A Review on Psychiatric Symptoms in Neuropsychiatric Systemic Lupus Erythematosus

Abstract Aim: This paper aims to synthesize current evidence on the epidemiology, pathophysiology, and clinical manifestations of selected psychiatric syndromes in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE), including acute confusional state, mood disorders, and psychosis. Material and methods: A PubMed search was conducted in August 2025, limited to English-language publications from 1st January 2001 to 15th August 2025. Search terms included “systemic lupus erythematosus”, “neuropsychiatric systemic lupus erythematosus”, “mood disorders”, “anxiety disorder”, “psychosis” and “acute confusional state.” Meta-analyses, clinical trials, cohort studies and review articles were screened and analyzed. In total, 60 articles met inclusion criteria. Results: NPSLE affects 20-97% of patients. Mood disorders (11.5-37.4%) and anxiety (19.2-32.9%) are most common, associated with higher disease activity, disability, and reduced quality of life. Psychosis is less frequent (1.0-4.3%) but represents one of the most severe syndromes, linked to younger age at diagnosis, higher disease activity, and autoantibody positivity. Acute confusional state (ACS) is rare (0.0-3.3%) yet often associated with poor outcomes and elevated intrathecal cytokine levels. Pathogenesis across syndromes is multifactorial, involving autoantibodies, cytokine-driven neuroinflammation, and blood–brain barrier dysfunction. Conclusions: Psychiatric manifestations in NPSLE range from common mood disorders to rare but severe conditions such as ACS and lupus psychosis, significantly worsening prognosis. Current diagnostic approaches remain limited by symptom overlap with primary psychiatric conditions and treatment-related effects. Improved epidemiological surveillance, biomarker validation, and interdisciplinary management strategies are critical to advancing diagnostic accuracy.