ISLAMABAD, May 31 (Online): Researchers from the University of Cambridge and King\u2019s College London have found that an increase in nightmares and hallucinations, sometimes termed \u2018daymares,\u2019 may signal the early stages of autoimmune diseases like lupus.
\nTheir new study surveyed and interviewed hundreds of patients and clinicians, revealing how these symptoms often precede disease flares.
\nRecognizing these early warning signs could improve patient care and prevent severe flare-ups by allowing for timely intervention.
\nIn a recent study, published in eClinicalMedicineTrusted Source, a team of researchers from the University of Cambridge and King\u2019s College London, both in the United Kingdom, surveyed 676 individuals with lupus and 400 clinicians who provided care for people with this condition.<\/p>\n
They also conducted in-depth interviews with 69 individuals living with systemic autoimmune rheumatic diseasesTrusted Source \u2014 including lupus \u2014 and 50 clinicians.<\/p>\n
Lupus is an autoimmune inflammatory disease that affects multiple organs, including the brain.<\/p>\n
Disrupted sleep, nightmares a common symptom of lupus
\nThe study asked patients about the timing of 29 neurological and mental health symptoms, such as depression, hallucinations, and loss of balance.<\/p>\n
During interviews, the participants were also asked to list the typical order in which their symptoms appeared during a flare-up.<\/p>\n
One of the more common symptoms reported was disrupted dream sleep, experienced by three out of five individuals, with a third of them noting this symptom appeared more than a year before the onset of lupus.<\/p>\n
Just under one in four people reported experiencing hallucinations, but for 85% of them, this symptom did not manifest until around the onset of the disease or later.<\/p>\n
However, interviews revealed that three in five lupus patients and one in three individuals with other rheumatology-related conditions experienced increasingly disrupted dream sleep \u2014 typically vivid and distressing nightmares \u2014 just before their hallucinations began.<\/p>\n
Lead author Melanie Sloan, PhD, DPH, from the Department of Public Health and Primary Care at the University of Cambridge explained the key findings to Medical News Today.<\/p>\n
She told us that:<\/p>\n
\u201cOne of the most important findings is that these types of neuropsychiatric symptoms could be an early warning system that people\u2019s autoimmune disease is about to flare. This included symptoms such as nightmares that aren\u2019t on any diagnostic criteria or on many doctors radars, yet experienced by many patients with lupus and the other systemic rheumatic diseases.\u201d<\/p>\n
\u201cWhat we found was that there was a lot of similarity in the symptoms that each person experienced just before \/ at the start of their flare ups for each subsequent flare up they had,\u201d Sloan highlighted.<\/p>\n
\u2018Daymares\u2019 less stigmatizing than \u2018hallucinations\u2019
\nThese nightmares often involved scenarios of being attacked, trapped, crushed or falling.<\/p>\n
A participant from Ireland described their nightmares as horrific and graphic, involving scenes such as murders and people\u2019s skin coming off.<\/p>\n
The study interviewers discovered that referring to hallucinations as \u201cdaymares\u201d often triggered a \u201clightbulb\u201d moment for patients, as they found this term to be less frightening and stigmatizing.<\/p>\n
A participant from England explained that the term \u201cdaymare\u201d immediately made sense to them. They described it as not necessarily scary but similar to having a dream while being awake, such as sitting in the garden and seeing different things.<\/p>\n
Patients experiencing hallucinations were hesitant to discuss them, and many specialists had not previously considered a link between nightmares, hallucinations and disease flare-ups.<\/p>\n
\u201cPatients often knew which was a \u2018bad\u2019 symptom for them that meant that their disease was about to flare [up], yet many of these symptoms are not discussed with doctors. Sometimes this is because patients and doctors don\u2019t know that these mental health and neurological symptoms are a very common part of these autoimmune diseases, particularly with lupus, which is well known to impact the brain.\u201d<\/p>\n
\u2013 Melanie Sloan, PhD, DPH<\/p>\n
\u201cSo the patients don\u2019t think to mention that they have been having nightmares, or their hands go numb, or they feel dizzy, or they have a sudden change in mood, or any combination of the many possible symptoms, and the doctors don\u2019t think to ask,\u201d Sloan noted.<\/p>\n
Why might autoimmune diseases cause nightmares, hallucinations?
