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New-onset psychiatric disorders after corticosteroid therapy in systemic lupus erythematosus: an observational case-series study

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Abstract

The objective of this study was to clarify the incidence, clinical characteristics, and courses of new-onset psychiatric manifestations after corticosteroid therapy in patients with systemic lupus erythematosus (SLE), including possible ways of differentiating between corticosteroid-induced psychiatric disorders (CIPDs) and central nervous system manifestations of SLE (CNS-SLE). We prospectively followed for 8 weeks 139 consecutive episodes in 135 in-patients who had a non–CNS-SLE flare treated with corticosteroids. Psychiatric events were evaluated once a week using DSM-IV criteria. We then conducted a post hoc etiological analysis of any newly developed psychiatric events during this follow-up period. In the 8 weeks of corticosteroid administration, new psychiatric events occurred in 20 (14.4 %) of the 139 episodes. The mean dosage of corticosteroids administered was prednisolone at 0.98 (range 0.24–1.39) mg/kg/day. Of the 20 psychiatric events, 14 (10.1 %) were suitable for the strict definition of CIPDs, accompanied by mood disorders in 13 (depressive in 2, manic in 9, and mixed in 2) and psychotic disorder in one. Two (1.4 %), both presenting delirium, were diagnosed as CNS-SLE on the basis of evidence of abnormal CNS findings even before psychiatric manifestations, all of which improved in parallel with these patients’ recoveries through augmentation of immunosuppressive therapy. The other four events (2.9 %) could not be etiologically identified. This study suggests that corticosteroid therapy triggers CIPDs and CNS-SLE in patients with SLE. Delirium may be suggestive of CNS-SLE, while mood disorders may be more suggestive of CIPDs. Electroencephalographic abnormalities may possibly be predictive of CNS-SLE.

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Acknowledgments

The authors thank Professors Naoshi Horikawa, Masako Hara, and Naoyuki Kamatani for helpful comments on the manuscript.

Ethical standard

The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Conflicts of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Katsuji Nishimura & Jun Ishigooka

  2. Kanagawa Psychiatric Center, Yokohama, Japan

    Masako Omori

  3. Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan

    Eri Sato, Yasuhiro Katsumata, Takahisa Gono, Yasushi Kawaguchi & Hisashi Yamanaka

  4. Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

    Masayoshi Harigai

Authors
  1. Katsuji Nishimura
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  2. Masako Omori
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  3. Eri Sato
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  4. Yasuhiro Katsumata
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  5. Takahisa Gono
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  6. Yasushi Kawaguchi
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  7. Masayoshi Harigai
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  8. Hisashi Yamanaka
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  9. Jun Ishigooka
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Correspondence to Katsuji Nishimura.

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Nishimura, K., Omori, M., Sato, E. et al. New-onset psychiatric disorders after corticosteroid therapy in systemic lupus erythematosus: an observational case-series study. J Neurol 261, 2150–2158 (2014). https://doi.org/10.1007/s00415-014-7472-y

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  • DOI: https://doi.org/10.1007/s00415-014-7472-y

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