Mental Health and Psycheducational Functioning

Central nervous system (CNS) involvement with SLE is a common event for children and adolescents, reported to occur in 20% to 95% of patients (29).

Table 2 Risk Factors for Accelerated Atherosclerosis in SLE

Traditional risk factors Hypertension Hypercholesterolemia Diabetes Smoking Obesity

Family history of CHD Potential disease-related risk factors

Proteinuria related to nephrotic syndrome

Chronic inflammation

Long-term corticosteroid treatment

Although some CNS events, such as seizure or neuropathies, may be relatively isolated with few long-term sequelae, many CNS events, such as stroke, transverse myelitis, psychosis, or depression, may result in a long-term impact on functional ability. In addition, there is data to suggest that many patients with SLE have subtle cognitive disturbances, which can impact memory (30). These disturbances may result in significant difficulties for adolescents with SLE in school and work, even if they have not had evidence of a major CNS insult.

In one study of a cohort of pediatric SLE patients, 48% were found to have neuropsychiatric SLE, which included depression, concentration or memory problems and psychosis (31). Some patients had more than one CNS manifestation. Although a good outcome was reported in these patients, with 90% reported to have recovery, this was analyzed over a short time period. The gradual and subtle long-term impact on neu-ropsychological functioning of these insults has never been adequately studied.

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