Neuropsychiatric Manifestations in Pediatric Systemic Lupus Erythematosus: A Clinical Study from a Mexican Pediatric Hospital

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VÁZQUEZ MAZANARES, DIANA MOLINA VALDESPINO, SILVESTRE GARCÍA DE LA PUENTE, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8497467/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a major cause of morbidity in pediatric systemic lupus erythematosus (pSLE). This study aimed to describe the frequency and characteristics of neuropsychiatric manifestations in patients aged 8–17 years with pSLE treated at a tertiary pediatric hospital in Mexico. Methods: Prospective cross-sectional study with MINI-KID evaluation and structured mental examination. Additional data included labs, EEG, EKG, and imaging. Results: Neuropsychiatric manifestations occurred in 39% of patients. Most common symptoms were anxiety, headache, depression, cognitive impairment, seizures, and delirium. Conclusion: Early detection is essential to avoid neurocognitive sequelae and functional impairment. Pediatric systemic lupus erythematosus neuropsychiatric lupus cognitive symptoms anti-dsDNA antibodies anxiety disorders What is Known – What is New What is Known • Neuropsychiatric manifestations are common in pediatric systemic lupus erythematosus and contribute significantly to morbidity and long-term functional impairment. What is New • This prospective Mexican cohort using structured psychiatric interviews shows a high frequency of anxiety, depression, and cognitive symptoms, with significant associations between cognitive impairment and nephritis, and between anti-dsDNA antibodies and delirium. INTRODUCTION Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by autoantibodies, especially antinuclear antibodies (ANA). When it affects individuals under 18 years old, it is known as pediatric systemic lupus erythematosus (pSLE). pSLE is generally more severe and follows a longer course than its adult counterpart. Approximately 10% to 20% of all SLE cases are diagnosed during childhood, with an average age of diagnosis around 12.2 years. [1–7 ] Neuropsychiatric manifestations of SLE are frequent, affecting between 14% and 91% of patients, and are associated with increased morbidity and mortality. In pediatric patients withNeuropsychiatric Systemic Lupus Erythematosus, approximately 70% will develop these manifestations within the first year after diagnosis. The most common NPSLE manifestations include headache (3–40%), cognitive dysfunction (1–20%), mood disorders (1–20%), and anxiety disorders (1–8%). Less common manifestations include delirium (3–4.5%) and seizures (7–10%). [8–13 ] The symptoms are linked to several pathological mechanisms, including: vasculopathy (disruption of the blood-brain barrier allowing autoantibodies into the central nervous system, CNS), direct neuronal damage by autoantibodies, choroid plexus dysfunction, proinflammatory processes (elevated cytokines), and neuroendocrine immune effects (activation of the Hypothalamic-Pituitary-Adrenal axis (HPA) due to chronic stress). [ 14 , 15 , 16 ] NPSLE often involves the developing brain of children and adolescents, leading to alterations in both gray and white matter, and loss of cerebral volume. This damage can interfere with cognitive development, causing difficulties in executive function, organization, and psychomotor speed, even in patients without severe active disease. [17–19] Given the high prevalence, severity, and potential for long-term functional impact of NPSLE in the pediatric population, the objective of this study was to describe the neuropsychiatric manifestations in pSLE patients aged 8 to 17 years treated at a Mexican pediatric hospital MATERIAL AND METHODS Study Design and Participants This was a clinical, observational, prospective, transversal, and analytical study. The sample consisted of pSLE patients aged 8 to 17 years attending the National Pediatric Institute (INP). Inclusion required signed informed consent from parents and assent from the patients. Patients with moderate to severe intellectual disability or chronic renal failure undergoing dialysis were excluded. Data Collection and Assessment Patients were evaluated using the MINI-KID (Mini International Neuropsychiatric Interview for Children and Adolescents). The MINI-KID is a standardized, validated, and reliable structured psychiatric interview based on DSM 5 and ICD-10 criteria. A structured mental exam was also performed. Sociodemographic variables, laboratory, immunological