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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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Most Read Articles
6 days ago
The choice between nonvitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) for stroke prevention appears to be complex and largely heterogenous across different, countries, a new study has found.
Yesterday
Monotherapy with tenofovir disoproxil fumarate increases virologic response for up to 240 weeks in pretreated patients with hepatitis B virus infection (HBV) who are resistant to entecavir and/or adefovir, a new study has found.
Elvira Manzano, 2 days ago
Long-term treatment with the interleukin-5 receptor alpha-directed cytolytic monoclonal antibody benralizumab led to long-term control of asthma, improvement in pulmonary function, and was safe in patients with severe eosinophilic asthma in the 2-year integrated analysis of the SIROCCO, CALIMA, and ZONDA pivotal studies plus the BORA extension study reported at ATS 2019.
Pearl Toh, 2 days ago
Emerging evidence is showing that the two major new classes of antidiabetic drugs — SGLT2* inhibitors and GLP-1** receptor agonists (RAs) — not only confer cardiovascular (CV) benefits to patients with type 2 diabetes (T2D), they also delay the loss of kidney function among these patients, potentially providing nephrologists with an additional tool in their armamentarium for managing patients with chronic kidney disease (CKD) in the future.