Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Feb 19, 2025; 15(2): 102247
Published online Feb 19, 2025. doi: 10.5498/wjp.v15.i2.102247
Attribution of psychiatric manifestations to systemic lupus erythematosus in Chinese patients: A retrospective study
Wen-Qi Geng, Xiao-Xi Yang, Jin-Ya Cao, Shang-Zhu Zhang, Yi-Nan Jiang, Jing Wei
Wen-Qi Geng, Jin-Ya Cao, Yi-Nan Jiang, Jing Wei, Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing 100730, China
Xiao-Xi Yang, Shang-Zhu Zhang, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
Xiao-Xi Yang, Shang-Zhu Zhang, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing 100730, China
Xiao-Xi Yang, Shang-Zhu Zhang, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing 100730, China
Xiao-Xi Yang, Shang-Zhu Zhang, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
Co-first authors: Wen-Qi Geng and Xiao-Xi Yang.
Co-corresponding authors: Jin-Ya Cao and Shang-Zhu Zhang.
Author contributions: Geng WQ conceptualized, did formal analysis, validated, and wrote the paper; Yang XX conceptualized, did formal analysis, validated, and wrote the paper; Cao JY conceptualized, investigated, performed project administration, and wrote the paper; Zhang SZ conceptualized, investigated, performed project administration, and wrote the paper; Jiang YN investigated and wrote the paper; Wei J conceptualized, supervised, performed project administration, acquired funding, and wrote the paper. Geng WQ and Yang XX contributed equally to this work as co-first authors. There are several reasons why there are two corresponding authors (one psychiatrist and one rheumatologist) in this article, which are as follows: The theme of this article, "neuropsychiatric systemic lupus erythematosus", involves interdisciplinary collaboration between psychiatry and rheumatology. All the patients in the study were jointly diagnosed and treated by the two specialties. During the writing process of this article, both co-corresponding authors provided professional guidance and put forward suggestions for original drafts and following revisions.
Supported by STI2030-Major Projects, No. 2021ZD0202001; National Natural Science Foundation of China, No. T2341003; and Capital Funds for Health Improvement and Research, No. CFH 2022-2-4012.
Institutional review board statement: The study was conducted in accordance with the Helsinki Declaration of the World Medical Association. The design and biostatistical analysis of the study was reviewed and approved by the Ethics Committee of Peking Union Medical College Hospital.
Informed consent statement: Informed consent was waived because of the observational/non-interventional design by the Ethics Committee of Peking Union Medical College Hospital.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: sharing statement: No additional data is available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Ya Cao, MD, Assistant Professor, Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. caojinya@pumch.cn
Received: October 12, 2024
Revised: December 7, 2024
Accepted: December 20, 2024
Published online: February 19, 2025
Processing time: 93 Days and 18.3 Hours
Abstract
BACKGROUND

Not all neuropsychiatric (NP) manifestations in patients with systemic lupus erythematosus (SLE) are secondary to lupus. The clarification of the cause of NP symptoms influences therapeutic strategies for SLE.

AIM

To understand the attribution of psychiatric manifestations in a cohort of Chinese patients with SLE.

METHODS

This retrospective single-center study analyzed 160 inpatient medical records. Clinical diagnosis, which is considered the gold standard, was used to divide the subjects into a psychiatric SLE (PSLE) group (G1) and a secondary psychiatric symptoms group (G2). Clinical features were compared between these two groups. The sensitivity and specificity of the Italian attribution model were explored.

RESULTS

A total of 171 psychiatric syndromes were recorded in 138 patients, including 87 cases of acute confusional state, 40 cases of cognitive dysfunction, 18 cases of psychosis, and 13 cases each of depressive disorder and mania or hypomania. A total of 141 (82.5%) syndromes were attributed to SLE. In contrast to G2 patients, G1 patients had higher SLE Disease Activity Index-2000 scores (21 vs 12, P = 0.001), a lower prevalence of anti-beta-2-glycoprotein 1 antibodies (8.6% vs 25.9%, P = 0.036), and a higher prevalence of anti-ribosomal ribonucleoprotein particle (rRNP) antibodies (39.0% vs 22.2%, P = 0.045). The Italian attribution model exhibited a sensitivity of 95.0% and a specificity of 70.0% when the threshold value was set at 7.

CONCLUSION

Patients with PSLE exhibited increased disease activity. There is a correlation between PSLE and anti-rRNP antibodies. The Italian model effectively assesses multiple psychiatric manifestations in Chinese SLE patients who present with NP symptoms.

Keywords: Systemic lupus erythematosus; Neuropsychiatric systemic lupus erythematosus; Attribution; Italian attribution model; Referral consultation

Core Tip: This retrospective study of 160 Chinese patients with systemic lupus erythematosus (SLE) focused on the attribution of psychiatric manifestations. SLE-related psychiatric syndromes tend to occur in patients with more severe disease activity and were associated with the presence of anti-ribosomal ribonucleoprotein particle antibodies. The Italian attribution model, which was initially developed and tested in European cohorts, also effectively assessed multiple psychiatric manifestations in Chinese SLE patients.