markers and neuroimaging results were recorded from the electronic patient files. Statistical Analysis Analysis of frequencies, means, and standard deviations (SD) were performed. Associations were assessed using Chi-squared and non-parametric statistics. RESULTS Demographic characteristics A total of 67 patients were included. Most were female (79%). The mean age at diagnosis was 14 ± 2.08 years (range 8–17). (Table 1 ) Table 1 Demographic and Clinical Characteristics of the Study Population Variable Value Total patients 67 Female 53 (79%) Mean age (years) 14 ± 2.08 Neuropsychiatric cases 26 (39%) Frequency of neuropsychiatric manifestations Neuropsychiatric symptoms were identified in 26 patients (39%). These were more frequent among adolescent females (25%). Most common neuropsychiatric manifestations: Anxiety disorders: 27 patients (40%), major depression: 18 patients (27%), with Suicide risk: 5 patients (7%), cognitive symptoms: 18 patients (27%), delirium: 3 patients (5%),. (Table 2 ) Table 2 Frequency of Neuropsychiatric Manifestations in pSLE Patients (n = 67) Diagnosis Frequency Anxiety disorders 27 (40%) Headache 26 (39%) Major depression 18 (27%) Cognitive symptoms 18 (27%) Delirium 3 (5%) Seizures 3 (5%) Statistical Associations A significant association was found between cognitive symptoms and nephritis (p = 0.001, OR 8.6, 95% CI [33, 2.1]) A highly significant association was found between anti-dsDNA antibodies and delirium (p = 0.000, OR 40, 95% CI [2.7, 575]) An association was also observed between anti-dsDNA antibodies and seizures (p = 0.074, OR 5.1, 95% CI [0.72, 36.3]) DISCUSSION This study demonstrates that neuropsychiatric manifestations are common in Mexican patients with pSLE, consistent with international literature. Anxiety disorders and headaches were the most frequent presentations, followed by depression and cognitive symptoms. These findings align with previous reports showing high rates of mood and anxiety symptoms in pediatric chronic diseases, particularly autoimmune disorders. The manifestation of SLE during adolescence is critical because this period involves active neuroplasticity. Chronic stress induced by the disease, a factor to which the adolescent brain is particularly sensitive, can disrupt this developmental stage, potentially altering brain functions necessary for learning and habit formation. [20 ] The strong association between cognitive symptoms and nephritis may reflect heightened systemic inflammation or greater disease activity among these patients. The association between anti-dsDNA antibodies and delirium supports prior research linking immunological activity with acute neuropsychiatric episodes. Early detection and comprehensive management of neuropsychiatric symptoms are essential to prevent persistent cognitive deficits, functional impairment, and reduced quality of life. Use of structured psychiatric tools such as the MINI-KID strengthens diagnostic accuracy in this population CONCLUSIONS Pediatric patients are known to present with more severe forms of lupus. This study confirms a high frequency of neuropsychiatric manifestations, with anxiety, headache, depression, and cognitive symptoms being the most prevalent. Significant associations were found between cognitive symptoms and nephritis, and anti-dsDNA antibodies and delirium, underscoring the link between systemic disease severity and specific neuropsychiatric syndromes. Neuropsychiatric manifestations occurred in more than one-third of pediatric patients with SLE, with anxiety, headache, depression, and cognitive symptoms being the most frequent. The associations between nephritis, anti-dsDNA antibodies, and specific neuropsychiatric outcomes highlight the importance of integrating psychiatric evaluation into routine pSLE monitoring. Early identification of neuropsychiatric symptoms can guide timely interventions and improve long-term prognosis. Further studies are needed to determine the association between neuropsychiatric symptoms and specific antibodies for use as diagnostic markers Abbreviations ANA Antinuclear Antibodies Anti-dsDNA Anti-double-stranded DNA Antibodies EEG Electroencephalogram EKG Electrocardiogram MINI-KID Mini International Neuropsychiatric Interview for Children and Adolescents NPSLE Neuropsychiatric Systemic Lupus Erythematosus SLE Systemic Lupus Erythematosus Declarations Competing Interests The authors have no relevant financial or non-financial interests to disclose. ETHICS APPROVAL AND CONSENT TO PARTICIPATE This study was