raising some issues of concern


1 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
2 Vidyasagar Institute of Mental Health and Neurosciences, New Delhi, India

Date of Web Publication7-Jul-2011

Correspondence Address:
Raman Deep Pattanayak
Senior Research Associate (CSIR-Pool), Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.82819

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How to cite this article:
Pattanayak RD, Pattanayak SK. Neuropsychiatric complications of SLE: Raising some issues of concern. Ann Indian Acad Neurol 2011;14:141

How to cite this URL:
Pattanayak RD, Pattanayak SK. Neuropsychiatric complications of SLE: Raising some issues of concern. Ann Indian Acad Neurol [serial online] 2011 [cited 2019 Jul 20];14:141. Available from: http://www.annalsofian.org/text.asp?2011/14/2/141/82819


Sir,

We read with great interest the original research article titled "Neuropsychiatric manifestations of systemic lupus erythematosus: Iranian experience" by Haghighi and Haza, [1] which presented the clinical data of SLE patients spanning over a decade. However, we would like to point a few omissions in the methodology and results section. The readers will benefit even more if some of these points are addressed.

First, the article reports the mean age at the time of onset of neuropsychiatric SLE (27 years), with an average delay of 3 years after the onset of SLE (printed as 4 years, possibly by mistake). However, the mention of Standard Deviation is conspicuously absent, which would have given valuable information regarding the extent of variation observed. The analysis would have been still more informative if the relation of age to neuropsychiatric manifestations was also noted in the study. Second, the study was a retrospective review of SLE patients who were admitted between 1995 and 2005. There is a good possibility that a patient may have had multiple admissions over years. Was there a mechanism at place to ensure that the clinical records did not duplicate for a patient who was admitted, say, once in 1995 and for the second time in 2005? Also, since multiple hospitals were place of study, a patient may have gotten admitted at different times to different hospitals, resulting in duplication in study results. Third, it would be useful to know the precise "number" of hospitals affiliated to the university from where data were gathered, and also, some background about the similarity/differences in geographic catchment areas. Since the particulars of the country of study are relatively unknown to readers outside Iran, this background will give us an idea about homogeneity of data gathered.

Lastly, we wish to highlight a point of clinical relevance and practical concern. While the neurological complications are likely to be detected faster (catastrophic in nature, crisis situation), psychiatric complications, e.g., depression and anxiety, continue to remain underdiagnosed, [2] especially in the presence of a medical illness. They may be the cause of lingering disability even after recovery from neurological complications. A routine psychiatric referral in all cases, while being an ideal solution, is neither practical nor feasible. It is, thus, prudent that all the patients of neuropsychiatric SLE should be screened for psychiatric comorbidity using simple, brief questionnaires, e.g., General Health Questionnaire has been successfully used in SLE patients. [3] Taking these easy steps in routine practice will ensure full justice to the term "neuropsychiatric" by unraveling the full spectrum of complications in SLE patients.

 
   References Top

1.Haghighi AB, Haza SG. Neuropsychiatric manifestations of systemic lupus erythematosus: Iranian experience. Ann Indian Acad Neurol 2010;13:108-11.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Perez-Stable EJ, Miranda J, Munoz JR, Ying YW. Depression in medical outpatients: Underrecognition and misdiagnosis. Arch Intern Med 1990;150:1083-8.  Back to cited text no. 2
    
3.Omdal R, Husby G, Mellgren SI. Mental Health Status in Systemic Lupus ErythematosusScand J Rheumatol 1995;24:142-5.  Back to cited text no. 3
    



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