Psychiatric illness associated with systemic lupus erythematosus.

Estimates of the frequency of mental changes associated with systemic lupus erythematosus (SLE) range from 3% to 65%. Variations in classifying and reporting symptoms account for much of the difficulty in determining the true incidence. Other problems in study design also make it difficult to compare results of various studies, although it appears that psychiatric illness associated with SLE falls into two categories: organic and functional disorders. The former occur in 22% to 29% of patients having SLE and rheumatoid arthritis and are associated with a poorer prognosis and higher mortality. The latter occur in 18% to 35% of SLE patients and slightly less in patients with rheumatoid arthritis. Several possible causes for mental changes of SLE have been proposed. The case of a patient with SLE having an acute psychotic episode illustrates the possible roles of premorbid personality, mental and environmental stress, and steroid therapy in precipitating psychiatric illness in SLE.