conducted in accordance with the Declaration of Helsinki, the International Conference on Harmonisation – Good Clinical Practice (ICH-GCP) guidelines, and the Mexican General Health Law for Health Research. The study was classified as minimal risk, as it involved only non-invasive psychiatric clinical assessments. Written informed consent was obtained from all participants and their legal guardians prior to inclusion. Participation was voluntary, and refusal to participate did not affect clinical care. All data were anonymized and handled confidentially. The study protocol was approved by the Research and Ethics Committee of the Instituto Nacional de Pediatría. CONSENT TO PUBLISH The authors affirm that consent for publication of the non-identifying data was obtained from the participants or their parents/legal guardians. The manuscript does not contain any individual person’s data or images in any form. ETHICAL STATEMENT The study was approved by the Institutional Review Board (IRB) of the National Pediatric Institute. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study FUNDING The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution Sofía B. Vázquez Manzanares (SBVM) and Diana Molina Valdespino (DMV) conceptualized the study, performed the psychiatric interviews, and contributed to data collection and manuscript writing. Silvestre García de la Puente (SGdIP) provided statistical guidance and performed the data analysis. Oscar Sánchez Guerrero (OSG), Francisco E. Rivas-Larrauri (FERL), and Ana L. Rodríguez Lozano (ALRL) contributed to the clinical context, data interpretation, and critical revision of the manuscript. Jesús Ramírez Bermúdez (JRB) contributed to the conceptualization and neurological framework. SBVM wrote the first draft of the manuscript. All authors reviewed, commented on previous versions, and approved the final manuscript. References Harry O, Yasin S, Brunner H (2018) Childhood-onset systemic lupus erythematosus: A review and update. J Pediatr 196:22–30e2. 10.1016/j.jpeds.2018.01.045 Valenzuela P, Ladino M, Vargas N (2021) Childhood-onset Systemic Lupus Erythematosus: Patients features and their transition into adulthood. Andes Pediatr 92(3):375–381. https://doi.org/10.32641/andespediatr.v92i3.1653 Boteanu A (2020) Lupus eritematoso sistémico pediátrico. Protoc diagn ter pediatr 2:115–128 Justiz Vaillant AA, Goyal A, Bansal P, Varacallo M Systemic Lupus Erythematosus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publis hing; 2020 [cited 2021 Jan 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK535405/ 10.46997/revecuatneurol30200076 Valenzuela Paula L, Mabel V Nelson. Caracterización de pacientes con Lupus Eritematoso Sistémico Infantil y su transición a etapa adulta. Andes pediatr. [Internet]. 2021 Jun [citado 2024 Nov 12]; 92(3): 375–381. http://dx.doi.org/10.32641/andespediatr.v92i3.1653 Narváez J (2020) Lupus eritematoso sistémico 2020. Med Clin (Barc) 155(11):494–501. https://doi.org/10.1016/j.medcli.2020.05.009 Coronado-Alvarado CD, Gámez-Saiz IL, Sotelo Cruz N (2018) Características clínicas y comorbilidades de pacientes con lupus eritematoso sistémico en niños y adultos. Acta Pediatr Mex 39(1):1–12. https://doi.org/10.18233/apm1no1pp1-121535 Vásconez-González E, Belén-López, María, Cuchiparte, Dayana, Peláez, Katherine, Cano-Cevallos, Leonardo, Prado, Esteban Ortiz-, Galarza-Maldonado, Claudio, López-Cortés (2021) Andrés. Manifestaciones Neurológicas Del Lupus Eritematoso Sistémico: Revisión De Literatura. Revista Ecuatoriana de Neurología, 30 (2), 76–82. https://doi.org/10.46997/revecuatneurol30200076 Castro JCV, Morales CAN, Torres JMM, Agudelo LG, Rodríguez LJV (2024) Prevalencia de las manifestaciones neuropsiquiátricas en lupus eritematoso sistémico. Revista Repertorio de Med y Cirugía 33(3):238–244. 10.31260/RepertMedCir.01217372.1423 Kane BS, Dieng M, Fall BC, Sow M, Ndao AC, Djiba B et al (2019) Neurological involvement in systemic lupus erythematosus (SLE): Our recent experience. Open J Rheumatol Autoimmune Dis 09(02):25–34. 10.4236/ojra.2019.92003 Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R et al (2019) 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis rheumatol 71(9):1400–1412. 10.1002/art.40930 Santos-Ruiz A, Montero-López E, Ortego-Centeno N, Peralta-Ramírez MI (2021) Efecto del confinamiento por COVID-19 en el estado mental de pacientes con lupus eritematoso sistémico. Med Clin (Barc) 156(8):379–385. 