A recent study published in eMedicineClinical suggests that an increase in nightmares and hallucinations could serve as warning signs of autoimmune diseases, such as lupus. Researchers argue that recognizing these mental health and neurological symptoms can help predict when a patient’s illness is about to worsen, allowing for earlier intervention and potentially improving patient care.
Lupus, or systemic lupus erythematosus, is a chronic autoimmune disease in which the body’s immune system mistakenly attacks its own tissues. This disease can affect various parts of the body, including the skin, joints, kidneys, heart, lungs, blood cells, and brain. Symptoms of lupus are diverse and often include fatigue, joint pain, rashes, and organ inflammation.
What makes lupus particularly difficult to diagnose and manage is its unpredictable nature, where periods of illness (flares) alternate with periods of remission. The disease can vary greatly from person to person, both in terms of severity and which organs are involved.
One of the lesser known but significant aspects of lupus is its impact on the brain, leading to neuropsychiatric symptoms such as mood swings, cognitive dysfunction, seizures, and psychosis. These symptoms can complicate the diagnosis and treatment of lupus because they are often mistaken for primary psychiatric disorders rather than manifestations of the autoimmune disease.
The motivation for this study arose from the need to better understand and treat neuropsychiatric symptoms associated with lupus. Researchers observed that many lupus patients reported experiencing vivid and distressing nightmares and hallucinations, which often went unreported or were misattributed to psychiatric problems. These symptoms can be profoundly distressing for patients and, if not properly understood, can lead to inappropriate treatments and delayed interventions for the underlying autoimmune disease.
The study aimed to determine whether these mental health symptoms could serve as warning signs of disease flares in lupus patients. By systematically studying the prevalence, timing and progression of symptoms such as nightmares and hallucinations, researchers hoped to uncover patterns that could help predict and manage disease activity.
The researchers conducted their new study using a mixed-methods approach, combining quantitative surveys and qualitative interviews to collect comprehensive data on the mental health and neurological symptoms experienced by people with autoimmune diseases. They surveyed 676 people living with lupus and 400 clinicians to get a comprehensive understanding of the prevalence and timing of 29 different symptoms, including depression, hallucinations and loss of balance.
In addition to the surveys, researchers conducted detailed interviews with 69 patients suffering from systemic autoimmune rheumatic diseases (including lupus) and 50 clinicians. These interviews were semi-structured, allowing participants to share their experiences and perspectives in depth.
One of the most significant findings was the prevalence of disturbed dream sleep in lupus patients. About three in five patients reported having vivid, distressing nightmares.
A third of these patients reported that these disturbed dreams occurred more than a year before the onset of other lupus symptoms. This suggests that nightmares may serve as an early warning sign, signaling the impending onset of illness well before more recognizable physical symptoms appear.
Hallucinations were another common symptom reported by lupus patients, with just under one in four experiencing them. Interestingly, 85% of these patients experienced hallucinations at the time of illness onset or later.
The study found a trend where three in five patients with lupus and one in three patients with other rheumatology-related conditions reported an increase in disturbed dream sleep, often characterized by vivid and distressing nightmares, just before starting to hallucinate. These findings suggest a progression from nightmares to hallucinations, indicating that these symptoms may be part of a broader spectrum of neurological manifestations associated with autoimmune disease flares.
“For many years, I discussed nightmares with my lupus patients and thought there was a link to their disease activity,” explained the study’s lead author, David D’Cruz, of King’s College London. “This research provides evidence of this, and we strongly encourage more doctors to ask about nightmares and other neuropsychiatric symptoms – considered unusual, but actually very common in systemic autoimmunity – to help us detect more disease outbreaks early.”
Qualitative data collected during patient interviews further explored these findings. Patients described their nightmares as extremely vivid and distressing, often involving themes of attack, entrapment, crushing, or falling. For example, one Irish patient described his nightmares as “horrible, like murder, like skin coming off people.”
These striking descriptions highlight the serious psychological impact of such symptoms and their potential link to disease activity. Additionally, using the term “nightmares” to describe hallucinations helped patients understand and articulate their experiences more clearly, leading to what many described as “light bulb” moments.
The study also highlighted a gap in current clinical practice. Many clinicians had not previously considered nightmares and hallucinations to be linked to disease flares. However, after learning the study results, most clinicians agreed that recognizing these symptoms could serve as an early warning system, allowing them to intervene earlier and potentially prevent serious flare-ups. Researchers highlighted the importance of clinicians discussing these symptoms with their patients and documenting each patient’s individual symptom progression to improve care.
“It is important that clinicians talk to their patients about these types of symptoms and take the time to write down each patient’s individual symptom progression,” said lead author Melanie Sloan of the Department of Public Health and Primary Care. from the University of Cambridge. “Patients often know which symptoms are a bad sign that their illness is about to get worse, but patients and doctors may be reluctant to discuss mental health and neurological symptoms, particularly if they don’t realize that these can be part of autoimmune diseases.
The study results suggest that nightmares and hallucinations could be significant indicators of disease activity. But there are some limitations to note. The data relied largely on patient reports, which may be subject to recall bias. Additionally, the study did not verify diagnoses and the sample may not be fully representative of the broader patient population. Further research is needed to quantitatively test the theory that neurological and psychiatric symptoms may serve as early indicators of autoimmune disease flares.
Future studies should also explore potential mechanisms underlying the association between sleep disturbances, nightmares, and autoimmune disease activity. This could involve looking at changes in brain activity and immune function during disease progression.
Guy Leschziner, study author and neurologist at Guys and St Thomas Hospital, and author of The Secret World of Sleep, said: “We have long been aware that alterations in dreaming can signify changes in physical health. , neurological and mental, and can sometimes be early indicators of disease. However, this is the first evidence that nightmares can also help us monitor an autoimmune disease as serious as lupus, and it is an important indication for patients and clinicians that sleep symptoms can warn of an imminent relapse.
The study titled “Neuropsychiatric prodromes and symptom timing in relation to disease onset and/or flares in SLE: results from the international mixed-methods INSPIRE study” was authored by Melanie Sloan, James A. Bourgeois, Guy Leschziner, Thomas A. Pollak, Mervi Pitkanen, Rupert Harwood, Michael Bosley, Alessandra Bortoluzzi, Laura Andreoli, Wendy Diment, James Brimicombe, Mandeep Ubhi, Colette Barrere, Felix Naughton, Caroline Gordon and David D’Cruz.
News Source : www.psypost.org
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