Characteristics, treatments and outcome of psychosis in Thai SLE patients

• Published in: Journal of psychosomatic research Vol. 73; no. 6; pp. 448 - 451
• Main Authors: Paholpak, Pongsatorn, Rangseekajee, Poonsri, Foocharoen, Chingching
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.12.2012
• Subjects: Adult; Antidepressants; Antidepressive Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Female; Humans; Immunosuppressive Agents - therapeutic use; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - psychology; Lupus psychosis; Lupus vasculitis; Male; Neuropsychiatric systemic lupus erythematosus (NPSLE); Psychiatry; Psychotic disorders; Psychotic Disorders - drug therapy; Psychotic Disorders - etiology; Psychotic Disorders - psychology; Thailand; Treatment Outcome; Thailand; Psychotic disorders; Lupus psychosis; Neuropsychiatric systemic lupus erythematosus (NPSLE); Lupus vasculitis
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2012.08.006

Abstract 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.