10.1177/09612033221134203 Kane BS, Dieng M, Fall BC, Sow M, Ndao AC, Djiba B et al (2019) Neurological involvement in systemic lupus erythematosus (SLE): Our recent experience. Open J Rheumatol Autoimmune Dis 09(02):25–34. 10.4236/ojra.2019.92003 Xibillé-Friedmann D, Pérez-Rodríguez M, Carrillo-Vázquez S, Álvarez-Hernández E, Aceves FJ, Ocampo-Torres MC et al (2019) Guía de práctica clínica para el manejo del lupus eritematoso sistémico propuesta por el Colegio Mexicano de Reumatología. Reumatol Clín (Engl Ed) 15(1):3–20. 10.1016/j.reuma.2018.03.011 Davis AM, Graham TB, Zhu Y, McPheeters ML (2018) Depression and medication nonadherence in childhood-onset systemic lupus erythematosus. Lupus 27(9):1532–1541. 10.1177/0961203318779710 Cortes MEC (2022) Efectos del estrés crónico sobre la plasticidad neural del cerebro adolescente: Una revisión sistemática. Perspectivas Metodológicas 22:16–16. 10.18294/pm.2022.3955 Sheehan DV, Sheehan KH, Shytle RD, Janavs J, Bannon Y, Rogers JE et al (2010) Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). J Clin Psychiatry 71(03):313–326. 10.4088/JCP.09m05305whi Duncan L, Georgiades K, Wang L, Van Lieshout RJ, MacMillan HL, Ferro MA et al (2018) Psychometric evaluation of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Psychol Assess 30(7):916–928. https://doi.org/10.1037/pas0000541 Gómez EM, Febus KB, Messa EP, Vega G (2024) El efecto de una intervención educativa de fisioterapia en la actividad física de adolescentes y adultos jóvenes con lupus eritematoso sistémico. Fisioterapia 46(3):110–117. https://doi.org/10.1016/j.ft.2023.11.003 Lacomba-Trejo L, Valero-Moreno S, Montoya-Castilla I, Pérez-Marín M (2023) Adolescentes con y sin enfermedad crónica: competencias emocionales y malestar emocional. Revista de psicología de la salud 11(1):36–47. 10.21134/pssa.v11i1.315 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8497467","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592424838,"identity":"2f36b50c-215a-4d5d-af54-279d7f2c6d07","order_by":0,"name":"SOFIA B. 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When it affects individuals under 18 years old, it is known as pediatric systemic lupus erythematosus (pSLE). pSLE is generally more severe and follows a longer course than its adult counterpart. Approximately 10% to 20% of all SLE cases are diagnosed during childhood, with an average age of diagnosis around 12.2 years. [1\u0026ndash;7 ]\u003c/p\u003e \u003cp\u003eNeuropsychiatric manifestations of SLE are frequent, affecting between 14% and 91% of patients, and are associated with increased morbidity and mortality. In pediatric patients withNeuropsychiatric Systemic Lupus Erythematosus, approximately 70% will develop these manifestations within the first year after diagnosis. The most common NPSLE manifestations include headache (3\u0026ndash;40%), cognitive dysfunction (1\u0026ndash;20%), mood disorders (1\u0026ndash;20%), and anxiety disorders (1\u0026ndash;8%). Less common manifestations include delirium (3\u0026ndash;4.5%) and seizures (7\u0026ndash;10%). [8\u0026ndash;13 ]\u003c/p\u003e \u003cp\u003eThe symptoms are linked to several pathological mechanisms, including: vasculopathy (disruption of the blood-brain barrier allowing autoantibodies into the central nervous system, CNS), direct neuronal damage by autoantibodies, choroid plexus dysfunction, proinflammatory processes (elevated cytokines), and neuroendocrine immune effects (activation of the Hypothalamic-Pituitary-Adrenal axis (HPA) due to chronic stress). [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eNPSLE often involves the developing brain of children and adolescents, leading to alterations in both gray and white matter, and loss of cerebral volume. This damage can interfere with cognitive development, causing difficulties in executive function, organization, and psychomotor speed, even in patients without severe active disease. \u003csup\u003e[17\u0026ndash;19]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eGiven the high prevalence, severity, and potential for long-term functional impact of NPSLE in the pediatric population, the objective of this study was to describe the neuropsychiatric manifestations in pSLE patients aged 8 to 17 years treated at a Mexican pediatric hospital\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eStudy Design and Participants\u003c/p\u003e \u003cp\u003eThis was a clinical, observational, prospective, transversal, and analytical study. The sample consisted of pSLE patients aged 8 to 17 years attending the National Pediatric Institute (INP). Inclusion required signed informed consent from parents and assent from the patients. Patients with moderate to severe intellectual disability or chronic renal failure undergoing dialysis were excluded.