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Catatonia Associated With Systemic Lupus Erythematosus (SLE): A Report of 2 Cases and a Review of the Literature

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Boeke A1, Pullen B1, Coppes L1, Medina M1, Cooper JJ2. Psychosomatics. 2018 Jun 27. pii: S0033-3182(18)30314-1. doi: 10.1016/j.psym.2018.06.007. [Epub ahead of print]

Abstract

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1 Department of Psychiatry (A.B.), NewYork-Presbyterian Hospital, New York, NY.

2 Department of Psychiatry (A.B.), NewYork-Presbyterian Hospital, New York, NY. Electronic address: acboeke@gmail.com.

Abstract

BACKGROUND: Systemic lupus erythematosus (SLE) is known to cause neuropsychiatric symptoms (NPSLE). While not formally recognized as a syndrome associated with NPSLE, catatonia has frequently been reported.

OBJECTIVE: It is important for clinicians to recognize and treat catatonia as a potential manifestation of NPSLE. We present 2 cases of SLE with catatonia and review the cases reported in the literature.

METHODS: We performed a PubMed search for reported cases of catatonia in SLE. Case reports that met Diagnostic and Statistical Manual of Mental Disorders-5th ed. diagnostic criteria for catatonia were summarized to assess common diagnostic tests and treatments.

RESULTS: Twenty-six articles describing a total of 35 patients (all female), in addition to our 2 patients, were included in the report. All but one of the patients received immunosuppressive therapy for treatment of SLE. To treat catatonia symptoms, 81% of the patients received benzodiazepines, and 38% received electroconvulsive therapy.

CONCLUSIONS: Catatonia can be a manifestation of NPSLE, particularly in the presence of serologies and symptoms indicative of an active lupus flare. Management of catatonia involves management of the underlying condition, in this case immunomodulatory treatments for NPSLE; avoidance of treatments, such as antipsychotics, which can worsen catatonia; and symptomatic treatments for catatonia, for which benzodiazepines are a first-line treatment, and electroconvulsive therapy when catatonia is refractory to benzodiazepines.