Nightmares and hallucinations called a possible sign of autoimmune diseases

Fearful dreams and hallucinations may be an early sign of autoimmune diseases, including systemic lupus erythematosus. An international group of researchers came to this conclusion after interviewing patients and doctors.

Autoimmune diseases are diseases in which the immune system attacks the body's own cells. This results in chronic inflammation of the intestines, thyroid gland, and type 1 diabetes. Recent studies have also reported on the autoimmune nature of schizophrenia and the link between autoimmune diseases and an increased risk of psychosis.

An international team of researchers from the UK, USA and Italy have drawn attention to the fact that psychosis is often confused with early symptoms of systemic lupus erythematosus or relapsing systemic lupus erythematosus. This is an autoimmune disease in which the body develops antibodies to its own DNA and affects various organs: joints, skin, kidneys, heart, lungs, blood vessels, brain. The scientific article, which considers vivid nightmares and waking hallucinations as "precursors" of lupus, was published by the journal EClinicalMedicine.

The researchers interviewed 676 people with confirmed systemic lupus erythematosus and 400 doctors via questionnaire. They also conducted in-depth interviews with 69 people diagnosed with rheumatic (affecting all connective tissue structures) autoimmune diseases, including lupus, and 50 doctors. Special attention was paid to 29 neurological and psychiatric symptoms. Where possible, patients reconstructed the order in which these symptoms appeared when the disease worsened.

One of the most common symptoms was sleep disturbance, in which patients had vivid, distressing nightmares. These dreams usually involved being attacked, being trapped, or experiencing natural disasters: "It was as if murders were being committed, as if people were being skinned." Sixty per cent of respondents experienced this symptom, a third of whom reported experiencing it more than a year before diagnosis. Three in five lupus patients and one in three with another rheumatic autoimmune disease were more likely to start having nightmares just before the hallucinations occurred.

Patients who had experienced hallucinations were reluctant to talk about their experiences, and many of the health professionals interviewed reported that they had never before considered "nightmares in sleep or in waking life" to be a sign of an exacerbation of autoimmune disease. A nurse from Scotland noted:

"I've seen patients, especially young women, come into hospital with a psychotic episode and not be tested for lupus until someone says, "I wonder if it could be lupus." It could be months before that happened. We're increasingly seeing that this is how lupus affects some people and they need a lot of steroids rather than antipsychotic drugs."

The researchers pointed out that doctors should discuss neurological and psychiatric symptoms, particularly nightmares and hallucinations, with patients in more detail. People who come to the hospital may consider them insignificant or embarrassing, and therefore withhold details important for diagnosis and subsequent treatment. As the doctors interviewed noted, attention to early symptoms can be an "early warning system". It would enable timely and competent initiation of care and even reduce the length of stay in the clinic by preventing exacerbations at an early stage.