\nSloan explained how, in some cases, \u201cpatients are reluctant to report mental health symptoms for fear of the stigma.\u201d<\/p>\n
\u201cA particular problem is that many patients with rheumatological and other chronic diseases have been misdiagnosed in the past with psychiatric or psychological problems, so these types of symptoms can be particularly hidden from doctors for fear that they will be misattributed again,\u201d she pointed out.<\/p>\n
These incidents were later identified as early indicators of their autoimmune disease.<\/p>\n
Most specialists agreed to discuss these symptoms with their patients in the future, recognizing that identifying these early signs of flare-ups could serve as an \u201cearly warning system.\u201d<\/p>\n
\u201cWe would strongly encourage patients and doctors to work together to see if there is a similar progression of symptoms for that patient in each flare-up. Then they both will be able to take action when the pattern starts again which should lead to earlier detection and therefore earlier treatment. Lupus in particular can cause organ damage, including the brain, and even death in some cases, so earlier detection is vital,\u201d Sloan told us.<\/p>\n
Guy Leschziner, PhD, one of the study authors, a neurologist at Guys\u2019 and St Thomas\u2019 NHS Foundation Trust and author of The Secret World of Sleep, pointed out that \u201cthe mechanisms by which nightmares may be precipitated by lupus flare-ups is at the current time unknown.\u201d<\/p>\n
\u201cSpeculatively, we know that inflammation or infection anywhere in the body can give rise to nightmares, as in \u2018fever dreams.\u2019 This may be a diffuse effect of chemicals mediating inflammation within the body, called cytokines, on the brain, and resulting in less stable REM sleep. An alternative possible explanation is direct inflammation of the brain itself disrupting the brain circuits that regulate sleep and dreaming, in the midbrain and brainstem.\u201d<\/p>\n
\u2013 Guy Leschziner, PhD<\/p>\n
Crucial to identify new signs and symptoms of lupus
\nJames Giordano, PhD, professor of neurology and biochemistry from the Pellegrino Center at Georgetown University Medical Center, not involved in this research, told MNT that \u201cthis is a well-conceived and -performed study that sought to examine if, and to what extent certain psychiatric signs and symptoms presented in advance of either formal (first) diagnosis or flare-ups of a neuropsychiatric (NP) variant of systemic lupus erythematosus (SLE).\u201d<\/p>\n
\u201cGiven that the pathologic autoimmune changes of NPSLE are focal to the brain, it is important that the present study defined that NP signs and symptoms often precede either initial diagnosis, or subsequent flare ups of SLE,\u201d he told us.<\/p>\n
Giordano further pointed out that \u201cthis study notes that formal diagnosis of SLE is often a process of elimination, which in some cases, can take considerable time.\u201d<\/p>\n
\u201cThe identification of psychiatric features, in combination with, or in advance of clinically-relevant presentation of other pathologic signs and symptoms may be an important marker to aid in both initial diagnosis, and assessment and prognosis of potential exacerbations of the disease.\u201d<\/p>\n
\u2013 James Giordano, PhD<\/p>\n
\u201cOf course, not every presentation of psychiatric signs and symptoms should be considered as indicative of (NP)SLE, and this is particularly true of individuals who have a durable history of psychiatric issues,\u201d he cautioned.<\/p>\n
\u201cHowever, the occurrence of psychiatric features in individuals with other rheumatological signs, symptoms, and\/or conditions may be of valuable consideration toward [either] establishing the differential diagnosis of (NP)SLE, or in clinically predicting flare-ups in those patients who have been diagnosed with the disease,\u201d said Giordano.<\/p>\n
\u201c[T]hese findings may serve to further mitigate individuals\u2019 hesitance to report psychiatric signs and symptoms for fear of stigmatization,\u201d he also added.<\/p>\n
Such symptoms could also be a sign of many other autoimmune conditions, Sloan emphasized.<\/p>\n
The study author highlighted that, \u201calthough we focused on lupus for this study, we also interviewed people with all the autoimmune rheumatic diseases \u2014 for example, Sjogrens, vasculitis, and systemic sclerosis \u2014 and many of them also experience these neuropsychiatric symptoms in their flares.\u201d<\/p>\n
\u201cThis is a very under-researched area, and more medical and societal understanding would help give patients the confidence to report these symptoms if they realise that they can be as much a part of their diseases as the more commonly understand joint pain and other physical symptoms.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
ISLAMABAD, May 31 (Online): Researchers from the University of Cambridge and King\u2019s College London have found that an increase in nightmares and hallucinations, sometimes termed \u2018daymares,\u2019 may signal the early stages of autoimmune diseases like lupus. Their new study surveyed and interviewed hundreds of patients […]<\/p>\n
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