Systemic lupus erythematosus

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Systemic lupus erythematosus is a connective tissue disease.

It can present with psychiatric features such as depression, anxiety, cognitive dysfunction (“brain fog”), mood disturbance, psychosis, agitation, and behavioural change. These may occur as part of neuropsychiatric lupus, systemic autoimmune disease activity, medication effects (e.g., corticosteroids), or associated psychosocial burden.

Other characteristic features include seizures, cognitive impairment, headache, cerebrovascular events (including stroke related to inflammatory or thrombotic mechanisms), and peripheral neuropathy. Other distinctive features include fluctuating multisystem inflammatory symptoms and the presence of autoantibodies, particularly antinuclear antibodies (ANA) and disease-associated antibodies such as anti-double-stranded DNA (anti-dsDNA) and anti-Smith antibodies.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Renal/electrolytes: lupus nephritis with proteinuria, haematuria, hypertension, and impaired renal function may occur.

  • Cardiovascular: increased risk of accelerated atherosclerosis, pericarditis, myocarditis, and thrombotic events, particularly in association with antiphospholipid antibodies.

  • Respiratory: pleuritis, pleural effusions, and interstitial lung disease may occur.

  • Hematologic: cytopenias including autoimmune haemolytic anaemia, leukopenia, and thrombocytopenia may occur.

  • Musculoskeletal: inflammatory arthralgias and non-erosive arthritis are common presenting features.

  • Dermatologic: malar rash, photosensitivity, subacute cutaneous lupus lesions, and other cutaneous manifestations may occur.

Early diagnosis is important to enable timely immunomodulatory treatment, identify and manage organ-threatening involvement (particularly renal, neurological, cardiovascular, and hematologic complications), reduce the risk of irreversible organ damage, and improve long-term prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.