Certain mental health and neurological symptoms can be early warning signs of an underlying autoimmune disorder. A spike in nightmares and hallucinations could indicate the onset of autoimmune diseases such as lupus and signal an approaching disease flare, a study revealed.

"For many years, I have discussed nightmares with my lupus patients and thought that there was a link with their disease activity. This research provides evidence of this, and we are strongly encouraging more doctors to ask about nightmares and other neuropsychiatric symptoms – thought to be unusual, but actually very common in systemic autoimmunity – to help us detect disease flares earlier," said Professor David D'Cruz from Kings College London, a senior study author of the latest study.

Researchers surveyed 676 patients who live with lupus and 400 clinicians. They also conducted detailed interviews with 69 people living with systemic autoimmune rheumatic diseases, including lupus, and 50 clinicians.

The study evaluated the timing of 29 neurological and mental health symptoms, including depression, hallucinations, and loss of balance. The researchers used the term "daymares" to talk about hallucinations, as it was a less frightening and stigmatized word. The participants were also asked to list the order in which their symptoms appeared when their disease was flaring.

Around 60% of the participants reported experiencing disrupted dream sleep, and one-third of them noted that these issues began over a year before the onset of lupus disease. A little less than 25% of patients reported hallucinations, but 85% of them said the symptom did not appear until around the onset of the disease or later.

Three in five lupus patients and one in three with other rheumatology-related conditions reported increasingly disrupted dreaming sleep and distressing nightmares just before their hallucinations. These nightmares were often vivid and involved themes of being attacked, trapped, crushed, or falling.

The researchers say recognizing these symptoms is important as many patients may get misdiagnosed or even hospitalized with psychotic episodes, and suicidal ideation, but later realize that those were the first signs of their autoimmune disease.

"It's important that clinicians talk to their patients about these types of symptoms and spend time writing down each patient's individual progression of symptoms. Patients often know which symptoms are a bad sign that their disease is about to flare, but both patients and doctors can be reluctant to discuss mental health and neurological symptoms, particularly if they don't realize that these can be a part of autoimmune diseases," said lead author, Dr. Melanie Sloan from the University of Cambridge.

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