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Psychosis an uncommon manifestation of neuropsychiatric systemic lupus erythematosus

26 Nov 2018

Psychosis as a manifestation of neuropsychiatric (NP) systemic lupus erythematosus (SLE) occurs rarely, taking place after SLE onset and negatively affecting health status, a study reports. Short- and long-term outlook appears to be good for most patients, although vigilant follow-up is needed.

Researchers looked at 1,826 SLE patients (mean age 35.1 years; 88.8 percent female; 48.8 percent Caucasian) with mean disease duration of 5.6 months. All patients were evaluated annually for 19 NP events including psychosis. Other assessments included SLE disease activity 2000, Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index, and SF‐36 scores.

During a mean follow‐up of 7.4 years, 31 psychotic events occurred in 28 patients (1.53 percent), most of whom (n=26; 93 percent) had a single event. Psychosis was attributed to SLE in 25 patients (89 percent), and the majority (n=20; 80 percent) had their first episode either in the year prior to or within 3 years following SLE diagnosis.

Factors associated with lupus psychosis were prior SLE NP events (hazard ratio [HR], 3.59; 95 percent CI, 1.16–11.14), male sex (HR, 3.0; 1.20–7.50), younger age at SLE diagnosis (HR per 10 years younger, 1.45; 1.01–2.07) and African ancestry (HR, 4.59; 1.79–11.76).

Physician assessment showed that most psychotic events resolved by the second annual visit following onset, consistent with an improvement in patient reported SF‐36 summary and subscale scores.

According to researchers, the present data indicate that majority of psychotic events are directly attributed to SLE, have a predilection to occur early in the course of the disease and are more frequent in male patients. Despite the presence of limitations, the study provides encouraging data on the outcome of this rare but potentially devastating manifestation of NPSLE.

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