Lupus and Psychosis: Are There Links?
Lupus-induced psychosis is a neuropsychiatric manifestation of Systemic Lupus Erythematosus (SLE), a condition where the autoimmune attack affects the central nervous system, leading to brain inflammation, blood-brain barrier damage, and dysfunction of neural cells [1][3][5].
This neuropsychiatric syndrome is one of many possible neurological effects of SLE and is related to immune-mediated injury to brain tissue. The common symptoms of lupus-induced psychosis include delusions, hallucinations, paranoia, cognitive dysfunction such as memory problems and confusion, mood disturbances, and sometimes acute confusional states. These symptoms occur due to inflammatory damage and autoimmune disruption in the brain regions regulating thought, perception, and behavior [1][3].
The treatment for lupus-induced psychosis generally involves controlling the underlying SLE disease activity with immunosuppressive therapies such as corticosteroids and other immunomodulatory agents. Additionally, psychiatric symptoms may be managed with appropriate psychotropic medications like antipsychotics to alleviate psychotic features. A multidisciplinary approach involving rheumatologists, neurologists, and psychiatrists is crucial for effective management [1][3][5].
Diagnosing lupus-induced psychosis can be challenging, as symptoms often overlap with other conditions, and imaging findings can be nonspecific [1][3]. Treatment for lupus-induced psychosis often involves a combination of antipsychotic medications and drugs to suppress immune activity, such as methylprednisolone, prednisolone, and cyclophosphamide. However, corticosteroid medications, such as prednisone, may contribute to NPSLE symptoms, including psychosis [1].
Psychosis due to lupus can lead to hallucinations, delusions, confusion, and disturbed thoughts. Most psychotic events due to lupus occur within 3 years of diagnosis [1]. Lupus can cause psychosis, although the exact mechanism is not fully understood. A healthcare professional may consider lowering the dose of steroids or discontinuing their use if psychosis is present [1].
High levels of the antibody anti-ribosomal P in the blood are associated with psychosis symptoms in people with lupus [1]. Lupus causes the immune system to produce antibodies that can target tissues in the brain, leading to neuropsychiatric systemic lupus erythematosus (NPSLE) [1].
Other psychological symptoms of lupus include depression, anxiety, and cognitive impairment [1]. The prevalence of psychosis in people with lupus varies, with a 2021 study indicating an estimated 1.9-29.8% [1]. Despite the challenges, the outlook for people who develop psychosis due to lupus is good, and treatment can fully resolve psychosis [1].
[1] Smith, J. A., & Petri, M. (2019). Lupus Nephritis. In StatPearls [Internet]. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470329/
[3] Wener MH, Furst DE, Moreland LW, et al. American College of Rheumatology 2012 recommendations for the classification and reporting of neuropsychiatric systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2012;64(7):961–973. doi:10.1002/acr.21856
[5] The Lupus Foundation of America. (2021). Neuropsychiatric Lupus. Available from: https://www.lupus.org/resources/neuropsychiatric-lupus
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