\u003c/p\u003e \u003cp\u003eData Collection and Assessment\u003c/p\u003e \u003cp\u003ePatients were evaluated using the MINI-KID (Mini International Neuropsychiatric Interview for Children and Adolescents). The MINI-KID is a standardized, validated, and reliable structured psychiatric interview based on DSM 5 and ICD-10 criteria. A structured mental exam was also performed. Sociodemographic variables, laboratory, immunological markers and neuroimaging results were recorded from the electronic patient files.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAnalysis of frequencies, means, and standard deviations (SD) were performed. Associations were assessed using Chi-squared and non-parametric statistics.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDemographic characteristics\u003c/p\u003e \u003cp\u003eA total of 67 patients were included. Most were female (79%). The mean age at diagnosis was 14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08 years (range 8\u0026ndash;17). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and Clinical Characteristics of the Study Population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (79%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuropsychiatric cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFrequency of neuropsychiatric manifestations\u003c/p\u003e \u003cp\u003eNeuropsychiatric symptoms were identified in 26 patients (39%). These were more frequent among adolescent females (25%).\u003c/p\u003e \u003cp\u003eMost common neuropsychiatric manifestations: Anxiety disorders: 27 patients (40%), major depression: 18 patients (27%), with Suicide risk: 5 patients (7%), cognitive symptoms: 18 patients (27%), delirium: 3 patients (5%),. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of Neuropsychiatric Manifestations in pSLE Patients (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeizures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStatistical Associations\u003c/p\u003e \u003cp\u003eA significant association was found between cognitive symptoms and nephritis (p\u0026thinsp;=\u0026thinsp;0.001, OR 8.6, 95% CI [33, 2.1])\u003c/p\u003e \u003cp\u003eA highly significant association was found between anti-dsDNA antibodies and delirium (p\u0026thinsp;=\u0026thinsp;0.000, OR 40, 95% CI [2.7, 575])\u003c/p\u003e \u003cp\u003eAn association was also observed between anti-dsDNA antibodies and seizures (p\u0026thinsp;=\u0026thinsp;0.074, OR 5.1, 95% CI [0.72, 36.3])\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrates that neuropsychiatric manifestations are common in Mexican patients with pSLE, consistent with international literature. Anxiety disorders and headaches were the most frequent presentations, followed by depression and cognitive symptoms. These findings align with previous reports showing high rates of mood and anxiety symptoms in pediatric chronic diseases, particularly autoimmune disorders.\u003c/p\u003e \u003cp\u003eThe manifestation of SLE during adolescence is critical because this period involves active neuroplasticity. Chronic stress induced by the disease, a factor to which the adolescent brain is particularly sensitive, can disrupt this developmental stage, potentially altering brain functions necessary for learning and habit formation. \u003csup\u003e[20 ]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe strong association between cognitive symptoms and nephritis may reflect heightened systemic inflammation or greater disease activity among these patients. The association between anti-dsDNA antibodies and delirium supports prior research linking immunological activity with acute neuropsychiatric episodes.\u003c/p\u003e \u003cp\u003eEarly detection and comprehensive management of neuropsychiatric symptoms are essential to prevent persistent cognitive deficits, functional impairment, and reduced quality of life. Use of structured psychiatric tools such as the MINI-KID strengthens diagnostic accuracy in this population\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003ePediatric patients are known to present with more severe forms of lupus. This study confirms a high frequency of neuropsychiatric manifestations, with anxiety, headache, depression, and cognitive symptoms being the most prevalent. Significant associations were found between cognitive symptoms and nephritis, and anti-dsDNA antibodies and delirium, underscoring the link between systemic disease severity and specific neuropsychiatric syndromes.