Neuxopsychiatric Problems in Systemic Lupus Erythematosus

Kaposi ¹ in his original description of systemic lupus erythematosus (S.L.E.), noted recurrent delirium in 2 out of 11 patients. During the past few years there has been a resurgence of interest in the central nervous system manifestations of S.L.E., together with an increasing awareness of their importance. In a recent large prospective study of S.L.E., central nervous system involvement, including psychosis, was seen in 59% of patients and was second only to renal involvement as a cause of death.” The use of sensitive tests for the diagnosis of S.L.E., in particular deoxyribonucleic acid (DNA) antibody titres’ and cerebrospinal fluid complement levels 4 may contribute to a more widespread recognition of this complication. The most difficult diagnostic and therapeutic problems have related to cases where psychiatric symptoms predominate.⁶ In this review case histories of five patients with central nervous system lupus seen recently at Hammersmith Hospital are reported to illustrate some of the clinical problems.