Cognitive deficit in patients with sys-temic lupus erythematosus.

This study aims to determine the prevalence of and variation in cognitive deficits in systemic lupus erythematosus (SLE) patients with a prior history of central nervous system involvement (+Hx CNS), and without (-Hx CNS); and the relationship of SLE-related cognitive deficits to medication dosage and disease activity. Ninety-four participants, 62 SLE and 32 controls, were screened for anxiety and depression before being tested for cogni-tive functioning. Subjects scoring >17 on the Hamilton anxiety score (HAM-A) and >10 on the Hamilton depressive score (HAM-D) were excluded from the study. After screening, 30 SLE patients, +Hx CNS (n = 11) and -Hx CNS (n = 19), and 22 healthy control subjects remained in the study. Cognitive impairment was identified in 9 (30.0%) SLE patients [5 (45.5%) SLE +Hx CNS patients and in 4 (21.1%) SLE -Hx CNS patients] compared with 0 (0%) control subjects (p = 0.003). The SLE +Hx CNS patients had a higher degree of cognitive impairment than SLE -Hx CNS patients in the area of attention/calculation, auditory comprehension, visuospatial ability, and executive function. Cognitive scores significantly correlated with total disease activity at the onset of SLE (p = 0.005, r = -0.500). Fur-ther evaluation of both disease activity and cognitive function in SLE patients is needed to better anticipate and provide for the social care needs of these patients in the activities of daily living.

An open-label study of quetiapine for delirium.

OBJECTIVE: To evaluate the effects of quetiapine treatment in patients with delirium. MATERIAL AND METHOD: All patients with delirium were assessed. The diagnosis of delirium was confirmed by using the Confusion Assessment Method (CAM). Quetiapine at the dose between 25 and 100 mg/day was given for 7 days. The efficacy of quetiapine on delirium was evaluated by using the Delirium Rating Scale (DRS) and the Clinical Global Impression-Severity scale (CGI-S). The extrapyramidal side effects were assessed by using the Modified (9-item) Simpson-Angus Scale (MSAS). RESULTS: Twenty-two patients had delirium. Seventeen (10 males and 7 females) subjects with a mean age (SD) of 55.6 (18.6) years were included in the present study. Means (SDs) dose and duration (SD) of quetiapine treatment were 45.7 (28.7) mg/day and 6.5 (2.0) days, respectively. The DRS and CGI-S scores of days 2-7 were significantly lower than those of day 0 (p < 0. 001) for all comparisons). Only two subjects were shown to have mild tremor. CONCLUSION: Quetiapine within the range of 25-100 mg/day improves delirious condition within 24 hours of treatment. It is well-tolerated and has a very low propensity to induce extrapyramidal side effects. Further randomized, placebo-controlled trials are warranted.