Association of psychosis with antiphospholipid antibody syndrome: A systematic review of clinical studies

Objective In this systematic review, we reviewed the association between Antiphospholipid antibody syndrome (APS) and psychosis and focused on the prevalence, clinical presentation, immunologic and neurological workup, treatment options, and clinical outcomes. Methodology We performed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)’s guidelines. We searched eight databases for potential articles and manually searched references and relevant articles of included studies. We included all articles reporting psychotic symptoms in patients with APS. Article quality was assessed using an adapted version of the Cancer Council Australia tool for case-series. Results We included 23 articles of 454 articles found. The mean patient age at presentation was 39 years and most patients were women. Delusions and hallucinations were the common clinical manifestations of APS-associated psychosis. Findings on neuroimaging were attributed to APS-associated thrombosis in most cases. Most patients had a complete resolution of psychotic symptoms. Conclusion APS-associated psychosis is rare. Later age of onset for psychosis, sudden onset, female sex, and comorbid medical and psychiatric symptoms should raise the suspicions for the presence of APS. APS-associated psychosis may have a favorable prognosis. However, further studies need to validate this conclusion.