A psychiatric perspective on the therapy of psychosis in systemic lupus erythematosus

Abstract

A brief description of psychosis in the general psychiatric setting and its treatment using antipsychotic agents including 'atypical' drugs. A review of the prevalence of neuropsychiatric syndromes in lupus (using The American College of Rheumatology standardized definitions) from recent studies showing wide variation in reported rates. Underlying pathophysiologic mechanisms postulated for neuropsychiatric manifestations of lupus are reviewed with implications for treatment. The use and success of intravenous pulsed cyclophosphamide (singly and in combination with methylprednisiolone) for severe neuropsychiatric psychosis is reviewed.

Electroconvulsive Therapy for Severe Neuropsychiatric Lupus With Psychosis

“…14 In severe NPSLE, combination pulsed cyclophosphamide with pulsed methylprednisolone has also produced significant improvement in psychotic symptoms. 5 A review 15 on the treatment of NPSLE commented that first-generation antipsychotics are not recommended for the treatment of psychotic symptoms in SLE patients as they may exacerbate NPSLE-associated movement disorders. 16 However, there is also paucity of data regarding the efficacy and safety of secondgeneration antipsychotics in these patients.…”

Clinical implications of neuropsychiatric systemic lupus erythematosus

“…In severe NPSLE, pulsed intravenous cyclo phospha mide has produced significant improve ment in psychotic symptoms (Bodani 2003). The medication was well tolerated in adult and paediatric patients.…”

Autoimmune disorders and postpartum psychosis: Case report with a comprehensive topical review

“…The European League against Rheumatism (EULAR) recommendations for the management of neuropsychiatric SLE note that patients with neuropsychiatric manifestations of SLE associated with a generalized systemic inflammatory process benefit from treatment with immunosuppressant and corticosteroid. However, they also recommend that neuropsychiatric manifestation in SLE (including depression and psychosis) should be first evaluated and treated as in patients without SLE (with antidepressant and/or antipsychotics as appropriate with concomitant cognitive therapy) [13][14][15].…”