Could nightmares, hallucinations be a sign?

The study asked patients about the timing of 29 neurological and mental symptoms, such as depression, hallucinations and loss of balance.

During the interviews, participants were also asked to list the usual order in which their symptoms appeared during a flare-up.

One of the most commonly reported symptoms was disturbed dream sleep, experienced by three in five people, with a third noting that this symptom had appeared more than a year before the onset of lupus.

Just under one in four people reported having hallucinations, but for 85% of them, this symptom did not appear until near the onset of the illness or later.

However, interviews revealed that three in five lupus patients and one in three people with other rheumatology-related conditions experienced increasingly disrupted dream sleep – usually vivid, distressing nightmares – just before the beginning of their hallucinations.

Lead author Melanie Sloan, PhD, DPH, from the Department of Public Health and Primary Care at the University of Cambridge, explained the key findings at Medical news today.

She told us that:

“One of the most important findings is that these types of neuropsychiatric symptoms could provide an early warning system that the autoimmune disease is about to flare up. This included symptoms such as nightmares that are not on any diagnostic criteria or on many doctors’ radars, but that many patients with lupus and other systemic rheumatic diseases experience.

“What we found was that there were a lot of similarities in the symptoms each person experienced just before/at the start of their flares for each subsequent flare,” Sloan pointed out.

These nightmares often involved attack, entrapment, crushing, or falling scenarios.

One Irish participant described his nightmares as horrific and graphic, involving scenes such as murder and people’s skin peeling off.

Study investigators found that labeling hallucinations as “nightmares” often triggered a “light bulb” moment for patients, as they found the term less frightening and stigmatizing.

A participant from England explained that the term “daymare” immediately took on meaning for him. They described it as not necessarily scary, but dream-like while awake, like sitting in the garden and seeing different things.

Patients suffering from hallucinations were reluctant to talk about them, and many specialists had not yet considered a link between nightmares, hallucinations and illness flare-ups.

“Patients often knew what a ‘bad’ symptom for them was that meant their illness was about to get worse, but many of these symptoms are not discussed with doctors. Sometimes this is because patients and doctors are unaware that these mental health and neurological symptoms are a very common part of these autoimmune diseases, especially lupus, which is well known to impact the brain.

– Mélanie Sloan, Ph.D., DPH

“So patients don’t think to mention that they’ve had nightmares, or that their hands are numb, or that they feel dizzy, or that they have a sudden change in mood, or any combination of the many possible symptoms, and doctors don’t think to mention I don’t think to ask,” noted Sloan.

Sloan explained how, in some cases, “patients are hesitant to report their mental health symptoms for fear of stigma.”

“A particular problem is that many patients with rheumatologic and other chronic illnesses have been misdiagnosed in the past with psychiatric or psychological problems, so these types of symptoms may be particularly hidden from doctors, for fear that they are not wrongly attributed again,” she stressed. .

These incidents were later identified as early indicators of their autoimmune disease.

Most specialists agreed to discuss these symptoms with their patients in the future, recognizing that identifying these early signs of flare-ups could serve as an “early warning system.”

“We strongly encourage patients and doctors to work together to see if there is a similar progression of symptoms in that patient with each flare-up. Then they will both be able to act when the regimen starts again, which should lead to earlier detection and therefore earlier treatment. Lupus in particular can cause organ damage, including the brain, and even death in some cases, so early detection is vital,” Sloan told us.

Guy Leschziner, PhD, one of the study authors, a neurologist at Guys’ and St Thomas’ NHS Foundation Trust and author of The secret world of sleeppointed out that “the mechanisms by which nightmares may be precipitated by lupus flares are currently unknown.”

“Speculatively, we know that inflammation or infection anywhere in the body can give rise to nightmares, as in “fever dreams.” This may be a diffuse effect of inflammatory mediating chemicals in the body, called cytokines, on the brain, leading to less stable REM sleep. Another possible explanation is direct inflammation of the brain itself, disrupting the brain circuits that regulate sleep and dreams, in the midbrain and brainstem.

– Guy Leschziner, PhD

James Giordano, PhD, professor of neurology and biochemistry at the Pellegrino Center at Georgetown University Medical Center, not involved in this research, said: MNT that “this is a well-designed and performed study that sought to examine whether, and to what extent, certain psychiatric signs and symptoms presented before a (first) formal diagnosis or relapses of a neuropsychiatric variant (NP ) of systemic disease. lupus erythematosus (SLE).

“Since the autoimmune pathological changes of NPSLE are localized to the brain, it is important that the present study defines that the signs and symptoms of NP often precede the initial diagnosis or subsequent flares of SLE,” we- he said.

Giordano further pointed out that “this study notes that formal diagnosis of SLE is often a process of elimination that, in some cases, can take considerable time.”

“Identification of psychiatric features, in association with or prior to the presentation of other clinically relevant pathological signs and symptoms, may be an important marker to facilitate both initial diagnosis, as well as assessment and prognosis of potential exacerbations of illness.”

–James Giordano, Ph.D.

“Of course, not all presentations of psychiatric signs and symptoms should be considered indicative of (NP)SLE, and this is particularly true for individuals who have a lasting history of psychiatric problems,” he cautioned.

“However, the occurrence of psychiatric features in individuals with other signs, symptoms and/or rheumatological conditions may be of great importance in (either) establishing the differential diagnosis of (NP)SLE or in clinically predicting flares. in these patients. who have been diagnosed with illness,” Giordano said.

“(T)hese findings could serve to further alleviate individuals’ hesitancy to report psychiatric signs and symptoms due to fear of stigma,” he also added.

Such symptoms could also be a sign of many other autoimmune diseases, Sloan pointed out.

The study author pointed out that “although we focused on lupus for this study, we also surveyed people with all autoimmune rheumatic diseases – for example Sjögren’s syndrome, vasculitis and systemic sclerosis – and many of them also experience these neuropsychiatric symptoms in their flares. .”

“This is a very understudied area, and better medical and societal understanding would help give patients the confidence to report these symptoms if they realize they may be as much a part of their illnesses as people who more commonly understand joint pain and other physical problems. symptoms.”

– Mélanie Sloan, Ph.D., DPH