jats:secjats:titleObjective</jats:title>jats:pTo determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (<jats:styled-content style="fixed-case">SLE</jats:styled-content>), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short‐ and long‐term outcomes as assessed by physicians and patients.</jats:p></jats:sec>jats:secjats:titleMethods</jats:title>jats:pPatients were evaluated annually for 19 neuropsychiatric (<jats:styled-content style="fixed-case">NP</jats:styled-content>) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (<jats:styled-content style="fixed-case">SF</jats:styled-content>‐36) were recorded. Time to event and linear regressions were used as appropriate.</jats:p></jats:sec>jats:secjats:titleResults</jats:title>jats:pOf 1,826 <jats:styled-content style="fixed-case">SLE</jats:styled-content> patients, 88.8% were female and 48.8% were Caucasian. The mean ± <jats:styled-content style="fixed-case">SD</jats:styled-content> age was 35.1 ± 13.3 years, the mean ± <jats:styled-content style="fixed-case">SD</jats:styled-content> disease duration was 5.6 ± 4.2 months, and the mean ± <jats:styled-content style="fixed-case">SD</jats:styled-content> follow‐up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [<jats:styled-content style="fixed-case">HR</jats:styled-content>s] and 95% confidence intervals [95% <jats:styled-content style="fixed-case">CI</jats:styled-content>s]) with lupus psychosis were previous <jats:styled-content style="fixed-case">SLE NP</jats:styled-content> events (<jats:styled-content style="fixed-case">HR</jats:styled-content> 3.59 [95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.16–11.14]), male sex (<jats:styled-content style="fixed-case">HR</jats:styled-content> 3.0 [95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.20–7.50]), younger age at <jats:styled-content style="fixed-case">SLE</jats:styled-content> diagnosis (per 10 years) (<jats:styled-content style="fixed-case">HR</jats:styled-content> 1.45 [95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.01–2.07]), and African ancestry (<jats:styled-content style="fixed-case">HR</jats:styled-content> 4.59 [95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.79–11.76]). By physician assessment, most psychotic events resolved by the second annual visit following onset, in parallel with an improvement in patient‐reported <jats:styled-content style="fixed-case">SF</jats:styled-content>‐36 summary and subscale scores.</jats:p></jats:sec>jats:secjats:titleConclusion</jats:title>jats:pPsychosis is an infrequent manifestation of <jats:styled-content style="fixed-case">NPSLE</jats:styled-content>. Generally, it occurs early after <jats:styled-content style="fixed-case">SLE</jats:styled-content> onset and has a significant negative impact on health status. As determined by patient and physician report, the short‐ and long‐term outlooks are good for most patients, although careful follow‐up is required.</jats:p></jats:sec>