Patient having SLE on steroid for two weeks, developed psychosis.Question is how to differentiate steroid induced psychosis and psychosis due to neurolupus in a patient with SLE patient clinically?
The differentiation is usually difficult, but some hints might be helpful. steroid-induced psychosis occurs within the first weeks after starting high daily doses of steroids (>40mg/day of prednisone or equivalent) and resolve after discontinuation. Lupus psychosis are associated with anti-P antibodies and with visual halluciantions while steoid-induced psychosis is more associated with auditory hallucinations.
According to literature, neurolupus is rare manifestation, has much more like-schizophrenia signs( delusions), despite of treatment...
"SLE" is once of artificial unethiological syndromas. with many, many causes! We know that the corticosteroids thehrapy can induce the steroid psychosis. The first step in therapy is teh reduction of dosis of steroids.
In lupus psychosis, there is acute confusional state with delusions/hallucinations plus other manifestations like seizure, encephalopathy. But, in steroid psychosis, there are more of mood symptoms which significantly alleviate on reduction of dose of steroid.
In lupus psychosis, lab report shows high level of ab to p-ribosomal proteins.
References:
1. https://acrabstracts.org/abstract/differential-characteristics-of-lupus-psychosis-and-steroid-psychosis/
2.http://www.remedypublications.com/open-access/a-case-report-of-steroid-induced-psychosis-in-a-female-with-systemic-lupus-erythematosus-4231.pdf?__cf_chl_jschl_tk__=182eb29800b5cf9c2ce9b2232e9885a5822a288e-1621947291-0-AXTk5wV1kay8arW7aE6KgMpVLGotRY3mVIb9BzRlrnrJ3RI8CTOpTY4fieQZXBIaBrWTyb5CfKYQ_At0PBTApEHfm-wIf9rqPXoZqcQVxGkB6iwU2SM8fpOgedBeFeCtoZ6_aTX6Ix5b8Rv7v-5eeF-ZhsI71ZXKZGzTs6CW32-h3hMt0jIutntLMj24_-8mnjc64GBCF5L6N8SC7lpC6LbuWThgFq_ZuXvqp1LDdnxfshpkSqoMKGTY-xLpUZIaMZaZd08OwxfZnb8VSmQYdGvp0WYngQ-klMXEshpb9hTbxulwu0lfh1LNMhfUw4kpE_RGe3kpR8G9rhMC8-QzDHpsLXRVM5FR6N1xoBw5WA3FdXmboURzmvE6pdoKenPpY5EtaCxoSm5tKRUXZ3LTcjDZXkcWpqvZY6zjw3KUCJvQ2t_VXDnXlrCGwItlXcCsHmg2SNQ7geU7lqjxeXJCbbQhPVMYUedWLzAoykQbsXyNOCHbHu6JcD3IIdhOk_MNWvSXQS7-IeTfCk5HJQRRV4Z19DfO6S-09Zm4heKlh56w
3. Article Psychosis in Patients with Systemic Lupus Erythematosus
4. Article Lupus psychosis: Differentiation from the steroid-induced state
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