Management of Psychosis in Neuropsychiatric Lupus

Kang, Di; Mok, Chi Chiu

doi:10.1142/s2661341719300015

Cited by 4 publications

(10 citation statements)

References 61 publications

(81 reference statements)

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“…[ 12 ] Psychosis in SLE can occur either due to neuro-lupus or drugs used to treat it (e.g., glucocorticoid and chloroquine) or flare-up of premorbid psychiatric condition due to disease burden. [ 11 13 ] In the present case, steroid-induced psychosis was a close differential. Steroid may cause psychosis, usually with a higher dose of prednisolone (>40 mg/day), is dose dependent.…”

Section: Discussionmentioning

confidence: 55%

“…The standard treatment for NPSLE is pulse methylprednisolone therapy. [ 11 ] Our patient responded well with methylprednisolone, but had a recurrence in follow-up. Therefore, she was given monthly cyclophosphamide therapy that has been the best second-line agent having greater efficacy than methylprednisolone with comparable safety.…”

Section: Discussionmentioning

confidence: 81%

“…[ 9 ] In different cohorts, psychosis has been reported among 0%–11% NPSLE cases. [ 10 11 ] Study in Indian patients showed psychosis was the predominant symptom. [ 12 ] Psychosis in SLE can occur either due to neuro-lupus or drugs used to treat it (e.g., glucocorticoid and chloroquine) or flare-up of premorbid psychiatric condition due to disease burden.…”

Section: Discussionmentioning

confidence: 99%

“…SLE patients are also more prone to develop steroid-induced psychosis if there is concurrent lupus nephritis causing hypoalbuminemia. [ 11 12 ] On the contrary, the presence of anti-P 0 antibody, neuroinflammatory markers in CSF, disease activity marker in blood, responsiveness to immunosuppressive agents and temporality with the underlying disease point towards the diagnosis of NPSLE. [ 11 12 14 15 ]…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous immunoglobulin, plasmapheresis, rituximab, and newer biological such as belymumab and tofacitinib are potential third-line agents to treat lupus psychosis. [ 11 ] Apart from immunosuppressive therapy NPSLE patients frequently need psychopharmaceuticals, particularly at its acute presentation. Moreover, SLE patients do have a higher psychological burden and are associated with an increased risk of suicide.…”

Section: Discussionmentioning

confidence: 99%

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Acute psychosis as the presenting manifestation of lupus

Kumar

Thakur

et al. 2021

Journal of Family Medicine and Primary Care

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Neuropsychiatric manifestations like cognitive dysfunction, peripheral neuropathy, stroke headache, seizures in systemic lupus erythematosus (SLE) are quite common. However, psychosis as the sole presenting manifestation of SLE is rarely encountered clinically. If lupus is not kept as differential among patients with acute psychosis, delay in diagnosis and subsequent mismanagement are likely to happen. Here, we present a case of a young female presenting with acute psychosis as the predominant symptom and was further evaluated and diagnosed as a case of SLE. The patient was managed with immunosuppressive agents and carried an excellent outcome.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute psychosis as the presenting manifestation of lupus

Kumar

Thakur

et al. 2021

Journal of Family Medicine and Primary Care

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Acute psychosis as the presenting manifestation of lupus: case reports

