Lupus & Psychosis

Reviewed by: HU Medical Review Board | Last reviewed: January 2020 | Last updated: March 2023

Mental illnesses like bipolar disorder and hallucinations can be among the most frightening and upsetting of lupus complications.

Serious mental disorders may occur when lupus attacks the brain, spine, or nerves. The medical term psychosis includes mood swings, mania, serious depression, hallucinations, or delusions. About 12 percent of people with lupus will develop psychosis at some time in their illness.1,2

Doctors believe this happens when lupus attacks the delicate structures of the:

  • Central nervous system (brain and spinal cord)
  • Peripheral nervous system (the nerves outside the brain and spinal cord)

Serious mental issues also may happen after the person takes large doses of steroids.1,2

Why does lupus cause mood disorders?

Doctors believe that lupus damages the structures of the nervous system in several ways. It can create antibodies that bind to the nerve cells which keeps these cells from working correctly. In other cases, lupus antibodies attack the blood vessels that feed nerves, causing the nerves to malfunction.

A small study in India tested people with lupus who also had a mental disorder. The test found antinuclear antibodies (ANA) in them all. They also found higher rates of anti-ribosomal antibodies (anti-Rib-P) and anti-neuronal antibodies compared to lupus patients without mental health issues.3

Adding to these difficulties, some lupus medications like steroids may cause new mood problems or aggravate existing ones. Finally, in people who often experience mental health issues, MRI scans tend to show that the brain’s gray matter has been damaged by lupus.1

How are neuropsychiatric symptoms diagnosed?

There is no one test to diagnose a mental complication of lupus.1 The tests that your doctor may use include:2

  • X-rays
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT scan)
  • Electroencephalograms (EEG)
  • Spinal tap
  • Memory and behavior tests

X-rays, MRIs, and CT scans may be used to show blockages, narrow or collapsed blood vessels, and other structural issues of the brain, nerves, and spinal tissue. An EEG will reveal electric patterns in the brain. Think of this as how the brain is “firing.” A spinal tap is a test that removes fluid from the spine so that it can be analyzed. Memory and behavior tests are also used to get an idea of how the brain is working.2

It may be hard for your doctor to tell what is causing your mental health symptoms. These conditions may be caused by structural or mechanical changes in the nervous system, or by the stress of a chronic illness, money worries, and isolation. Genes may play a role too. Those with lupus can develop a mental illness like bipolar disorder or schizophrenia just like other people.

You may need to see a neurologist or psychologist in order to get a correct diagnosis. A neurologist is a doctor who specializes in conditions of the nervous system. A psychologist is a doctor who specializes in mental illness.2

How is psychosis treated?

There is no one way to treat the mental disorders of lupus. How your psychosis is treated will depend on what the doctor believes is causing this symptom. The types of drugs you may be prescribed may vary widely. Depression and anxiety are treated with:4

  • Antidepressants
  • Antianxiety medicines such as diazepam (Valium)
  • Exercise
  • Psychotherapy
  • Good sleep habits
  • Reducing pain

Mood swings, hallucinations, and delusions are treated with:1

  • Antipsychotics such as quetiapine (Seroquel) or olanzapine (Zyprexa)
  • Antidepressants

Psychoses caused by steroid use is called drug-induced psychosis. To treat it, your doctor will decrease the number of steroids you take and increase and change the immunosuppressant you take.

However, if your doctor believes the psychosis is caused by inflammation, high doses of steroids and immunosuppressants may be given to bring symptoms under control quickly.5

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