Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T17:38:49.585Z Has data issue: false hasContentIssue false
  • English
  • Français

The association between systemic lupus erythematosus and bipolar disorder – a big data analysis

Published online by Cambridge University Press:  23 March 2020

S. Tiosano ,
Z. Nir ,
O. Gendelman ,
D. Comaneshter ,
H. Amital ,
A.D. Cohen  and
D. Amital
S. Tiosano
Affiliation:
Department of Medicine ‘B’, Sheba Medical Center, 52621Tel-Hashomer, Israel Sackler Faculty of Medicine, Tel-Aviv University, 6997801Tel-Aviv, Israel
Z. Nir
Affiliation:
Ness-Ziona/Beer-Yaakov Mental Health Center, 70300Beer-Yaakov, Israel
O. Gendelman
Affiliation:
Department of Medicine ‘B’, Sheba Medical Center, 52621Tel-Hashomer, Israel Sackler Faculty of Medicine, Tel-Aviv University, 6997801Tel-Aviv, Israel
D. Comaneshter
Affiliation:
Chief Physician's Office, Clalit Health Services, 6209804Tel-Aviv, Israel
H. Amital*
Affiliation:
Department of Medicine ‘B’, Sheba Medical Center, 52621Tel-Hashomer, Israel Sackler Faculty of Medicine, Tel-Aviv University, 6997801Tel-Aviv, Israel
A.D. Cohen
Affiliation:
Chief Physician's Office, Clalit Health Services, 6209804Tel-Aviv, Israel Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, 84105 Beer Sheva, Israel
D. Amital
Affiliation:
Ness-Ziona/Beer-Yaakov Mental Health Center, 70300Beer-Yaakov, Israel
*
*Corresponding author. Department of Medicine ’B’, Sheba Medical Center, 52621 Tel.:-Hashomer, Israel. Tel.: +972 3 530 2652; fax: +972 3 535 4796. E-mail address:howard.amital@sheba.health.gov.il
Get access

Abstract

Background:

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that has a wide variety of physical manifestations, including neuropsychiatric features. Bipolar disorder (BD) is a chronic, episodic illness, that may present as depression or as mania. The objective of this study was to investigate the association between SLE and BD using big data analysis methods.

Methods:

Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of BD in a cross-sectional study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis, adjusting for confounders. The study was performed utilizing the chronic disease registry of Clalit Health Services medical database.

Results:

The study included 5018 SLE patients and 25,090 matched controls. BD was found in a higher prevalence among SLE patients compared to controls (0.62% vs. 0.26%, respectively, P < 0.001). BD patients had a greater prevalence of smokers compared to non-BD patients (62.5% vs 23.5%, respectively, P < 0.001). In a multivariate analysis, smoking and SLE were both found to be significantly associated with BD.

Conclusions:

SLE was found to be independently associated with BD. These findings may imply that an autoimmune process affecting the central nervous system among SLE patients facilitates the expression of concomitant BD.

