Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease

Rheumatology (Oxford). 2008 Oct;47(10):1498-502. doi: 10.1093/rheumatology/ken260. Epub 2008 Jul 25.


Objective: To determine the prevalence, characteristics and long-term outcome of psychosis due to SLE defined according to the ACR nomenclature for neuropsychiatric (NP) syndromes.

Methods: All the patients who strictly fulfilled the ACR definition for psychosis due to lupus were identified within the 485 patients of our lupus cohort and retrospectively evaluated.

Results: Psychosis due to lupus was diagnosed in 11 (2.3%) patients. Lupus psychosis presented as the initial presentation of SLE in 60% of the patients and within the first year of the disease in 80% of the cases. All the patients developed psychotic symptoms within the context of multi-systemic lupus activity, with 90% of them having cutaneous involvement. Psychosis activity in our patients was associated with biological markers of lupus activity in 90% of the cases. The aPLS were observed in 10% of the cases. Seventy percent of our patients showed complete resolution of psychotic symptoms after a mean follow-up of 155 months. Long-lasting remissions were seen in all those patients. Chronic mild psychotic symptoms were observed in 30% of our patients.

Conclusion: Psychosis due to lupus is an uncommon event that usually occurs early in the course of the disease and is associated with other clinical and biological features of SLE. Long-term outcome appears to be favourable after intensive immunosuppressive treatment. This report highlights the need for prospective multi-centre studies to improve our knowledge and to help establish guidelines for the treatment of this rare complication of lupus.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Antipsychotic Agents / therapeutic use
  • Cerebrovascular Circulation
  • Drug Therapy, Combination
  • Electroencephalography
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lupus Vasculitis, Central Nervous System / drug therapy
  • Lupus Vasculitis, Central Nervous System / physiopathology
  • Lupus Vasculitis, Central Nervous System / psychology*
  • Magnetic Resonance Imaging
  • Male
  • Prognosis
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / etiology*
  • Psychotic Disorders / physiopathology
  • Retrospective Studies
  • Treatment Outcome


  • Antipsychotic Agents
  • Glucocorticoids
  • Immunosuppressive Agents