Chronic Schizophrenia Comorbid with Neuropsychiatric Systemic Lupus Erythematosus

慢性精神分裂症病人併有神經精神性紅斑性狼瘡

10.29478/TJP.201203.0007

郭純雅(Chun-Ya Kuo)；曾懷萱(Huai-Hsuan Tseng)；吳彥雯(Yen-Wen Wu)；鄭楣方(Mei-Fang Cheng)；陳品豪(Pin-Hao Chen)；謝松洲(Song-Chou Hsieh)；劉智民(Chih-Min Liu)

中樞神經系統性紅斑性狼瘡 ； 精神分裂症 ； 認知功能退化 ； neuropsychiatric systemic lupus erythematosus ； schizophrenia ； central nervous system involvement ； cognitive impairment

台灣精神醫學

26卷1期（2012 / 03 / 01）

6+58 - 63

英文

背景：中樞神經系統紅斑性狼瘡的疾病表現十分多元，在慢性精神分裂症病人出現該疾病症狀時與原先疾病的症狀更加難以區分。病例報告：一位55歲女性病人，被診斷為精神分裂症長達九年，第一次住院時因幻聽及妄想被診斷為精神分裂症；最近一次住院前發現認知功能變差，於住院檢查時診斷為紅斑性狼瘡，過程中完整呈現關於精神分裂症合併紅斑性狼瘡病人於認知功能和腦部影像學於治療前後之改變，並討論兩者共病之可能性。結論：本篇報告提醒臨床醫師於慢性精神分裂症患者出現急性認知功能退化時，需考慮病人可能同時具有器質疾病。

Background: The neuropsychiatric events are frequently encountered in patients with systemic lupus erythematosus (SLE). The psychotic symptoms and cognitive dysfunctions are relatively common in SLE with central nervous system (CNS) involvement. Case Report: We present a patient with SLE with CNS involvement, who has also carried a diagnosis of schizophrenia for nine years. The presentation of progressive cognitive impairment suggested the diagnosis of SLE with CNS involvement. The result of the neuropsychological assessment showed great improvement after a six-month immunosuppressant therapy, especially in the dimensions of verbal and visual memory. The brain perfusion scan also showed the finding of remarkable improvement after treatment. Conclusion: This case shows the differences and complex presentations in psychopathology, neuropsychological tests, and brain imaging in those two diseases. Clinicians should be alert for considering other organic causes for progressive cognitive impairments in the course of chronic schizophrenia.

1. Ainiala, H,Hietaharju, A,Loukkola, J(2001).Validity of the new American College of Rheumatology criteria for neuropsychiatric lupus syndromes: a population- based evaluation.Arthritis Rheum,45,419-23.
2. Camargo, EE(2001).Brain SPECT in neurology and psychiatry.J Nucl Med,42,611-23.
3. Emori, A,Matsushima, E,Aihara, O(2005).Cognitive dysfunction in systemic lupus erythematosus.Psychiatry Clin Neurosci,59,584-9.
4. Govoni, M,Castellino, G,Padovan, M,Borrelli, M,Trotta, F(2004).Recent advances and future perspective in neuroimaging in neuropsychiatric systemic lupus erythematosus.Lupus,13,149-58.
5. Harrison, PJ(1999).The neuropathology of schizophrenia: a critical review of the data and their interpretation.Brain,122,593-624.
6. Liu, SK,Hsieh, MH,Huang, TJ(2006).Patterns and clinical correlates of neuropsychologic deficits in patients with schizophrenia.J Formos Med Assoc,105,978-91.
7. Monastero, R,Bettini, P,Del, Zotto, E(2001).Prevalence and pattern of cognitive impairment in systemic lupus erythematosus patients with and without overt neuropsychiatric manifestations.J Neurol Sci,184,33-9.
8. Pego-Reigosa, JM,Isenberg, DA(2008).Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease.Rheumatology,47,1498-502.
9. Petri, M,Naqibuddin, M,Carson, KA(2008).Cognitive Function in a Systemic Lupus Erythematosus Inception Cohort.J Rheumatol,35,1776-81.
10. Stojanovich, N,Zandman-Goddard, G,Pavlovich, S,Sikanich, N(2007).Psychiatric manifestations in systemic lupus erythematosus.Autoimmun Rev,6,421-6.