Evaluation of psychiatric disorders associated with rheumatological diseases in children and adolescents

ABSTRACT Objective: Rheumatological diseases are prevalant chronic diseases in children and adolescents. It is thought that neuropsychiatric symptoms and mental disorders will frequently accompany rheumatologic diseases due to their episodic course and autoimmune etiologic background. The aim of this study is to investigate frequencies of psychiatric disorders associated with rheumatologic diseases, additionally the possible relationship between the psychiatric disorders and the biochemical parameters, psychometric measurements, drug using. Material and Methods: The study was conducted between May 2018 and October 2018 in Cukurova University Child and Adolescent Mental Health Clinic, 265 patients (145 females, 120 males) who were followed up in the pediatric rheumatology outpatient clinic were included in the study. To determine the psychiatric diagnoses a structured clinical interview, Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (K-SADS-PL), to evaluate the symptoms and severity of the OCD Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS) and to evaluate the symptoms and severity of the TB The Yale Global Tic Severity Scale (YGTSS) were applied to the participants. Attention related functions were evaluated by Stroop TBAG. Children's Depression Inventory, Screen for Child Anxiety Related Disorders, Maudsley Obsessional Compul sive Inventor and Conners' Parental Graduation Scale (CPRS), Turgay Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S) were applied. Conners' Teacher Design Scale (CTRS) and Turgay Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S). The demographic information, history of immunity-infection, familial autoimmune diseases were recorded. Hematological and biochemical parameters (ASO, CRP, ferritin, vitamin B12, vitamin D) of the patients were screened by hospital data processing system retrospectively. SPSS v.22.0 for Windows was used for statistical analysis. Results: 202 of 76 cases (76.2%) were diagnosed with psychiatric disorder. Of the females, 71.7% and 81.7% of the males were diagnosed with psychiatric disorders. ADHD was the most common 51.3% psychiatric disorder. Anxiety disorders and adjustment disorder were found to be the most common in ADHD patients. It was determined that 14.3% of the patients were diagnosed with PANDAS and 63.2% of those patients were male in PANDAS group. Diagnosis of PANDAS, being male gender and lower Hgb levels were found to increase the risk of psychiatric diagnosis, respectively (OR: 3.0 CI: 1.1-9.2, p = 0.048 ; OR: 2.1 CI: 1.1-4.2, p= 0.021; OR: 1.2 CI: 0.9-1.6, p = 0.062) . There was no significant difference in terms of psychiatric diagnosis distribution and frequency for rheumatologic diagnosis subgroups and the rheumatologic drug using group. Conclusions: This study has demonstrated that rheumatologic diseases are closely related to neurodevelopmental disorders including ADHD and PANDAS. Further studies with larger samples are needed to determine whether rheumatic disease itself, anti-inflammatory therapy or excessive inflammation may be related with psychiatric disorders. Key Words: Rheumatologic disease, autoimmunity, psychiatric disorders, pandas, child and adolescent psychiatry