Seventy-six ambulatory patients with systemic lupus erythematosus and a comparison group of 23 ambulatory patients with rheumatoid arthritis were given a structured interview and standard psychological tests, including the Minnesota Multiphasic Personality Inventory, to determine the psychosocial impact of the illness. Both groups had significantly elevated scores on 3 Minnesota Multiphasic Personality Inventory scales: Hypochondriasis, Depression, and Hysteria. Psychological difficulties are an integral part of systemic lupus erythematosus and are as common as most other manifestations. The implications for clinical practice are discussed.The prevalence of psychological symptoms in systemic lupus crythematosus (SLE) is between 3 and 65% (1-8). Reported symptoms include depression, anxiety, depersonalization, withdrawal, hallucination, cognitive problems, and frank psychosis. Whether psychiatric symptoms are an integral part of lupus, are related to the stress of having a serious chronic illness, or are the result of drugs used in treating lupus (such as corticosteroids) is frequently difficult to determine in the individual patient.Existing studies on this subject are based on selected patients (ill or hospitalized), without controls or standardized measures of psychiatric symptoms (5). Improved understanding of psychological symptoms in SLE patients who are not acutely ill would help us in managing S L E patients and in defining the boundary between normal symptoms in reaction to an illness and the psychological manifestations of a multisystem disease (9).This study reports the psychological symptomatology assessed by a standardized interview and psychological testing, in a sample of ambulatory SLE patients and a comparison group of patients with rheumatoid arthritis (RA). PATIENTS AND METHODSPatient selection. Subjects were recruited through news media and letters to 132 active patients from our Lupus Clinic. Patients were asked to participate in a study "to help us to understand what it's like to have lupus." A total of 76 SLE patients participated. One hundred sixty patients with RA, randomly selected from a registry of RA patients at our hospital, were sent a similar letter. Twenty-three volunteered to participate after two mailings.Questionnaire and psychological scales. A 55-item questionnaire and a standardized interview gathering demographic, medical history, and psychosocial information were administered after informed consent was obtained. Five trained interviewers were checked for reliability at the beginning of and during the study by review of the taped interviews.Replies to the open-ended questions were transcribed directly from tapes for coding. These responses were categorized by 3 independent observers. Operational rules were established for coding the results, and the interviews

The present study examined the prescription practices concerning psychotropic drugs in 5 major oncology centers over a 6 month period. During the survey period 1579 patients were admitted to the collaborating institutions, and 51% of them were prescribed at least one psychotropic medication. Hypnotics were the most frequently prescribed drugs, accounting for 48% of total prescriptions, followed by anti-psychotics at 26% and anti-anxiety agents at 25%. Anti-depressant drugs accounted for only 1% of psychotropic prescriptions. Analysis of prescription rationales revealed that 44% of the psychotropic prescriptions were written for sleep, while 25% were given for nausea and vomiting; approximately 17% were attributed to psychological distress, and 12% were associated with diagnostic medical procedures. The overall rate of prescription was approximately 2 psychotropic drugs per patient per admission, with only 2% of prescriptions resulting in chart-documented side effects. At the level of individual compounds, 3 distinct drugs accounted for 72% of total prescriptions--flurazepam (33%), prochlorperazine (21%), and diazepam (17%).

Systemic mastocytosis is a disease characterized by an excessive accumulation of mast cells, and associated with skin lesions, flushing, diarrhea, tachycardia, and psychiatric manifestations. In order to define more clearly the psychiatric manifestations, ten patients with this disorder underwent unstructured psychiatric interviews and a battery of psychologic testing. Both revealed a pattern of cognitive and affective changes in the majority of these patients, best categorized as an atypical or mixed organic brain syndrome. The cognitive changes consisted of diminished attention and memory, and the affective changes of anger, irritability, and, to a lesser extent, depression. These manifestations fluctuated with the level of disease activity, and appeared in some cases to respond to histamine antagonists and disodium cromoglycate, medications used to control the excessive mast cell activity. It is important for psychiatrists to be aware that mental status changes can represent psychiatric manifestations of mastocytosis, a readily treatable medical disorder.

One hundred and four cancer survivors 3 years past their last cancer treatment reported a significantly lower sense of self-control and more general health worries than a matched sample of healthy controls. The two groups did not differ on variables of anxiety, depression, positive well being, and vitality or on two composite scores of mental and general well-being. The well-being scores of the survivors from three geographically distinct cancer centers revealed no significant differences among centers on the composite or any of the individual subscores. Sociodemographic and treatment variables revealed only marriage and no change in job were significantly related to the amount of general well-being experienced.