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Electroconvulsive Therapy for Severe Neuropsychiatric Lupus With Psychosis

Tan, Lynnette Pei Lin MMed (Psych), MBBS, MCI*; Tan, Lynnette Ee Sing

Journal of ECT:
doi: 10.1097/YCT.0b013e3182809c01
Case Reports
Abstract

Objective: Systemic lupus erythematosus (SLE) is an autoimmune disorder that requires long-term management and can have a profound impact on the quality of life of patients. Among patients with SLE, neuropsychiatric manifestations are fairly common, occurring in up to 75% of patients with SLE. Neuropsychiatric symptoms of SLE (NPSLE) presenting with psychosis, however, is less common, with a prevalence of up to 11%. Treatment of psychosis in NPSLE has largely involved antipsychotics and immunosuppressants, with not much in the literature about the use of electroconvulsive therapy (ECT) as a method of treatment.

Methods: We report 3 cases of patients who presented with psychosis during a lupus relapse, who were treated successfully with ECT after their symptoms did not improve on medical treatment.

Results and Conclusion: Although all 3 patients were treated with antipsychotics and immunosuppressants simultaneously with the ECT sessions, the time scale of these 3 case studies suggests that ECT played a role in the resolution of these patients’ symptoms. Our 3 cases highlight that ECT can be safely and effectively used in patients with NPSLE with prominent psychotic symptoms.

Author Information

From the *Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore; and †Yong Loo Lin School of Medicine, Singapore.

Received for publication October 18, 2012; accepted November 29, 2012.

Reprints: Lynnette Pei Lin Tan, MMed (Psych), MBBS, MCI, Tan Tock Seng Hospital, Dept of Psychological Medicine, 11 Jalan Tan Tock Seng, Singapore 308433 (e-mail: Lynnette_Tan@ttsh.com.sg).

The authors have no conflicts of interest or financial disclosures to report.

This work did not receive any funding from any of the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), or other(s).

© 2013 by Lippincott Williams & Wilkins