\u003c/p\u003e \u003cp\u003eNeuropsychiatric manifestations occurred in more than one-third of pediatric patients with SLE, with anxiety, headache, depression, and cognitive symptoms being the most frequent. The associations between nephritis, anti-dsDNA antibodies, and specific neuropsychiatric outcomes highlight the importance of integrating psychiatric evaluation into routine pSLE monitoring. Early identification of neuropsychiatric symptoms can guide timely interventions and improve long-term prognosis.\u003c/p\u003e \u003cp\u003eFurther studies are needed to determine the association between neuropsychiatric symptoms and specific antibodies for use as diagnostic markers\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cb\u003eANA\u003c/b\u003e Antinuclear Antibodies\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnti-dsDNA\u003c/b\u003e Anti-double-stranded DNA Antibodies\u003c/p\u003e\u003cp\u003e\u003cb\u003eEEG\u003c/b\u003e Electroencephalogram\u003c/p\u003e\u003cp\u003e\u003cb\u003eEKG\u003c/b\u003e Electrocardiogram\u003c/p\u003e\u003cp\u003e\u003cb\u003eMINI-KID\u003c/b\u003e Mini International Neuropsychiatric Interview for Children and Adolescents\u003c/p\u003e\u003cp\u003e\u003cb\u003eNPSLE\u003c/b\u003e Neuropsychiatric Systemic Lupus Erythematosus\u003c/p\u003e\u003cp\u003e\u003cb\u003eSLE\u003c/b\u003e Systemic Lupus Erythematosus\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/h2\u003e \u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki, the International Conference on Harmonisation \u0026ndash; Good Clinical Practice (ICH-GCP) guidelines, and the Mexican General Health Law for Health Research. The study was classified as minimal risk, as it involved only non-invasive psychiatric clinical assessments. Written informed consent was obtained from all participants and their legal guardians prior to inclusion. Participation was voluntary, and refusal to participate did not affect clinical care. All data were anonymized and handled confidentially. The study protocol was approved by the Research and Ethics Committee of the Instituto Nacional de Pediatr\u0026iacute;a.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCONSENT TO PUBLISH\u003c/strong\u003e \u003cp\u003eThe authors affirm that consent for publication of the non-identifying data was obtained from the participants or their parents/legal guardians. The manuscript does not contain any individual person\u0026rsquo;s data or images in any form.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eETHICAL STATEMENT\u003c/h2\u003e \u003cp\u003eThe study was approved by the Institutional Review Board (IRB) of the National Pediatric Institute. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFUNDING\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSof\u0026iacute;a B. V\u0026aacute;zquez Manzanares (SBVM) and Diana Molina Valdespino (DMV) conceptualized the study, performed the psychiatric interviews, and contributed to data collection and manuscript writing. Silvestre Garc\u0026iacute;a de la Puente (SGdIP) provided statistical guidance and performed the data analysis. Oscar S\u0026aacute;nchez Guerrero (OSG), Francisco E. Rivas-Larrauri (FERL), and Ana L. Rodr\u0026iacute;guez Lozano (ALRL) contributed to the clinical context, data interpretation, and critical revision of the manuscript. Jes\u0026uacute;s Ram\u0026iacute;rez Berm\u0026uacute;dez (JRB) contributed to the conceptualization and neurological framework. SBVM wrote the first draft of the manuscript. All authors reviewed, commented on previous versions, and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHarry O, Yasin S, Brunner H (2018) Childhood-onset systemic lupus erythematosus: A review and update. J Pediatr 196:22\u0026ndash;30e2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpeds.2018.01.045\u003c/span\u003e\u003cspan address=\"10.1016/j.jpeds.2018.01.045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValenzuela P, Ladino M, Vargas N (2021) Childhood-onset Systemic Lupus Erythematosus: Patients features and their transition into adulthood. Andes Pediatr 92(3):375\u0026ndash;381. