ویژگی های، درمان و نتیجه روان پریشی در بیماران SLE تایلندی

Objectives To study the clinical characteristics and outcomes of psychosis and its clinical correlation with disease activity in Thai systemic lupus erythematosus (SLE) patients. Methods From 750 SLE patients, 36 episodes of psychosis or psychotic depression in SLE patients were retrospectively identified between June 1999 and June 2009 at Srinagarind Hospital, Khon Kaen University. The clinical characteristics, laboratory analyses, disease activity, treatments and outcomes were studied. Results A total of 35 SLE patients had 36 psychotic episodes that consisted of 29 psychotic episodes and 7 psychotic depressive episodes. Eleven episodes (30.6%) occurred during the first manifestation of lupus. Psychotic symptoms included persecutory delusion (50%), bizarre delusion (44.4%), third person auditory hallucinations (44.4%) and visual hallucinations (36.1%). Twenty four episodes (67%) were associated with active lupus in CNS and other organs. All patients received immunotherapy and psychotropic treatments. Psychosis and depressive psychosis were treated with antipsychotics and antidepressants for a mean duration of 71 and 410 days. One death resulted from suicide, and one of thirty four cases (2.9%) had a reoccurrence within a mean follow-up period of 44 months. Conclusion About one-third of the psychotic episodes occurred during the first manifestation of lupus. Persecutory delusion, bizarre delusion, third person auditory hallucination, and visual hallucination were common. During psychotic episodes, lupus activity was active in other parts of CNS and organs in 67% of patients. Depressive psychosis required psychotropic treatment longer than psychosis alone. The psychiatric outcome was very favorable. Most of psychotic episodes (97.1%) were fully remitted and rarely showing recurrences.

Systemic lupus erythematous (SLE) is an autoimmune disorder which manifests with systemic inflammation. It can cause abnormalities to either the central or the peripheral autonomic system and can result in a wide range of neuropsychiatric (NP) disorders. In 1999, American College of Rheumatology (ACR) presented neuropsychiatric systemic lupus erythematosus (NPSLE) as a standardized group of SLE-induced NP disorders [1]. NPSLE which required psychiatric attention included acute confusional state (delirium), affective disorders, cognitive impairment, and psychosis. Since clinical presentations and laboratory findings varied widely among each of the NPSLE patients, further study was warranted for each individual disorder. Psychosis and seizure were the only 2 NP manifestations in which ACR included in diagnostic criteria for SLE [2]. Psychosis is a mental state which is characterized by hallucination, thought disturbance and disorganized behavior. The clinical condition is probably mediated by autoantibodies, microvasculopathies and the intracranial production of inflammatory mediators [3]. Many studies have found that the prevalence of psychosis ranged from 1 to 22.3% [4], [5], [6], [7], [8], [9], [10], [11], [12], [13] and [14] in the SLE population. Psychosis may be influenced by disease-related psychological stressors [15] and it usually has occurred during an aggravation of lupus activity, especially skin rashes and vasculitis [12] and [13]. Treatment options for psychosis in lupus patients included the use of immunosuppressive agents to control disease activity and supportive management with psychotropic medications [16]. However, characteristic, treatment and outcomes of this rare syndrome are not well established. Furthermore, none of the previous publications have mentioned psychotic depression which appears to be an overlap syndrome between depression and psychosis. By using the definition of NPSLE from ACR, this group of SLE patients who had been diagnosed with either psychosis or psychotic depression were studied in order to report the following: 1) their clinical characteristics and laboratory data, 2) treatment options for patients, and 3) and long term outcomes of patients.