Systemic lupus erythematosus is the most common type of connective tissue disease. The condition often affects the central nervous system, with 20-30% of patients exhibiting psychiatric symptoms.

bubble_chart Etiology

Systemic lupus erythematosus is considered an autoimmune disease that affects multiple systems in the body. The mechanism of mental disorders is complex and related to the following cerebral pathophysiological changes: ① Immune complexes and γ-globulin deposits can be detected in cerebral blood vessel walls and the choroid plexus; complement levels in cerebrospinal fluid decrease; the presence of DNA and anti-DNA antibody immune complexes in the blood-brain barrier allows lymphocytotoxins to pass through, causing widespread brain damage. ② Among the autoantibodies, there are anti-brain cell protoplasm antibodies that directly damage the central nervous system. ③ Due to systemic lupus erythematosus damaging vital organs such as the heart, liver, and kidneys, severe secondary complications arise, leading to cerebral dysfunction and the manifestation of psychiatric symptoms.

bubble_chart Clinical Manifestations

The condition is more common in women and typically manifests in young adults. In its early stages or during convalescence, it presents as a cerebral asthenia syndrome. Severe cases may exhibit various forms of consciousness disturbances, even unconsciousness. The disease progresses rapidly, but some patients recover with timely treatment. Chronic and prolonged sexually transmitted disease cases often display functional psychosis-like symptoms, such as schizophrenia-like states, depressive states, and manic-like states. The latter must be differentiated from toxic reactions caused by corticosteroid therapy. Neurological symptoms include generalized seizures due to increased intracranial pressure, hemiplegia, aphasia, and choreiform involuntary movements. Physical symptoms reflect physiological changes in the affected organs. Abnormal EEG findings are common, occurring in 60-80% of cases, primarily showing slow waves. EEG changes parallel the resolution of central nervous system symptoms.

The diagnosis must confirm systemic lupus erythematosus, with psychiatric symptoms often appearing during the peak of the disease and improving as physical conditions ameliorate. Laboratory tests: A positive fluorescent antinuclear antibody is significant for diagnosis. Psychiatric symptoms and physical conditions often correlate positively with its titer. The primary distinction should be made from psychogenic reactions associated with physical illnesses.

bubble_chart Treatment Measures

Adrenocortical hormones are the main treatment for this disease. In critical conditions, pulse therapy and intrathecal drug administration are necessary. Immunosuppressants such as cyclophosphamide and azathioprine, when combined with hormones, can alleviate the condition. Antipsychotic drugs and anti-depression or anti-anxiety treatments should be used cautiously if psychiatric symptoms or depressive symptoms appear. The prognosis for each episode tends to become more optimistic with advancements in treatment. Efforts should be made to prevent recurrent episodes and prolonged conditions of systemic lupus erythematosus. Avoid and prevent triggering factors such as sun exposure, infections, and inappropriate medication. Anti-subcutaneous node drugs, sulfonamides, anticonvulsants, antipsychotics, and antibiotics are more likely to induce lupus-like reactions.