SLE and autoimmune neuropsychiatry

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Target exams

Red flags

• New psychosis or acute confusional state in known or suspected SLE — attribute carefully, exclude infection, and co-manage with rheumatology urgently
• Focal neurology, seizure, or suspected stroke in SLE — activate stroke/neurology pathway and complete antiphospholipid work-up
• Do not escalate immunosuppression until infection (including opportunistic CNS infection) is actively excluded
• High-dose glucocorticoid mania or psychosis is iatrogenic until proven otherwise — coordinate steroid plan rather than automatic depot antipsychotic
• aPL-positive vascular phenotype needs antithrombotic strategy, not steroids alone
• Normal MRI does not exclude diffuse inflammatory NPSLE phenotypes
• Headache alone is rarely sufficient for aggressive cytotoxic escalation