05/08/2026
Neuropsychiatric systemic lupus erythematosus (NPSLE) is a rare complication of lupus that can cause both psychosis and catatonia. Managing these symptoms together is challenging, as administering antipsychotics may worsen catatonia. Standard management includes high-dose benzodiazepines, introducing antipsychotics after catatonia stabilizes, and electroconvulsive therapy (ECT) for refractory cases. This poses a dilemma when patients experience severe psychosis and medication-refractory catatonia, especially where ECT is unavailable. Despite the recent surge of published pediatric NPSLE cases with concurrent psychosis and catatonia, there has not been an updated review of the literature. Our report summarizes the clinical outcomes from 8 patient cases to provide a brief update of the literature, examine treatment modalities, and discuss the importance of judicious pharmacological sequencing in optimizing outcomes. https://twp.ai/4hr11g