Rarely, lupus can lead to psychosis, which might be due to immune activity or a side effect of certain medications for lupus.

Systemic lupus erythematosus (SLE) is a chronic disease of the immune system that can attack tissues across the body.

Lupus causes widespread inflammation that leads to various symptoms in each person with the condition.

Along with painful, swollen joints, rashes, fatigue, and other various symptoms, lupus can also have psychological symptoms. This might occur due to lupus attacking brain tissue directly or as a side effect of some lupus medications.

Among these psychological symptoms is psychosis, which is rare but can be debilitating.

This article explains lupus-related psychosis and its features.

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In some cases, lupus can cause psychosis, although researchers do not fully understand how it develops.

It is not a common psychiatric symptom of lupus, and studies show wide variations in how many people with lupus experience it. For example, A 2021 study indicates that an estimated 1.9-29.8% of all people with lupus also experience psychosis based on a 40-year review of patient data at a specialist center.

A study from 2019 using the data of 1,826 people with lupus showed that those with psychosis due to lupus often develop it early in the progression of the disease. Researchers found that most psychotic events occurred within 3 years of diagnosis.

Learn more about lupus.

Why can lupus cause psychosis?

Lupus causes the immune system to produce antibodies that incorrectly target an individual’s own tissues instead of infections or injuries. Lupus can attack tissue in the brain and central nervous system, leading to a type of lupus called neuropsychiatric systemic lupus erythematosus (NPSLE).

People with lupus who have high levels of an antibody called anti-ribosomal P in the blood have had significant associations with psychosis symptoms. However, more research is necessary to confirm the link, as this antibody may not specifically relate to psychotic symptoms.

Some people treat lupus flares of inflammation with corticosteroid medications, such as prednisone. However, these may contribute to NPSLE symptoms, including psychosis. Psychosis may be a common side effect of taking steroids for any condition, according to a 2023 case study.

Psychosis is a short-term mental health problem that can lead to several different psychological effects. It may be different from person to person. However, symptoms generally include:

  • Hallucinations: A person with psychosis may experience sights, sounds, smells, textures, or tastes that do not exist. These are known as hallucinations.
  • Delusions: Psychosis may trigger unshakeable beliefs in provably false ideas or scenarios. For example, a person may have grandiose delusions that make them believe they have supernatural powers or are the president of a nation. They may also believe individuals or organizations wish them harm.
  • Confusion and disturbed thoughts: People may talk constantly or rapidly, switch between topics mid-sentence, or commonly lose their train of thought.

No studies report that lupus-induced psychosis has different characteristics from psychosis not related to an underlying condition.

The outlook for people who develop psychosis due to lupus is good, and healthcare professionals consider it to be treatable. In a 2021 study, treatment involved a combination of antipsychotic medications and drugs to suppress immune activity, such as:

Treatment fully resolved psychosis in 66.7% of the individuals in the study. A healthcare professional may also consider lowering the dose of steroids or discontinuing the use of them completely if psychosis is present.

Researchers conducting the previously discussed 2021 study involving 709 people who attended a specialist lupus treatment center maintain that around half of all people with NPSLE show signs of a psychiatric syndrome. It is important to note that this population may not be reflective of the experiences of those with lupus in the general population and not being treated at a specialist center.

Other psychological symptoms of lupus might include:

  • depression, which is the most common psychiatric effect of lupus and might be visible in people before they have a formal SLE diagnosis
  • mania, which can be the first symptom of SLE in some people
  • problems with memory and thinking, which can be twice as common as in the general population
  • anxiety disorders, which are also twice as common among people with SLE compared to people without the disease
  • some symptoms of attention deficit hyperactivity disorder (ADHD)

Read about early signs of lupus.

No cure is currently available for lupus. People will typically need long-term treatment to manage the condition. Depending on symptoms, lupus treatment often involves a combination of approaches that aim to achieve the following:

  • symptom management
  • reducing or stopping flares
  • limiting disease activity
  • slowing or stopping organ damage
  • helping people with lupus maintain a good quality of life

Various medications are proven to help treat lupus, including:

  • anti-inflammatory medications
  • antimalarial drugs, which can reduce fatigue, inflammation of the lungs, skin rashes, and joint pain, as well as reducing the risk of flares
  • corticosteroid pills, liquids, injections, creams, or infusions, prescribed at the lowest dose to reduce the risk of side effects
  • immunosuppressants to reduce immune activity
  • B-lymphocyte stimulator (BlyS) protein inhibitor, which can help control lupus reactions by reducing immune cell activity
  • medications to manage complications or medication side effects, such as antipsychotics to manage psychosis

As symptoms change or side effects occur, a physician can change these to meet individual needs.

Learn more about treating lupus.

The following are some questions people frequently ask about lupus and psychosis.

What happens when lupus attacks the brain?

Lupus attacks in the brain and other parts of the nervous system can cause a symptom known as lupus brain fog. This can affect memory and cause confusion, as well as cause issues with expressing thoughts. People with lupus have an increased risk of seizures and stroke.

Lupus might also contribute to mental health disorders, including depression, anxiety, and psychosis.

What does lupus psychosis look like?

Lupus psychosis causes different effects in different people. However, psychosis often causes hallucinations, delusions, confusion, and disturbed speech. It often develops within 3 years of a person receiving their initial lupus diagnosis.

Lupus can cause treatable psychosis either by attacking brain tissue or as a side effect of taking corticosteroids to manage lupus-induced inflammation. This often occurs early in the progression of the disease.

Psychosis often causes delusions, confusion, and confused thoughts, which may vary from person to person. Antipsychotic medications can help to treat lupus psychosis, often in combination with medications that reduce inflammation.

Other psychiatric effects of lupus can include cognitive difficulties, depression, and anxiety.