Catatonia in systemic lupus erythematosus: a case report and review of literature

Abstract

Although, neuropsychiatric morbidity is quite high in patients with systemic lupus erythematosus (SLE), catatonia has been rarely reported. We report a case of a 22-year-old female who presented with catatonic symptoms at the time of relapse of SLE and have discussed the presentation in the context of existing literature with regard to phenomenology of catatonia, psychiatric co-morbidity and treatment of catatonia in patients with SLE.

Low Doses of Benzodiazepines for Catatonia Associated With Systemic Lupus Erythematosus

“…Psychosis overall is uncommon in SLE and occurs in ,10% of patients with SLE. 5 In a recent review of the literature, Grover et al 6 identified 22 case reports of patients with SLE who developed catatonia, including patients whose initial presenting symptom of SLE was catatonia. Psychosis at the onset of SLE is associated with disease activity, and is associated more with positive antiphospholipid and ribosomal P antibodies than cutaneous or renal manifestations of SLE.…”

“…14 Patients with SLE who develop psychosis usually do so in the first year of their SLE diagnosis and may present with paranoid delusions or audiovisual hallucinations, causing significant distress and social impairment. [6][7][8][9] To our knowledge, there are no controlled trails comparing treatment modalities of catatonia in patients with SLE. 14,15 It is important to identify and treat patients with SLE who develop psychosis, because these patients are at increased risk of developing other central nervous manifestations of SLE, such as strokes and seizures, and psychotic symptoms typically remit with treatment of the underlying SLE.…”

“…1 Catatonia, recognized by DSM-5 as a symptom domain of psychosis, is characterized by disorganized motor behavior and decreased ability to respond appropriately to environmental cues. [6][7][8][9] To our knowledge, no studies have compared treatment modalities of catatonia associated with SLE; however, high doses of benzodiazepines, electroconvulsive therapy, and plasma exchange have been shown to be effective. 5 There are rare reports of patients with SLE developing catatonia.…”

“…Patients with catatonia demonstrate social withdrawal, mutism, bizarre posturing, and motor immobility or excessive movement. 6,7,[10][11][12] We describe a patient with SLE who presented with paranoid delusions, abnormal behaviors, and motor immobility and was determined to be catatonic. These patients are at increased risk of developing pulmonary emboli and cerebrovascular accidents secondary to immobility.…”

SLE presenting with catatonia in an adolescent girl

“…In a recent review,[6] authors presented the data of catatonia and SLE and concluded that there are only 22 cases of catatonia reported in literature to be associated with SLE and their case being the 23 rd . Of these 23 cases of catatonia in SLE, only eight cases[789101112131415] have been reported in patients younger than 18 years of age with youngest patient being aged 13 years.…”