Background To determine the frequency, characteristics and long-term outcome of psychosis due to systemic lupus erythematosus (SLE) in a cohort of Barbadian patients.

Materials and methods All patients with 4 or more American College of Rheumatology (ACR) classification criteria for SLE along with a clinical diagnosis of lupus psychosis were included in the assessment. Patients were identified from rheumatology clinic data and the Barbados lupus registry. Analysis was restricted to events occurring between January 1985 and December 2015.

Results Lupus psychosis was diagnosed and treated in 28 of 376 patients (7.4%) making it the most common manifestation of neuropsychiatric lupus (NPSLE) in this group of patients. Most patients were female (F = 27) and the median age at diagnosis of lupus psychosis was 31 years. In 61% of patients the psychosis was a presenting feature or developed within a year of SLE diagnosis. Psychosis was part of a multisystemic involvement characterised by polyarthritis (84%), haematologic features (74.1%), serositis (50.3%), renal disease (47%)- the frequency of these complications being in keeping with that of the entire group of SLE patients. All patients had resolution of the psychotic symptoms within weeks of treatment. Lupus psychosis was not a direct contributor to mortality. The 18 deaths recorded were secondary to intercurrent illness – SLE nephritis (39%), stroke (28%) and infection (22%).

Conclusion Lupus psychosis is the most common characteristic of NPSLE in this group of Black Caribbean patients and is an early, highly responsive complication- typically occurring in the setting of multisystemic involvement. The long-term outcome of patients was generally not favourable because of concurrent complications which lead to death.