Appenzeller Simone, Cendes Fernando, Costallat Lilian Tereza Lavras
Rheumatology Unit, State University of Campinas, São Paulo, Brazil.
Rheumatol Int. 2008 Jan;28(3):237-43. doi: 10.1007/s00296-007-0410-x. Epub 2007 Jul 20.
To evaluate the frequency and risk factors of acute psychosis in a large cohort of patients with systemic lupus erythematosous (SLE). To identify clinical and laboratory variables useful in differentiating acute psychosis as a primary manifestation of central nervous system (CNS) from corticosteroid induced psychosis. Five hundred and thirty seven consecutive patients with SLE were studied, with follow-up ranging from 4 to 8.8 years. A standardized medical history, neurological, rheumatologic, and psychiatric examinations and serologic testing were performed in all patients. The type and frequency of risk factors associated with acute psychosis as a primary manifestation of CNS system and corticosteroid induced psychosis was determined using multivariate regression with automatic backward stepwise selection. We identified acute psychosis in 89 of 520 (17.1%) SLE patients. Psychosis primary to CNS involvement was diagnosed in 59 of these patients, corticosteroid induced psychosis in 28 and primary psychotic disorder not related to SLE or medication in two patients. Psychosis secondary to SLE at disease onset occurred in 19 patients and was associated with disease activity (p = 0.001; OR = 2.4; CI = 1.5-6.2). Psychosis during follow-up of SLE was observed in 40 patients and associated with positive antiphospholipid antibodies (p = 0.004; OR = 3.2; CI = 1.9-4.5) and less frequently with renal (p = 0.002; OR = 1.9; CI = 0.0-0.6) and cutaneous (p = 0.04; OR = 1.1; CI = 0.0-0.8) involvement. We identified 28 patients with 38 episodes of psychosis associated with corticosteroid therapy. All the patients had severe active disease and ten of these patients had hypoalbuminemia when psychosis developed. At the time of psychotic event, all the patients were taking prednisone in doses varying from 0.75 to 1 mg/kg day(-1). Psychosis resolved after tapering prednisone down in all patients. Acute psychosis related to SLE was observed in 11.3% of our cohort. Recurrence of primary psychosis was associated with other CNS manifestations related to SLE.
评估一大群系统性红斑狼疮（SLE）患者中急性精神病的发生率及危险因素。识别有助于区分作为中枢神经系统（CNS）原发性表现的急性精神病与皮质类固醇诱发精神病的临床和实验室变量。对537例连续的SLE患者进行研究，随访时间为4至8.8年。对所有患者进行了标准化病史、神经学、风湿病学和精神病学检查以及血清学检测。使用自动向后逐步选择的多元回归确定与作为CNS系统原发性表现的急性精神病和皮质类固醇诱发精神病相关的危险因素的类型和频率。我们在520例SLE患者中的89例（17.1%）中发现了急性精神病。其中59例患者被诊断为CNS受累引起的原发性精神病，28例为皮质类固醇诱发的精神病，2例为与SLE或药物无关的原发性精神障碍。19例患者在疾病发作时出现SLE继发的精神病，且与疾病活动相关（p = 0.001；OR = 2.4；CI = 1.5 - 6.2）。在SLE随访期间，40例患者出现精神病，与抗磷脂抗体阳性相关（p = 0.004；OR = 3.2；CI = 1.9 - 4.5），与肾脏（p = 0.002；OR = 1.9；CI = 0.0 - 0.6）和皮肤受累（p = 0.04；OR = 1.1；CI = 0.0 - 0.8）的相关性较低。我们确定了28例患者出现38次与皮质类固醇治疗相关的精神病发作。所有患者均患有严重的活动性疾病，其中10例患者在精神病发作时伴有低白蛋白血症。在精神病发作时，所有患者均服用剂量为0.75至1 mg/kg·天⁻¹的泼尼松。所有患者在逐渐减少泼尼松剂量后精神病症状缓解。在我们的队列中，11.3%的患者出现了与SLE相关的急性精神病。原发性精神病的复发与SLE相关的其他CNS表现有关。
