Appendix A: Case Definitions for Neuropsychiatric Syndromes in Systemic Lupus Erythematosus

Mood Disorders

Prominent and persistent disturbance in mood characterized by

• depressed mood or markedly diminished interest or pleasure in almost all activities OR;
• elevated, expansive or irritable mood

Diagnostic criteria:

I. Major depressive-like episode

One or more major depressive episodes with at least five of the following symptoms, including either A or B or both, during a 2-week period and nearly every day:

1. Depressed mood most of the day, by subjective report or observation made by others
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, by subjective report or observation made by others
3. 1. Significant weight loss without dieting or weight gain (>5% of body weight in one month)
   2. Insomnia or hypersomnia. Psychomotor agitation or retardation (observable by others, not merely subjective feeling of restlessness or being slowed down)
   3. Fatigue or loss of energy
   4. Feelings of worthlessness or excessive or inappropriate guilt (may be delusional)
   5. Diminished ability to think or concentrate, or indecisiveness
   6. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

II. Mood disorder with depressive features
All of the following:

1. Prominent and persistent mood disturbance characterized by predominantly depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
2. Full criteria for major depressive-like episode are not met

III. Mood disorder with manic features
Prominent and persistent mood disturbance characterized by predominantly elevated, expansive, or irritable mood

IV. Mood disorder with mixed features
Prominent and persistent mood disturbance characterized by symptoms of both depression and mania; neither predominates

For all mood disorders:
Symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning.

Exclusions:

• Primary mental disorders
• Substance-induced mood disorder
• Adjustment disorder with depressed mood

NB: If mood disturbance occurs exclusively during an acute confusional state: classify as acute confusional state if mood disturbance occurs exclusively during a psychotic disorder: classify as psychosis

Associations:

• Marked psychosocial stress
• Corticosteroids

Ascertainment:

• History
• Standardized instruments (e.g., Center for Epidemiological Studies-Depression Scale [CES-D] [33], Hospital Anxiety and Depression Scale [35]) when indicated

Record:

• Basic descriptors
• Type of mood disturbance

(References: 22, 33, 35, 67)

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