Keywords

SLEBipolar disorderPsychosisAutoimmune diseasesComorbidity
Type
Original article
Information
European Psychiatry , Volume 43 , June 2017 , pp. 116 - 119
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Borchers, ATNaguwa, SMShoenfeld, YGershwin, METhe geoepidemiology of systemic lupus erythematosus. Autoimmun Rev 2010;9(5):A277–A287.CrossRefGoogle ScholarPubMed
Ramos-Casals, MBrito-Zeron, PKostov, BSiso-Almirall, ABosch, XBuss, Det al.Google-driven search for big data in autoimmune geoepidemiology: analysis of 394,827 patients with systemic autoimmune diseases. Autoimmun Rev 2015;14(8):670–679.CrossRefGoogle ScholarPubMed
Shapira, YAgmon-Levin, NShoenfeld, YGeoepidemiology of autoimmune rheumatic diseases. Nat Rev Rheumatol 2010;6(8):468–476.CrossRefGoogle ScholarPubMed
Danchenko, NSatia, JAAnthony, MSEpidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus 2006;15(5):308–318.CrossRefGoogle ScholarPubMed
Yaniv, GTwig, GShor, DBFurer, ASherer, YMozes, Oet al.A volcanic explosion of autoantibodies in systemic lupus erythematosus: a diversity of 180 different antibodies found in SLE patients. Autoimmun Rev 2015;14(1):75–79.CrossRefGoogle ScholarPubMed
Kivity, SAgmon-Levin, NZandman-Goddard, GChapman, JShoenfeld, YNeuropsychiatric lupus: a mosaic of clinical presentations. BMC Med 2015;13:43.CrossRefGoogle ScholarPubMed
Kivity, SShoenfeld, YAssociation between autoantibodies and neuropsychiatric manifestations of autoimmune disease: comment on the article by Lauvsnes et al.. Arthritis Rheumatol 2015;67(6):1683CrossRefGoogle ScholarPubMed
Meszaros, ZSPerl, AFaraone, SVPsychiatric symptoms in systemic lupus erythematosus: a systematic review. J Clin Psychiatry 2012;73(7):993–1001.CrossRefGoogle ScholarPubMed
Unterman, ANolte, JEBoaz, MAbady, MShoenfeld, YZandman-Goddard, GNeuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum 2011;41(1):1–11.CrossRefGoogle ScholarPubMed
Zandman-Goddard, GChapman, JShoenfeld, YAutoantibodies involved in neuropsychiatric SLE and antiphospholipid syndrome. Semin Arthritis Rheum 2007;36(5):297–315.CrossRefGoogle ScholarPubMed
Knight, AMVickery, MEMuscal, EDavis, AMHarris, JGSoybilgic, Aet al.Identifying targets for improving mental healthcare of adolescents with systemic lupus erythematosus: perspectives from pediatric rheumatology clinicians in the United States and Canada. J Rheumatol 2016;43(6):1136–1145.CrossRefGoogle ScholarPubMed
Alao, AOChlebowski, SChung, CNeuropsychiatric systemic lupus erythematosus presenting as bipolar I disorder with catatonic features. Psychosomatics 2009;50(5):543–547.CrossRefGoogle ScholarPubMed
Ho, RCThiaghu, COng, HLu, YHo, CSTam, WWet al.A meta-analysis of serum and cerebrospinal fluid autoantibodies in neuropsychiatric systemic lupus erythematosus. Autoimmun Rev 2016;15(2):124–138.CrossRefGoogle ScholarPubMed
Zardi, EMTaccone, AMarigliano, BMargiotta, DPAfeltra, ANeuropsychiatric systemic lupus erythematosus: tools for the diagnosis. Autoimmun Rev 2014;13(8):831–839.CrossRefGoogle ScholarPubMed
Ainiala, HLoukkola, JPeltola, JKorpela, MHietaharju, AThe prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology 2001;57(3):496–500.CrossRefGoogle ScholarPubMed
Petri, MNaqibuddin, MCarson, KAWallace, DJWeisman, MHHolliday, SLet al.Depression and cognitive impairment in newly diagnosed systemic lupus erythematosus. J Rheumatol 2010;37(10):2032–2038.CrossRefGoogle ScholarPubMed
Bachen, EAChesney, MACriswell, LAPrevalence of mood and anxiety disorders in women with systemic lupus erythematosus. Arthritis Rheum 2009;61(6):822–829.CrossRefGoogle ScholarPubMed
Brey, RLHolliday, SLSaklad, ARNavarrete, MGHermosillo-Romo, DStallworth, CLet al.Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology 2002;58(8):1214–1220.CrossRefGoogle ScholarPubMed
Tiosano, SFarhi, AWatad, AGrysman, NStryjer, RAmital, Het al.Schizophrenia among patients with systemic lupus erythematosus: population-based cross-sectional study. Epidemiol Psychiatr Sci 2016; 1–6.CrossRefGoogle Scholar
Belmaker, RHBipolar disorder. N Engl J Med 2004;351(5):476–486.CrossRefGoogle ScholarPubMed
Grant, BFStinson, FSHasin, DSDawson, DAChou, SPRuan, WJet al.Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: results from the National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry 2005;66(10):1205–1215.CrossRefGoogle ScholarPubMed
