title: Psychiatric illness of systemic lupus erythematosus in childhood: spectrum of clinically important manifestations.
abstract: OBJECTIVE
  To determine the spectrum of manifestations in clinically important (i.e., requiring alterations of immunosuppressive therapy) psychiatric illness of pediatric systemic lupus erythematosus (pSLE) and to describe the laboratory and imaging features associated with psychiatric illness of pSLE (psySLE).
  
  
  METHODS
  This was a single-center cohort study of patients with pSLE followed at a pediatric SLE clinic from August 1985 to July 2009. Patients with organic psychiatric disease due to SLE were included. Data regarding psychiatric features at initial presentation and during followup were obtained from psychiatry and rheumatology visits. Data regarding concomitant SLE disease activity and laboratory results were obtained from the institutional SLE database. Information from imaging studies was abstracted from patients' charts.
  
  
  RESULTS
  Our cohort consisted of 53 pediatric patients (87% female) diagnosed with psySLE, representing 12% of the total pSLE cohort of 447 in the same time period. The median age at diagnosis of pSLE was 15.0 years and 16.1 years for psySLE. All patients reported symptoms of cognitive dysfunction and 75% of patients had additional psychotic features. Insight was preserved in 64% of patients with psychosis at diagnosis of psySLE. Visual distortion was observed among 32% of children with psySLE. Eighty-two percent of patients demonstrated clinical response to the institutional protocol of immunosuppression.
  
  
  CONCLUSIONS
  Cognitive dysfunction was present in all and additional psychosis present in 75% of pediatric patients with psySLE. Visual distortion and early preservation of insight were unique features of psychosis observed in this cohort of children/adolescents with psySLE.
authors.affiliation: Division of Rheumatology, and the Division of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Lily Siok Hoon
authors.initials: LS
authors.lastname: Lim
authors.forename: Arlette
authors.initials: A
authors.lastname: Lefebvre
authors.forename: Susanne
authors.initials: S
authors.lastname: Benseler
authors.forename: Michelle
authors.initials: M
authors.lastname: Peralta
authors.forename: Earl D
authors.initials: ED
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000209:etiology; D012720:Severity of Illness Index