Department of Rheumatology, 4501Leiden University Medical Center, the Netherlands.
Department of Psychiatry, Leiden University Medical Center, the Netherlands.
Lupus. 2021 Nov;30(13):2151-2156. doi: 10.1177/09612033211050347. Epub 2021 Oct 29.
Lupus fog is ill-defined. We aimed to study whether lupus fog is the result of dissociation by studying the prevalence of dissociation and dissociative fog in patients with SLE and neuropsychiatric manifestations of inflammatory and non-inflammatory origin.
Patients visiting the tertiary referral center for neuropsychiatric systemic lupus erythematosus (NPSLE) of the LUMC between 2007-2019 were included. Patients were classified as having neuropsychiatric symptoms of inflammatory or non-inflammatory origin. Dissociation was studied using the Dissociative Experience Scale-II (DES), in which the presence of 28 dissociative symptoms is rated (0-100% of the time), of which one question assesses the presence of a dissociative fog directly. Average scores are calculated and scores ≥ 25 are considered indicative of a dissociative disorder. A score of ≥ 30 on question 28 (dissociative fog) was considered indicative for the presence of a fog. Summary scores in the general adult population range from 4.4 to 14. Multiple regression analysis (MRA) was performed to study the association between inflammatory neuropsychiatric symptoms and dissociation. DES results are presented as median (range) and MRA as B and 95% confidence interval (CI).
DES questionnaires were available for 337 patients, of which 69 had an inflammatory NPSLE phenotype (20%). Mean age in the total study population was 43 ± 14 years and the majority was female (87%). The median dissociation score was 7.1 (0-75) and did not differ between patients with neuropsychiatric symptoms of inflammatory or non-inflammatory origin (B: -0.04 (95% CI: -0.17; 0.09)). 35 patients (10%) had a score indicative of a dissociative disorder. The most common type of dissociation was absorption/imagination. 43 patients (13%) reported a dissociative fog.
In most patients with SLE and neuropsychiatric symptoms, dissociative symptoms are within normal range, regardless of underlying etiology. Dissociative fog is present, but uncommon. Lupus fog is most likely not associated with dissociation.
狼疮性认知障碍的定义并不明确。我们旨在通过研究炎症性和非炎症性神经精神表现的系统性红斑狼疮（SLE）患者中解离和分裂性认知障碍的患病率，来研究狼疮性认知障碍是否是解离的结果。
纳入 2007 年至 2019 年间在莱顿大学医学中心（LUMC）神经精神病学系统性红斑狼疮（NPSLE）三级转诊中心就诊的患者。将患者分为具有炎症性或非炎症性神经精神症状的患者。使用分离体验量表-II（DES）研究解离，其中对 28 种分离症状的存在情况进行评分（0-100%的时间），其中一个问题直接评估分离性认知障碍的存在。计算平均得分，得分≥25 被认为提示存在分离性障碍。问题 28（分离性认知障碍）得分≥30 被认为存在认知障碍。一般成年人群的综合评分范围为 4.4 至 14。采用多元回归分析（MRA）研究炎症性神经精神症状与解离之间的关系。DES 结果以中位数（范围）表示，MRA 以 B 和 95%置信区间（CI）表示。
共有 337 名患者提供了 DES 问卷，其中 69 名患者有炎症性 NPSLE 表型（20%）。总研究人群的平均年龄为 43±14 岁，大多数为女性（87%）。分离评分中位数为 7.1（0-75），在有炎症或非炎症性神经精神症状的患者之间无差异（B：-0.04（95%CI：-0.17；0.09））。35 名患者（10%）的评分提示存在分离性障碍。最常见的分离类型是吸收/想象。43 名患者（13%）报告存在分离性认知障碍。
在大多数有 SLE 和神经精神症状的患者中，无论潜在病因如何，分离症状都在正常范围内。存在但不常见的分离性认知障碍。狼疮性认知障碍最有可能与解离无关。