Crump, CSundquist, KWinkleby, MASundquist, JComorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA Psychiatry 2013;70(9):931–939.CrossRefGoogle ScholarPubMed
Fernandez, DKirou, KAWhat causes lupus flares?. Curr Rheumatol Rep 2016;18(3):14CrossRefGoogle ScholarPubMed
Leelahanaj, TKongsakon, RChoovanichvong, STangwongchai, SPaholpak, SKongsuk, Tet al.Time to relapse and remission of bipolar disorder: findings from a 1-year prospective study in Thailand. Neuropsychiatr Dis Treat 2013;9: 1249–1256.Google ScholarPubMed
Murdoch, TBDetsky, ASThe inevitable application of big data to health care. JAMA 2013;309(13):1351–1352.CrossRefGoogle ScholarPubMed
Dahan, SShor, DBComaneshter, DTekes-Manova, DShovman, OAmital, Het al.All disease begins in the gut: celiac disease co-existence with SLE. Autoimmun Rev 2016;15(8):848–853.CrossRefGoogle ScholarPubMed
Merdler-Rabinowicz, RTiosano, SComaneshter, DCohen, ADAmital, HComorbidity of gout and rheumatoid arthritis in a large population database. Clin Rheumatol 2017;36(3):657–660.CrossRefGoogle Scholar
Shor, DBDahan, SComaneshter, DCohen, ADAmital, HDoes inflammatory bowel disease coexist with systemic lupus erythematosus?. Autoimmun Rev 2016;15(11):1034–1037.CrossRefGoogle ScholarPubMed
Shovman, OTiosano, SComaneshter, DCohen, ADAmital, HSherf, MAortic aneurysm associated with rheumatoid arthritis: a population-based cross-sectional study. Clin Rheumatol 2016;35(11):2657–2661.CrossRefGoogle ScholarPubMed
Watad, ATiosano, SAzrielant, SWhitby, AComaneshter, DCohen, ADet al.Low levels of calcium or vitamin D, which is more important in systemic lupus erythematosus patients? An extensive data analysis. Clin Exp Rheumatol 2017;35(1):108–112.Google ScholarPubMed
Watad, AMahroum, NWhitby, AGertel, SComaneshter, DCohen, ADet al.Hypothyroidism among SLE patients: case-control study. Autoimmun Rev 2016;15(5):484–486.CrossRefGoogle ScholarPubMed
Bruce, INO’Keeffe, AGFarewell, VHanly, JGManzi, SSu, Let al.Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Ann Rheum Dis 2015;74(9):1706–1713.CrossRefGoogle ScholarPubMed
Parker, BUrowitz, MBGladman, DDLunt, MDonn, RBae, SCet al.Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis 2015;74(8):1530–1536.CrossRefGoogle ScholarPubMed
Tan, EMCohen, ASFries, JFMasi, ATMcShane, DJRothfield, NFet al.The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25(11):1271–1277.CrossRefGoogle ScholarPubMed
Symmons, DPGabriel, SEEpidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat Rev Rheumatol 2011;7(7):399–408.CrossRefGoogle ScholarPubMed
Barbosa, IGMachado-Vieira, RSoares, JCTeixeira, ALThe immunology of bipolar disorder. Neuroimmunomodulation 2014;21(2–3):117–122.CrossRefGoogle ScholarPubMed
Farhi, ACohen, ADShovman, OComaneshter, DAmital, HAmital, DBipolar disorder associated with rheumatoid arthritis: a case-control study. J Affect Disord 2016;189: 287–289.CrossRefGoogle ScholarPubMed
Wilens, TEBiederman, JMartelon, MZulauf, CAnderson, JPCarrellas, NWet al.Further evidence for smoking and substance use disorders in youth with bipolar disorder and comorbid conduct disorder. J Clin Psychiatry 2016;77(10):1420–1427.CrossRefGoogle ScholarPubMed
Barbosa, IGRocha, NPAssis, FVieira, ELSoares, JCBauer, MEet al.Monocyte and lymphocyte activation in bipolar disorder: a new piece in the puzzle of immune dysfunction in mood disorders. Int J Neuropsychopharmacol 2015;18(1):pyu021.CrossRefGoogle Scholar
Rege, SHodgkinson, SJImmune dysregulation and autoimmunity in bipolar disorder: synthesis of the evidence and its clinical application. Aust N Z J Psychiatry 2013;47(12):1136–1151.CrossRefGoogle ScholarPubMed
Ortiz-Dominguez, AHernandez, MEBerlanga, CGutierrez-Mora, DMoreno, JHeinze, Get al.Immune variations in bipolar disorder: phasic differences. Bipolar Disord 2007;9(6):596–602.CrossRefGoogle ScholarPubMed
Brietzke, EKapczinski, FTNF-alpha as a molecular target in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2008;32(6):1355–1361.CrossRefGoogle ScholarPubMed
Pego-Reigosa, JMIsenberg, DAPsychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease. Rheumatology (Oxford) 2008;47(10):1498–1502.CrossRefGoogle ScholarPubMed
Merikangas, KRAkiskal, HSAngst, JGreenberg, PEHirschfeld, RMPetukhova, Met al.Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007;64(5):543–552.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.