Table 4.
Characteristics of GABABR autoantibody positive lupus psychosis patients on fixed cell-base assay (n = 3)
| Patient 1 | Patient 2 | Patient 3 | |
|---|---|---|---|
| Sex/ethnicity | F/AC | M/C | F/C |
| Follow-up (years) | 18 | 30 | 12 |
| Age at diagnosis SLE/psychosis | 35/35 | 16/16 | 31/31 |
| Total no of psychosis episodes | 1 | 1 | 3 |
| Psychotic manifestations | Delusions (not specified), auditory hallucinations | Manic episode with grandiose delusions and change in personality. Grandiose beliefs about self. Persecutory delusions and delusions of misidentification. | Mania with grandiose delusions, visual hallucinations and change in behaviour. |
| Other NP features | Seizures | Depression, headache | Headache (frontal) |
| Non-NP SLE features | Arthritis, pleuritis, lupus nephritis (class 3 or greater on WHO criteria) | Rash, arthritis, interstitial lung disease, Raynaud’s | Rash, arthritis, fatigue, serositis, Raynaud’s |
| CNS investigations | Normal MRI, abnormal EEG | Normal MRI, nil other results | EEG normal, normal MRI, normal LP (HSV -ve, oligoclonal band -ve) |
| Induction therapy | IV methylprednisolone, cyclophosphamide, prednisolone (high) | Azathioprine, prednisolone (med) | IV methylprednisolone, cyclophosphamide |
| Maintenance therapy | Prednisolone (low), azathioprine | Azathioprine, prednisolone (low) | Prednisolone (high) |
| Psychiatric medication | Nil psychotropic, acute only with haloperidol, lorazepam) | Olanzapine | Olanzapine, diazepam |
| Long-term outcome of psychosis | Resolution after 1 week. No recurrence, died (bacterial endocarditis) aged 49. | Good response to immunotherapy and olanzapine (20 mg), no recurrence, long-term depression requiring treatment (sertraline). Alive and under follow-up. | First manic episode resulted in 1 week admission, followed by resolution. Second episode 2 years later (improved with IV methylprednisolone pulses after 5-6 days). Third admission with similar presentation. Olanzapine and diazepam used and repeated pulses cyclophosphamide. Continues on long-term olanzapine. Alive and under follow-up. |
| First serum sample (at time of psychosis) | GABABR (1:80) | GABABR (1:20) | Negative all |
| Second serum sample (at least 1 year later) | Negative all | GABABR (1:20) | GABABR (1:20) |
Prednisolone doses: (0–7.5 mg/day), medium (7.5–19mg/day) and high (≥20mg/day). AC: Afro-Caribbean; C: Caucasian; F: female; M: male; NP: neuropsychiatric; SLE: systemic lupus erythematosus.