The time course of acute psychiatric episodes in systemic lupus erythematosus.

Acute psychotic manifestations in systemic lupus erythematosus (SLE) have been considered usually to occur early in the course of illness, although these findings are primarily based on studies with few patients and limited lengths of observation. To further investigate the chronology of acute psychiatric disturbances in SLE, the time course of these episodes was examined in 36 patients over a median duration of observation of 72 months. Twenty-two of 36 (61.1%) initial psychiatric episodes occurred within the first year of diagnosis of SLE, although several patients experienced the initial onset of psychiatric manifestations several years after the onset of SLE. Recurrent episodes occurred in 10 of 36 patients at a median of 8 months after the initial episode. Although tending to occur early in SLE, primary acute psychiatric events may first occur in patients with long durations of illness, and the time of onset of these episodes does not appear helpful in their differential diagnosis.