Neuropsychiatric manifestations of systematic lupus

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  • Corticosteroid induced psychosis: 3-4 days after initial therapy symptoms appear. Last days to 3wks or more. Abnormalities of the hypothalamo-pituitary-adrenal axis can result in mood 40mg or more increases risk.
  • A true vasculitic process occurs much less often.Autoantibodies for SLE: ANA, Anti-dsDNA, Anti-Sm, Anti-SSA or B Anti-histone for drug induced Lupus procainamide and hydralazine
  • Neuropsychiatric manifestations of systematic lupus

    1. 1. NEUROPSYCHIATRIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS
    2. 2.  Systemic Lupus is an autoimmune disorder affecting multiple organs.  Inflammation and tissue damage occurs due to the body attacking its own cells and tissues.  It is a type III reaction in which antibody- immune complexes precipitate and cause a further immune response.
    3. 3.  the production of unusual antibodies in the blood.  Eight times more common in women than men.  About 10% of people with lupus isolated to the skin will develop the systemic form of lupus (SLE).
    4. 4.  Heart  Joint  Skin  Lungs  Blood vessels  Liver  Kidney  CNS
    5. 5.  headache  Seizure  Transient ischemic attack, stroke, movement disorders, cerebral venous thrombosis, idiopathic intracranial hypertension, optic neuritis, cranial nerve palsies, cerebellar syndromes, transverse myelitis, and other rare neurological symptoms.
    6. 6.  Amnesia,  Acute confusional state  Delirium, dementia  Depression, anxiety, obsessive-compulsive disorder,  Hallucinosis, and schizophrenia-like psychosis.
    7. 7.  Mechanism is still unknown but some theories are talked about are:  The presence of a vasculopathic state (abnormal vessel walls without inflammatory cell infiltrates) of small vessels which alters cerebral microcirculation.
    8. 8.  NSAIDS: Ibuprofen  Corticosteroids cream for rash  Antimalaria drugs  Corticosteroids for immunosupression  Antidepressant medication  Antipsychotics
    9. 9.  Futrell N, Schultz LR, Millikan C. Central nervous system disease in patients with systemic lupus erythematosus. Neurology. 1992;42:1649–57.  Weiner SM, Peter NH. Neuropsychiatric involvement in systemic lupus erythematosus: Part 1: Clinical presentation and pathogenesis. Med Klin (Munich) 2002;97:730–7.  Hochberg MC, Petri M. Clinical features of systemic lupus erythematosus. Curr Opin Rheumatol. 1993;5:575–86.  Hay EM, Black D, Huddy A, Creed F, Tomenson B, Bernstein RM, et al. Psychiatric disorder and cognitive impairment in systemic lupus erythematosus. Arthritis Rheum. 1992;35:411–6.  Kasitanon N, Louthrenoo W, Piyasirisilp S, Sukitawut W, Wichainun R. Neuropscyhiatric manifestations in Thai patients with systemic lupus erythematosus: A 15 year experience. Ann Rheum Dis. 2002;61:96.

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