Electroconvulsive therapy for severe neuropsychiatric lupus with psychosis

J ECT. 2013 Sep;29(3):243-6. doi: 10.1097/YCT.0b013e3182809c01.

Abstract

Objective: Systemic lupus erythematosus (SLE) is an autoimmune disorder that requires long-term management and can have a profound impact on the quality of life of patients. Among patients with SLE, neuropsychiatric manifestations are fairly common, occurring in up to 75% of patients with SLE. Neuropsychiatric symptoms of SLE (NPSLE) presenting with psychosis, however, is less common, with a prevalence of up to 11%. Treatment of psychosis in NPSLE has largely involved antipsychotics and immunosuppressants, with not much in the literature about the use of electroconvulsive therapy (ECT) as a method of treatment.

Methods: We report 3 cases of patients who presented with psychosis during a lupus relapse, who were treated successfully with ECT after their symptoms did not improve on medical treatment.

Results and conclusion: Although all 3 patients were treated with antipsychotics and immunosuppressants simultaneously with the ECT sessions, the time scale of these 3 case studies suggests that ECT played a role in the resolution of these patients' symptoms. Our 3 cases highlight that ECT can be safely and effectively used in patients with NPSLE with prominent psychotic symptoms.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Anesthesia
  • Anti-Inflammatory Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Asian People
  • Cyclophosphamide / therapeutic use
  • Electroconvulsive Therapy / adverse effects
  • Electroconvulsive Therapy / methods*
  • Electroencephalography
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / psychology
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / etiology
  • Psychotic Disorders / psychology
  • Psychotic Disorders / therapy*
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Antipsychotic Agents
  • Immunosuppressive Agents
  • Cyclophosphamide