Lupus?

[randomdoc1]

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Whoa, for the very first time ever in my career, I got a patient who has actual well documented lupus. All that emphasis in medical school and I remember wondering so many times when I'll actually encounter this. It is indeed very interesting. But I was wondering if anyone on the board has experience with managing neuropsychiatric effects of the disease itself and/or the medications that come with treating this? It's definitely not very straightforward, it's not like I can tell them to just stop their steroids. Specifically, I was wondering about the depression, anxiety, and cognitive complaints. SSRIs (amongst a variety of other psychotropics) will certainly be considered but what about the cognitive complaints (maybe Trintellix)? I have thought of working together with the rheumatologist to collaborate our medications as well as referral to someone to help the individual develop compensatory means. Pt thinks she has ADHD and would like stimulants but the developmental history is not at all consistent with the dx. I think it's coming more from the lupus and the meds. Continuing to do more literature searching but I have certainly heard good ideas from other posters on this forum on other topics which is why I am asking. Any thoughts are greatly appreciated!

 

[Merovinge]

Are there any neuropsychiatrists around? This is totally the time to talk to one if there is. We had a soul crushing case when I was a resident where she ended up with malignant catatonia that was not recognized by the primary (ICU) team for several days and she had a persistently elevated fever that burned out a lot of her cognitive functioning. It was a miracle she lived at all but I got assigned her case in therapy and it was like talking to a zombie, she only made it a few visits before dropping off.