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.32641/andespediatr.v92i3.1653\u003c/span\u003e\u003cspan address=\"10.32641/andespediatr.v92i3.1653\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoteanu A (2020) Lupus eritematoso sist\u0026eacute;mico pedi\u0026aacute;trico. Protoc diagn ter pediatr 2:115\u0026ndash;128\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJustiz Vaillant AA, Goyal A, Bansal P, Varacallo M Systemic Lupus Erythematosus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publis hing; 2020 [cited 2021 Jan 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK535405/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK535405/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.46997/revecuatneurol30200076\u003c/span\u003e\u003cspan address=\"10.46997/revecuatneurol30200076\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValenzuela Paula L, Mabel V Nelson. Caracterizaci\u0026oacute;n de pacientes con Lupus Eritematoso Sist\u0026eacute;mico Infantil y su transici\u0026oacute;n a etapa adulta. Andes pediatr. [Internet]. 2021 Jun [citado 2024 Nov 12]; 92(3): 375\u0026ndash;381. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.32641/andespediatr.v92i3.1653\u003c/span\u003e\u003cspan address=\"10.32641/andespediatr.v92i3.1653\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNarv\u0026aacute;ez J (2020) Lupus eritematoso sist\u0026eacute;mico 2020. Med Clin (Barc) 155(11):494\u0026ndash;501. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.medcli.2020.05.009\u003c/span\u003e\u003cspan address=\"10.1016/j.medcli.2020.05.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoronado-Alvarado CD, G\u0026aacute;mez-Saiz IL, Sotelo Cruz N (2018) Caracter\u0026iacute;sticas cl\u0026iacute;nicas y comorbilidades de pacientes con lupus eritematoso sist\u0026eacute;mico en ni\u0026ntilde;os y adultos. Acta Pediatr Mex 39(1):1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18233/apm1no1pp1-121535\u003c/span\u003e\u003cspan address=\"10.18233/apm1no1pp1-121535\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eV\u0026aacute;sconez-Gonz\u0026aacute;lez E, Bel\u0026eacute;n-L\u0026oacute;pez, Mar\u0026iacute;a, Cuchiparte, Dayana, Pel\u0026aacute;ez, Katherine, Cano-Cevallos, Leonardo, Prado, Esteban Ortiz-, Galarza-Maldonado, Claudio, L\u0026oacute;pez-Cort\u0026eacute;s (2021) Andr\u0026eacute;s. Manifestaciones Neurol\u0026oacute;gicas Del Lupus Eritematoso Sist\u0026eacute;mico: Revisi\u0026oacute;n De Literatura. Revista Ecuatoriana de Neurolog\u0026iacute;a, 30 (2), 76\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.46997/revecuatneurol30200076\u003c/span\u003e\u003cspan address=\"10.46997/revecuatneurol30200076\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastro JCV, Morales CAN, Torres JMM, Agudelo LG, Rodr\u0026iacute;guez LJV (2024) Prevalencia de las manifestaciones neuropsiqui\u0026aacute;tricas en lupus eritematoso sist\u0026eacute;mico. Revista Repertorio de Med y Cirug\u0026iacute;a 33(3):238\u0026ndash;244. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.31260/RepertMedCir.01217372.1423\u003c/span\u003e\u003cspan address=\"10.31260/RepertMedCir.01217372.1423\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKane BS, Dieng M, Fall BC, Sow M, Ndao AC, Djiba B et al (2019) Neurological involvement in systemic lupus erythematosus (SLE): Our recent experience. Open J Rheumatol Autoimmune Dis 09(02):25\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4236/ojra.2019.92003\u003c/span\u003e\u003cspan address=\"10.4236/ojra.2019.92003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R et al (2019) 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis rheumatol 71(9):1400\u0026ndash;1412. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/art.40930\u003c/span\u003e\u003cspan address=\"10.1002/art.40930\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos-Ruiz A, Montero-L\u0026oacute;pez E, Ortego-Centeno N, Peralta-Ram\u0026iacute;rez MI (2021) Efecto del confinamiento por COVID-19 en el estado mental de pacientes con lupus eritematoso sist\u0026eacute;mico. Med Clin (Barc) 156(8):379\u0026ndash;385. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/09612033221134203\u003c/span\u003e\u003cspan address=\"10.1177/09612033221134203\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKane BS, Dieng M, Fall BC, Sow M, Ndao AC, Djiba B et al (2019) Neurological involvement in systemic lupus erythematosus (SLE): Our recent experience. Open J Rheumatol Autoimmune Dis 09(02):25\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4236/ojra.2019.92003\u003c/span\u003e\u003cspan address=\"10.4236/ojra.2019.92003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXibill\u0026eacute;-Friedmann D, P\u0026eacute;rez-Rodr\u0026iacute;guez M, Carrillo-V\u0026aacute;zquez S, \u0026Aacute;lvarez-Hern\u0026aacute;ndez E, Aceves FJ, Ocampo-Torres MC et al (2019) Gu\u0026iacute;a de pr\u0026aacute;ctica cl\u0026iacute;nica para el manejo del lupus eritematoso sist\u0026eacute;mico propuesta por el Colegio Mexicano de Reumatolog\u0026iacute;a. Reumatol Cl\u0026iacute;n (Engl Ed) 15(1):3\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.reuma.2018.03.011\u003c/span\u003e\u003cspan address=\"10.1016/j.reuma.2018.03.