Attributing psychopathology to systemic lupus erythematosus: some methodological considerations.

Accepted for publication 12 February 1991 The presence of psychiatric problems in patients with systemic lupus erythematosus (SLE) is frequently discussed. 1-14 These psychiatric disorders are commonly believed to be an integral part of the disease process, and, in fact, the 1982 revised criteria for diagnosis include psychosis.'5 The purpose of this review is to comment on the current beliefs about the relation between SLE and psychiatric manifestations. There is little doubt that patients with this debilitating disease have psychiatric symptoms. What is unclear from the available research, however, is the prevalence of such problems and the extent to which psychiatric difficulties can be directly attributed to the disease process. It is our intention to highlight the methodological inadequacies of selected studies and to encourage more sound investigations which may elucidate the critical variables relevant to such discussions. In a review of work published in the 1950s and 1960s, Gurland et al delineated the methodological problems of previous investigations of the psychiatric sequelae of SLE. 16 These authors noted that there was a dramatic increase in the reported incidence ofpsychiatric problems in the 1960s compared with the 1950s. There