New Onset Psychosis as The First Manifestation of Neuro-Psychiatric Lupus. A Situation Causing Diagnostic Dilemma

First episode of psychosis can occur at any age and it can be primarily psychiatric or secondary to other occult diseases. It is of great therapeutic relevance to be cautious about organic etiology as early diagnosis can help in early initiation of disease modifying treatments. To study patients who presented with first episode of psychosis and later turned out to be due to lupus erythematosus with varying periods of delay. Details of patients who were considered as treatment unresponsive psychosis and later turned out to be due to vasculitis were entered in excel sheet and analyzed. The details of patients including neuropsychological features, apparent soft signs which were initially ignored, lab data and signs during follow-up were tabulated and warning signs analysed. All our patients were highly intelligent young females and there were stressors in all of them. They presented with panic, followed by psychotic symptoms which was resistant to regular psychiatric treatment and therefore possibility of organicity explored. All of them had history of transient symptoms referable to other systems which were treated as such and patients did not volunteer the same unless questioned. During follow-up full-fledged features of SLE came up in all patients. When a young female with no past or family history of mental illness presents with psychotic features, unprovoked panic, and limbic symptoms always ask for minor or transient symptoms and signs referable to the other systems which might give valuable clues.