Systemic lupus erythematous

Question 1

The acute onset of psychosis in a child or adolescent is rare, next step?

Answer 1

rule out medical or substance induced conditions that are potentially reversible.

Question 2

Sceondary causes of acute onset psychosis in children and adolescents?

Answer 2

medical disorders ( cns injury/dysfunction, metabolic/elctrolytes disturbances, systemic disorders), illicit substance use, medication side effects.

Question 3

Central nervous system injury/dysfunction:

Answer 3

trauma, space-occupying lesions, infection, stroke, epilepsy, cerebral hypoxia.

Question 4

Metabolic/electrolyte disturbances?

Answer 4

urea cycle disturbance, acute intermittent porphyria, wilson’s disease, renal/liver failure/ hypoglycemia/ sodium/calcium/magnesium disturbances.

Question 5

Systemic disorders?

Answer 5

Systemic lupus erythematous, thyroiditis

Question 6

illicit substance use

Answer 6

hallucinogens ( PCP,LSD, ketamine), marijuana, sympathomimetics ( cocaine, amphetamines), alcohol withdrawal , bath salts.

Question 7

medication side effects?

Answer 7

intoxication: anticholinergics (diphenhydramine, scopolamine) serotonin syndrome, amoxicillin/erythromycin/clarithromycin, anticonvulsants, corticosteroids, isoniazid.
withdrawal: baclofen, benzodiazepines.

Question 8

Systemic lupus erythematous

Answer 8

arthralgia, psychosis, thrombocytopenia, hematuria and proteinuria. classic malar rash is often absent.

Question 9

neuropsychiatric manifestations seen in SLE?

Answer 9

seizure, headache, peripheral neuropathy, strokes and chorea.

Question 10

inflammatory disorders such as SLE

Answer 10

can affect the CNS and manifest with both acute and chronic psychiatric symptoms including psychosis, depression, mania and anxiety.

Question 11

most appropriate next step?

Answer 11

check for antinuclear antibodies if positive further testing for more specific antibodies ( anti-double stranded dna, anti-smith,anti-U1 ribonucleoprotein).