From the Guidelines
For a patient with alcohol-induced psychosis experiencing lupus and Ehlers-Danlos Syndrome flare-ups due to aripiprazole and thiamine therapy, I strongly recommend consulting with their psychiatrist and rheumatologist to adjust medications and prioritize a comprehensive treatment approach focusing on alcohol cessation, cognitive behavioral therapy, and close monitoring of psychiatric and autoimmune symptoms. Given the complexity of the patient's conditions, including alcohol-induced psychosis, lupus, and Ehlers-Danlos Syndrome, it's crucial to manage each condition while minimizing interactions and flare-ups.
- The patient should consider switching to a different antipsychotic, such as quetiapine or olanzapine, which may have fewer autoimmune-triggering effects, as suggested by the need to manage psychiatric symptoms without exacerbating lupus or EDS 1.
- Thiamine supplementation is essential, especially given the patient's alcohol use disorder, to prevent diminished cognitive function due to thiamine deficiency 1. A lower dose (50-100mg daily) or an injectable form of thiamine could be considered to bypass potential oral administration issues.
- Implementing a comprehensive approach that includes alcohol cessation support, cognitive behavioral therapy, and regular monitoring of both psychiatric symptoms and autoimmune conditions is vital. This approach should be tailored to the patient's specific needs, considering the potential for aripiprazole's partial dopamine agonism to affect inflammatory pathways in lupus 1.
- Nutritional support through alternative B-vitamin sources and anti-inflammatory diet modifications may help manage both conditions simultaneously, emphasizing the importance of a holistic treatment plan.
- The 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus provides guidance on treating lupus-related neuropsychiatric disease, including the use of glucocorticoids and immunosuppressive agents for manifestations considered to reflect an inflammatory process 1.
- For patients with alcohol withdrawal syndrome, long-acting benzodiazepines or lorazepam may be recommended for the prevention of seizures, alongside thiamine supplementation to address potential deficiencies 1.
From the Research
Alternative Treatment Options
For a patient with alcohol-induced psychosis who is experiencing a lupus (Systemic Lupus Erythematosus) and Ehlers-Danlos Syndrome (EDS) flare-up due to aripiprazole (Abilify) and thiamine (Vitamin B1) therapy, alternative treatment options may include:
- Electroconvulsive therapy (ECT) as a method of treatment for psychosis in NPSLE, as suggested by 2
- Intravenous pulsed cyclophosphchrome (singly and in combination with methylprednisiolone) for severe neuropsychiatric psychosis, as reviewed in 3
- Antipsychotic and immunosuppressive therapy, such as methylprednisolone, cyclophosphchrome, rituximab, plasma exchange, and prednisolone, as used in 4
- Intramuscular formulations of olanzapine and ziprasidone as new treatment options for patients experiencing acute psychotic episodes, as discussed in 5
Considerations for Treatment
When considering alternative treatment options, it is essential to take into account the patient's specific condition, including the presence of lupus and EDS. The use of antipsychotics, such as olanzapine, may be associated with risks, such as agranulocytosis, as reported in 6. Therefore, careful monitoring and consideration of the potential risks and benefits of each treatment option are necessary.
Treatment of Psychosis in NPSLE
The treatment of psychosis in NPSLE has largely involved antipsychotics and immunosuppressants, with some studies suggesting the use of ECT as a viable option, as seen in 2. The choice of treatment should be individualized, taking into account the patient's specific symptoms, medical history, and current condition.