A patient with systemic lupus erythematosus (SLE) develops psychosis, mood lability, and cognitive decline. The psychiatrist must first differentiate primary neuropsychiatric lupus (NPSLE) from steroid-induced psychosis. Which feature FAVOURS steroid-induced psychosis?

• A Active SLE serology (elevated anti-dsDNA, low complement)
• B Cerebrospinal fluid pleocytosis
• C MRI showing white matter lesions
• D Onset within 2 weeks of starting or increasing high-dose corticosteroids ✓

Explanation

Steroid-induced psychosis typically begins within 2 weeks of starting or escalating high-dose corticosteroids (prednisone >40 mg/day equivalent) and often resolves with dose reduction. NPSLE is favoured by active serology, CSF abnormalities (pleocytosis), and neuroimaging findings (white matter lesions, vasculitis). Management differs: NPSLE may require immunosuppression; steroid psychosis requires dose reduction and possibly temporary antipsychotics.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.