An increase in hallucinations and nightmares could be an indication of the onset of autoimmune diseases.
Research published in eClincalMedicine found that symptoms like nightmares and hallucinations may also be an early warning sign for people with lupus to identify a flare up period.
“Nightmares and hallucinations can represent early symptoms in autoimmune disease, and these symptoms should be considered in the context of comprehensive medical evaluation and management. In patients with already established autoimmune diseases, which tend to occur in “flares” of illness over time, these central nervous system symptoms could be an early sign of an impending flare of illness, possibly mobilizing earlier intervention,” Dr James Alan Bourgeois, co-author of the study and professor in the UC Davis Department of Psychiatry and Behavioral Sciences and vice chair of Hospital Psychiatry Services at UC Davis Health told Theravive.
The researches conducted a survey of 767 people who live with lupus and 400 clinicians. Detailed interviews were also undertaken for 69 people living with lupus and 50 clinicians.
Those with lupus were asked about timing of neuropsychiatric symptoms including loss of balance, hallucinations and depression. They were also asked to detail the order they experienced symptoms during a flare up of their disease.
They found that three in five of the people with lupus surveyed reported that they experienced disrupted dream sleep. A third of respondents said this symptom began more than a year before the onset of lupus.
Just under one in four of those with lupus reported experiencing hallucinations. For 85% of those, the symptom of hallucination didn’t appear until onset of lupus or later.
Three in five of those with lupus said that they experienced an increase in disrupted dreaming sleep not long before they experience hallucinations. They reported that the nightmares were distressing and often vivid. In many cases the nightmares involved being attacked, crushed, falling or trapped.
The researchers noted that using the term “daymares” to describe hallucinations was often helpful for patients who found it less frightening or stigmatizing.
Those with lupus noted that if they were experiencing hallucinations they were reluctant to share their experience. Specialists also said they hadn’t considered that hallucinations and nightmares could be related to a flare up of disease.
Increasing awareness of neuropsychiatric symptoms, the researchers argue, is important to patients.
“We decided to carry out this study for two main reasons. Firstly, the key research ethos of our team is that we ask patients what their research priorities are, and improving clinician awareness about neuropsychiatric symptoms in these diseases was a priority. We also ask patients which symptoms they are actually experiencing rather than assuming that they will only experience those in the published criteria, so we had a wider range of patient-derived symptoms and questions than has previously been studied,” Dr Melanie Sloan, lead author of the study and a researcher at the Department of Public Health and Primary Care at the University of Cambridge told Theravive.
The researchers say their study should be a strong encouragement to doctors to ask their patients about nightmares and other psychiatric symptoms.
They note that there are reports of patients being wrongly diagnosed or hospitalized for a psychotic episode, which later on was in fact found to be the first sign of autoimmune disease.
“Patients with lupus and other systemic rheumatic autoimmune diseases usually have many different symptoms as parts of their disease pattern, some will be physical (such as joint swellings and rashes) and some will be mental health (such as depression and hallucinations),” Sloan said.
“Not all patients will experience all the possible symptoms, but if we can raise awareness of these symptoms being a common part of these rheumatological diseases, then patients and doctors can monitor each person’s usual progression of symptoms in a flare up (period of worsening disease activity). We found that people often had a similar pattern of symptoms each flare up, which means that earlier treatment may be possible. Lupus in particularly can lead to organ damage and even death in some cases, so earlier intervention is essential.”