Neuropsychiatric Manifestations of Systemic Lupus Erythematosus

Corticosteroids, immune suppression, and psychosis

“…In fact, SLE-associated CNS effects sometimes respond to corticosteroid therapy [32•]. It was once believed that neuropsychiatric symptoms in SLE could be attributed to vasculitis [30], or were an understandable reaction to the stress of coping with a chronic, fatal disease [33]. However, the discovery of antineuronal antibodies led to the theory that these antibodies were affecting the brain by passing an impaired blood-brain barrier.…”

“…Studies have examined the presence of specific immunoglobulins such as antiphospholipid, lymphocytotoxic, and antiribosomal P (anti-P) antibodies in patients with SLE presenting with neuropsychiatric symptoms. For example, elevated anti-P antibody levels have been found in psychotic episodes in SLE, but not during exacerbation of other symptoms of the disease [33]. Elevated cerebrospinal fluid (CSF) IgM and parameters of IgG have also been reported.…”

“…Neuroimaging techniques such as positron emission tomography (PET), CT, single photon emission computed tomography (SPECT), or MRI may help to confirm CNS involvement in patients with SLE presenting with psychiatric disturbance [33,34]. Neuropsychiatric symptoms are often treated with corticosteroids (although the efficacy and safety of this approach remains controversial [35]), but can also be successfully treated with concomitant psychotropic medication [33]. However, there have not yet been any systematic studies of the treatment of psychiatric symptoms in SLE [33].…”

“…Neuropsychiatric symptoms are often treated with corticosteroids (although the efficacy and safety of this approach remains controversial [35]), but can also be successfully treated with concomitant psychotropic medication [33]. However, there have not yet been any systematic studies of the treatment of psychiatric symptoms in SLE [33].…”

Diagnosis and treatment of mood disorders in patients with rheumatic disease

“…7 In patients with rheumatological disease, SLE is the disease that poses many dilemmas to the treating physician. The diffuse, non-focal neuropsychiatric presentations of affective, behavioural, and cognitive symptoms in patients with SLE may be attributable to one or several neuropsychiatric disorders, occurring sequentially or simultaneously 8. No matter the origin of the mood disorder, treatment goals for depression include restoration of normal mood, prevention of suicide, return of self esteem, improvement in the quality of life and work productivity, and increase in satisfaction of both patients and doctors.…”