Pediatrik Sle (Sistemik Lupus Eritematozus) Hastalarında Nöropsikiyatrik Tutulum Ve Psikometrik Durumun Değerlendirilmesi

Abstract

Aliyev E. Evaluation of neuropsychiatric involvement and psychometric status in pediatric Systemic Lupus Erythematosus (SLE). The thesis of Hacettepe University Faculty of Medicine, Child Health and Diseases. Ankara 2019. Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement. Neuropsychiatric involvement is seen in 20-27% of patients. Approximately 1/4 of diagnosed SLE patients develop neuropsychiatric SLE 2 years after diagnosis. The aim of the study was to determine the risky groups before the development of neurological, psychiatric and cognitive involvement and findings in SLE patients, as well as to evaluate sleep quality, anxiety and depression, relationship with peers and quality of life. Ninety eight children and adolescents were included in the study. 61 (62.2%) of the patients were female and 37 (37.8%) were male. Research group included 34 (34.7%) SLE patients, 31 (31.6%) JIA patients, and 33 (33.7%) healthy children and adolescents. The median age of the patients was 17 (12-21) years, and the median follow-up period was 4 years (0-13). The median SLEDAI of the patients was 2 points (0-19). As a result of psychiatric screening, separation anxiety disorder, generalized anxiety disorder and specific phobia were significantly more common in SLE patients than in healthy controls (respectively p=0,054, p=0,052, p=0,018). The Wechsler Intelligence Scale for Children-IV (WISC-IV) was applied to children and adolescents. In the test results, Perceptual Reasoning Converted Index (PRCI) and Perceptual Reasoning Standard Index (PRSI) were significantly lower in SLE patients compared to the healthy control group (respectively p=0,039, p=0,046). The ‘comprehension’ subtest, ‘symbol search’ subtest and Verbal Comprehension Standard Index (VCSI) were found significantly lower in SLE patients compared to the healthy control group (respectively p=0,046, p=0,017, p=0,036). This study is the first in the literature about this field. It is important to show early neuropsychiatric involvement with neurocognitive and neuropsychological tests in pediatric SLE patients. We also examined the incidence of psychiatric diagnosis in SLE patients. SLE patients should be evaluated with neurocognitive and neuropsychological tests regardless of disease activity, even though they do not have neurological signs and symptoms. Patients should be closely monitored for neuropsychiatric involvement and tests should be repeated if necessary.