Dawn Black

A prospective study of psychiatric disorder and cognitive function in systemic lupus erythematosus.

OBJECTIVES--To investigate change in psychiatric disorder and change in cognitive function in patients with systemic lupus erythematosus (SLE) assessed on two occasions two years apart. METHODS--A prospective cohort study of 49 patients with SLE using standardised psychiatric and clinical research methods. RESULTS--The point prevalence of psychiatric disorder (20% and 24%), and of cognitive impairment (23% and 18%), was similar at first and second interview for the whole group. There was, however, considerable change in individual patients psychiatric status and cognitive function: only 1/9 patients with impairment on two or more cognitive tests at first interview was still impaired at second interview. Change in cognitive function appeared to mirror change in psychiatric status. CONCLUSIONS--These findings suggest that the previously reported high prevalence of cognitive impairment in SLE may be explained by coexisting psychiatric disorder, rather than reflecting subclinical central nervous system (CNS) involvement.

PSYCHOLOGICAL STRESS IN MEDICAL STUDENTS: A COMPARISON OF TWO VERY DIFFERENT UNIVERSITY COURSES

This study compared the psychological morbidity of medical students in their first year of medical training at two different medical schools. One medical school had a 5-year course: 2 years intensive preclinical training followed by 3 years clinical work. The second medical school had a 6-year course: a 3-year degree course in basic medical sciences followed by 3 years clinical work. Students on both courses were asked to complete the General Health Questionnaire, the Stress Incident Record and the Maslach Burnout Inventory. The students on the first course reported significantly higher amounts of stress related to course work than the students on the second course (χ2=24.4, df=1, p<0.001), but there was no difference in the prevalence of psychological morbidity between the students on the two courses (z=−1.377, p=0.168). Psychological morbidity was most closely associated with thoughts of dropping out, stressful relationships with other medical students and stress related to dissection. The findings suggest that medical students have high rates of psychological disturbance during the first year of their training, which are not explained by marked differences in the type of training they receive. Reduction in psychological morbidity may be best achieved by targeting those students who are reporting psychological distress or thinking of dropping out.© 1997 John Wiley & Sons, Ltd.