Shahada,

Khalalyli,

Allahham

et al. 2023

International Journal of Surgery: Global Health

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Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects multiple organs with a wide range of clinical manifestations. Neuropsychiatric manifestation (NPSLE) is present among 28–40% of the SLE patients. Psychosis is rarely the only initial symptom of lupus, as neuropsychiatric lupus is often associated with systemic activity. We present two cases of young ladies presenting with acute psychosis as the predominant symptom and further diagnosed with SLE disease. Case reports: Case 1 A 20-year-old female, unmarried, presented to the Psychology Department with acute behavioral abnormality associated with staring, insomnia and, aggressive behavior, hearing voices for the last 3 days. No other psychiatric or neurological symptoms; she was taking 20 mg oral prednisolone prescribed according to a history of fatigue, low-grade fever, loss of appetite, pain in almost all joints, and myalgia for the last 1 month. There was no sign of focal neurological deficit or meningeal irritation. Examination of other systems did not find any clinical abnormality except for the presence of photosensitivity. A psychiatric consultation was ordered. Laboratory tests: white blood cells 3200 cell/mm3 (range=4000–11 000) with normal differentiation, hemoglobin 9.2 mg/dl (range=12.5–16), platelet 90 000/dl (range=150 000–400 000), C-reactive protein (CRP) 65 mg/l (n≤6), and erythrocyte sedimentation rate (ESR) 100 mm/h(range=0–20). anti-nuclear antibody (ANA) profile which was positive in 1:320 dilution, homogenous type, along with anti-ds-DNA positive (+), decreased C3 and C4. The diagnosis of SLE was done according to the European League Against Rheumatism/American College of Rheumatology Classification Criteria (EULAR/ACR Criteria). Case2 A 37-year-old married female with 3 children presented to the Psychology Department with disorientation, staring, hearing voices, seeing images of people who want to hurt her, refusing to respond to people, and insomnia for the last 10 days. She had complained of fatigue and low-grade fever for last month. A psychiatric consultation was ordered, and the patient was managed with an injection of haloperidol 5 mg BD. Laboratory tests: white blood cells 7300 cells/mm3 (range=4000–11 000) with normal differentiation, hemoglobin 8.7 mg/dl (range=12.5–16), platelet 90 000/dl (range=150 000–400 000), reticulocyte:1.4, CRP 7 mg/l (n≤6), and ESR 50mm/h (range=0–20). The ANA profile was positive in 1:320 dilution, homogenous type, along with the anti-ds-DNA negative (−), decreased C3, and normal C4. Brain magnetic resonance imaging (MRI) showed a high white matter signal around the lateral ventricles and in the semi-oval centers. Mild dilation of the lateral ventricles and slight elevation of the left insular and medial temporal lobe signal. Conclusion: Our case reports showed that organic disorders should be considered while evaluating acute psychosis, especially autoimmune disorders. The presence of laboratory features like anemia, elevated ESR, and elevated CRP should be taken with utmost importance.

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The psychological effects of systemic lupus erythematosus: the imitator of aging

Özsungur

2020

LymphoSign Journal

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Objectives: To assess the psychological effects of systemic lupus erythematosus (SLE), including perception of aging, in a cohort of participants who were either diagnosed with SLE or had an affected family member. Methods: Over a period of 1 year, we conducted once-monthly face-to-face interviews with 12 participants. The participants were from 4 related families and include 7 females and 5 males. Three participants had a confirmed diagnosis of SLE. Spouses were also included in this study to assess transitivity of the psychological signs of SLE. Responses to structured interview questions were analyzed to assess the perception of aging. Results: The major complaints in participants diagnosed with SLE were pain and psychological stress. Nephrotic syndrome, urinary tract infection, weight disorders and increased need for psychosocial support were common in the participants’ medical history. Qualitative analysis of questionnaires completed by participants with SLE revealed a correlation of “feeling old” with the non-resolution of health complaints. Family members who did not have SLE also reported “feeling old”. Complaints of stress, anxiety, nervousness and lack of enjoyment of life were common in those who were diagnosed with SLE, as well as those who were not. All spouses reported experiencing digestive disorders, hemorrhoids as well as various phobias, regardless of whether their partners had a confirmed SLE diagnosis. Conclusions: In this study, we found that participants with SLE or those who had a close family member with SLE displayed psychological signs of aging. All participants had a predisposition to anxiety, while spouses developed various phobias. Statement of novelty: We show that individuals with SLE and close family members have an increased self-perception of aging.

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Management of Psychosis in Neuropsychiatric Lupus

Cited by 4 publications

References 61 publications

Acute psychosis as the presenting manifestation of lupus

Acute psychosis as the presenting manifestation of lupus

Acute psychosis as the presenting manifestation of lupus: case reports

The psychological effects of systemic lupus erythematosus: the imitator of aging

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