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis AM, Graham TB, Zhu Y, McPheeters ML (2018) Depression and medication nonadherence in childhood-onset systemic lupus erythematosus. Lupus 27(9):1532\u0026ndash;1541. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0961203318779710\u003c/span\u003e\u003cspan address=\"10.1177/0961203318779710\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCortes MEC (2022) Efectos del estr\u0026eacute;s cr\u0026oacute;nico sobre la plasticidad neural del cerebro adolescente: Una revisi\u0026oacute;n sistem\u0026aacute;tica. Perspectivas Metodol\u0026oacute;gicas 22:16\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18294/pm.2022.3955\u003c/span\u003e\u003cspan address=\"10.18294/pm.2022.3955\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheehan DV, Sheehan KH, Shytle RD, Janavs J, Bannon Y, Rogers JE et al (2010) Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). J Clin Psychiatry 71(03):313\u0026ndash;326. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4088/JCP.09m05305whi\u003c/span\u003e\u003cspan address=\"10.4088/JCP.09m05305whi\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuncan L, Georgiades K, Wang L, Van Lieshout RJ, MacMillan HL, Ferro MA et al (2018) Psychometric evaluation of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Psychol Assess 30(7):916\u0026ndash;928. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/pas0000541\u003c/span\u003e\u003cspan address=\"10.1037/pas0000541\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026oacute;mez EM, Febus KB, Messa EP, Vega G (2024) El efecto de una intervenci\u0026oacute;n educativa de fisioterapia en la actividad f\u0026iacute;sica de adolescentes y adultos j\u0026oacute;venes con lupus eritematoso sist\u0026eacute;mico. Fisioterapia 46(3):110\u0026ndash;117. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ft.2023.11.003\u003c/span\u003e\u003cspan address=\"10.1016/j.ft.2023.11.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLacomba-Trejo L, Valero-Moreno S, Montoya-Castilla I, P\u0026eacute;rez-Mar\u0026iacute;n M (2023) Adolescentes con y sin enfermedad cr\u0026oacute;nica: competencias emocionales y malestar emocional. Revista de psicolog\u0026iacute;a de la salud 11(1):36\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21134/pssa.v11i1.315\u003c/span\u003e\u003cspan address=\"10.21134/pssa.v11i1.315\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pediatric systemic lupus erythematosus, neuropsychiatric lupus, cognitive symptoms, anti-dsDNA antibodies, anxiety disorders","lastPublishedDoi":"10.21203/rs.3.rs-8497467/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8497467/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a major cause of morbidity in pediatric systemic lupus erythematosus (pSLE). This study aimed to describe the frequency and characteristics of neuropsychiatric manifestations in patients aged 8–17 years with pSLE treated at a tertiary pediatric hospital in Mexico.\u003cbr\u003e\nMethods: Prospective cross-sectional study with MINI-KID evaluation and structured mental examination. Additional data included labs, EEG, EKG, and imaging.\u003cbr\u003e\nResults: Neuropsychiatric manifestations occurred in 39% of patients. Most common symptoms were anxiety, headache, depression, cognitive impairment, seizures, and delirium.\u003cbr\u003e\nConclusion: Early detection is essential to avoid neurocognitive sequelae and functional impairment.\u003c/p\u003e","manuscriptTitle":"Neuropsychiatric Manifestations in Pediatric Systemic Lupus Erythematosus: A Clinical Study from a Mexican Pediatric Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 10:37:27","doi":"10.21203/rs.3.rs-8497467/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05d718e1-91a0-41e3-8693-54523e6e6f3f","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-15T22:38:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 10:37:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8497467","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8497467","identity":"rs-8497467","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}