Acta Dermato-Venereologica Issue 8, 2017 97-8CompleteContent

CLINICAL REPORT 941 High Prevalence of Personality Disorders in Skin-restricted Lupus Patients Isabelle JALENQUES 1 , Fabien RONDEPIERRE 2 , Catherine MASSOUBRE 3 , Sophie BONNEFOND 4 , Raymond SCHWAN 5 , Bruno LABEILLE 6 , Jean-Luc PERROT 6 , Marianne COLLANGE 2 , Aurelien MULLIEZ 7 , The LuPsy Cohort Investigators and Michel D’INCAN 8 Adult Psychiatry A and Medical Psychology Department and 8 Dermatology Department, CHU Clermont-Ferrand, Clermont Auvergne University, Adult Psychiatry A and Medical Psychology Department and 7 Clinical Research and Innovation Department, CHU Clermont-Ferrand, Clermont- Ferrand, 3 Psychiatry Department, CHU St-Etienne, University Jean Monnet, St-Etienne, 4 Psychiatric Emergencies, Esquirol Hospital, Limoges, 5 University Hospital of Psychiatry and Psychotherapy, Laxou, 6 Dermatology Department, CHU Nord Hospital, Saint-Etienne, France 1 2 Psychiatric and personality disorders have been exten- sively documented in patients with systemic lupus ery thematosus (SLE). However, the prevalence of perso- nality disorders in skin-restricted lupus (SRL) patients remains unknown. The aim of this study was to assess the prevalence of personality disorders in SRL outpa- tients and to examine the associated factors. We eva- luated 60 SRL outpatients and 118 controls matched for sex, age and education level. On the basis of the Personality Diagnostic Questionnaire 4+, 38% of pa- tients vs 20% of controls fulfilled the criteria for at least one personality disorder (OR 2.2 [95% CI 1.01– 4.6], p = 0.048). Only one patient with a personality di- sorder had specialised mental health care. Late lupus onset and more frequent past treatments by thalidomi- de were associated factors. This study evidences a high prevalence of personality disorders in SRL patients and shows that most SRL patients with personality disor- der do not receive specialised mental health care. Key words: skin-restricted lupus; personality disorders; PDQ4 + ; LuPsy cohort. this study had several limitations. First, the patient sample was small. Second, patients were prospectively recruited but on a voluntary basis and hence, although more than 30% of those interviewed agreed to participate, it can be assumed that the sample was not truly representative of SRL patients because enriched by patients beset by feelings of sadness. Finally, there was no comparison with a control group. We therefore decided to conduct a prospective study to systematically assess the prevalence of PDs among SRL patients recruited in dermatological outpatient clinics. Our secondary objectives were to exa- mine the co-occurring Axis I psychiatric disorders and to invest igate the factors associated with PD in SRL patients. METHODS The study received approval from the regional Ethical Review Board (Comité de Protection des Personnes Sud-Est 6, ref. 2008- A00343-52/AU740, 18 June 2009). The aims and procedures were explained to participants, who all gave written informed consent. Accepted Apr 27, 2017; Epub ahead of print Apr 27, 2017 Patients Acta Derm Venereol 2017; 97: 941–946. From June 2009 to June 2012, outpatients with SRL aged 18 years or older were consecutively recruited in 8 French university hospitals. Inclusion criteria were designed to select patients with indisputable chronic or sub-acute lupus restricted to the skin and to exclude those having systemic lupus with cutaneous symptoms (see Jalenques et al. (6). Patients were either newly diagnosed or already undergoing lupus treatment. After recruitment, they were evaluated on the same day by a dermatologist and a trained psychiatrist. Corr: Prof Isabelle Jalenques, Adult Psychiatry A and Medical Psychology Department, CHU Clermont-Ferrand, 58 rue Montalembert, FR-63003 Clermont-Ferrand Cedex 1, France. E-mail: ijalenques@chu-clermontfer- rand.fr P sychiatric and personality disorders (PD) have been reported in patients with systemic lupus erythe- matosus (SLE) (1–4). Although skin-restricted lupus erythematosus (SRL), which comprises discoid lupus erythematosus (DLE), lupus tumidus (LT) and subacute cutaneous lupus erythematosus (SCLE), is as common as SLE (5) its relation with psychiatric disorders and PDs has only exceptionally been explored. We recently evi- denced a high prevalence of several psychiatric disorders (anxiety, depression, suicide risk and alcohol dependence) among SRL patients (6). Another study reported that about 35% of cutaneous lupus erythematosus patients met criteria for depression and/or anxiety (7). In an explora- tory study, our group observed that 50% of 20 patients with SCLE and DLE had at least one PD, in particular obsessive-compulsive and depressive PD (8). However, Controls Control subjects were recruited through a poster campaign and corporate intranet among volunteers from a clinical research cen- tre, workers in public hospitals and the national railway company, and administrative personnel of the state education system. All individuals who had symptoms that could be related to a past or present lupus (systemic or cutaneous) were excluded. Two control subjects were matched with each patient for age ( ± 5 years), sex and education level (equivalent diploma). Controls underwent a medical examination and the same psychiatric evaluation as the patients. Medical examination We collected data concerning sex, age at visit, education level, smoking and medical history. Lupus history comprised date of first symptoms, ongoing and past specific treatments and smoking This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340/00015555-2691 Acta Derm Venereol 2017; 97: 941–946

Acta Dermato-Venereologica Issue 8, 2017 97-8CompleteContent | Page 13