A recent study conducted by researchers from the University of Cambridge and King’s College London explored the relationship between neuropsychiatric symptoms and the early stages of autoimmune diseases such as lupus. By surveying hundreds of patients and clinicians, the researchers found that nightmares and hallucinations, referred to as ‘daymares,’ may signal the onset of disease flares. Recognizing these early warning signs could potentially improve patient care and prevent severe flare-ups through timely intervention.
The study, published in eClinicalMedicine, included surveys of 676 individuals with lupus, interviews with 400 clinicians, and in-depth interviews with 69 individuals living with systemic autoimmune rheumatic diseases. Lupus is an autoimmune inflammatory disease that affects multiple organs, including the brain. Participants were asked about the timing of various neurological and mental health symptoms, such as disrupted dream sleep, depression, hallucinations, and loss of balance. One of the more common symptoms reported was disrupted dream sleep, with vivid and distressing nightmares often preceding hallucinations in flare-ups.
Lead author Melanie Sloan highlighted the significance of the study’s findings, noting that neuropsychiatric symptoms could serve as an early warning system for autoimmune disease flares. She emphasized the importance of recognizing symptoms like nightmares, as they may not be on diagnostic criteria or radar for many doctors. Interviews with participants revealed that nightmares often involved scenarios of being attacked, trapped, crushed, or falling. Referring to hallucinations as ‘daymares’ helped some patients better understand and discuss their experiences.
Patients experiencing hallucinations were often hesitant to disclose these symptoms to specialists, who may not have previously associated nightmares and hallucinations with disease flare-ups. Sloan explained that many patients are reluctant to report mental health symptoms due to fear of stigma or misdiagnosis as psychiatric issues. Specialists involved in the study expressed readiness to discuss these symptoms with patients in the future, recognizing the potential value of identifying early signs of flare-ups as an ‘early warning system’ for intervention.
Guy Leschziner, a neurologist and study author, acknowledged that the mechanisms linking nightmares to lupus flare-ups remain unknown. He suggested that inflammation or infection in the body could affect the brain’s regulation of sleep and dreaming, potentially contributing to nightmares. James Giordano, a professor of neurology and biochemistry, emphasized the importance of recognizing psychiatric signs and symptoms in advance of formal diagnosis or flare-ups in lupus. While not all psychiatric symptoms indicate lupus, they may be valuable in differential diagnosis and predicting disease exacerbations.
Sloan noted that the study’s focus on lupus also sheds light on neuropsychiatric symptoms in other autoimmune rheumatic diseases, such as Sjogrens, vasculitis, and systemic sclerosis. These conditions may also involve similar symptoms during flares, underscoring the need for further research and understanding in this area. Greater awareness of these symptoms could empower patients to report their experiences and seek appropriate care. Overall, the study highlights the potential significance of nightmares and hallucinations as early indicators of autoimmune disease flare-ups, emphasizing the importance of timely detection and intervention for improved patient outcomes.
