Systemic lupus erythematosus can cause inflammation of virtually any tissue of the body. Depending on the tissue affected and the intensity of the inflammation, the function of the organs can be disturbed. Brain inflammation in lupus is referred to as cerebritis.

When lupus affects the brain, it can lead to headache, seizure, stroke, or psychosis.

Psychosis is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People experiencing a psychotic episode may report hallucinations or delusional beliefs (e.g., grandiose or paranoid delusions), and may exhibit personality changes and disorganized thinking. This is often accompanied by lack of insight into the unusual or bizarre nature of their behavior, as well as difficulty with social interaction and impairment in carrying out the activities of daily living. 

Psychosis is not common in patients with lupus and occurs when the disease is first diagnosed in under 3% of patients. It occurs at sometime during the course of the disease in 5% of patients. Moreover, though infrequent, psychosis is now used by doctors as classical criteria for the diagnosis of systemic lupus.

Psychosis, when due to the lupus disease itself, is referred to as one of the neuro-psychiatric manifestations of lupus. 

Psychotic states may also be associated with steroid therapy. Case reports shows a small percentage that psychosis may occur with use of drugs such as steroids which is one of the key medications in lupus.

Psychological and emotional effects, such as grief, depression and anger, are commonly experienced by lupus patients. These can be related to the outward changes, such as skin alterations caused by the disease as well as by other aspects of the disease and its treatment. It is important for health professionals, care-givers, and family to be alert to potential psychological repercussions and to assist in alleviating them. 

Potential Psychological Manifestations:

o         Lowered self-esteem

o         Negative feelings about body

o         Decreased confidence

o         Feelings of decreased self-worth

o         Depression

o         Feelings of sadness, hopelessness, helplessness

o         Difficulty in completing self-care activities, caring for children, maintaining a household, and other activities of daily living (ADL)

o         Inability to maintain full- or part-time employment

o         Decreased social activities

o         Lack of energy or ambition

o         Irritability

o         Impaired concentration

o         Crying

o         Insomnia

o         Suicidal thoughts  

REFERENCES:

·          Shiel, W: “Connection between lupus and psychosis” MedicineNet.com
<http://www.medicinenet.com/script/main/art.asp?articlekey=21147>

·          Wikipedia: “Psychosis” <http://en.wikipedia.org/wiki/Psychosis>

·          Fessel WJ, Solomon GF:
“Psychosis and Systemic Lupus Erythematosus - A Review of the Literature and Case Reports”
PubMed Central, Western Journal of Medicine
<http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1578071>

·          Terry Nass RN, Wauwatosa, WI: “General Manifestations of SLE, Potential Psychological Manifestations”
National Institutes of Health, National Institute of Arthritis and Muskoskeletal and Skin Diseases
Lupus: A Patient Care Guide for Nurses and Other Health Professionals, Page 30-31