Corticosteroid-induced psychiatric disturbances: It is time for pharmacists to take notice

Abstract

Corticosteroids are widely used to relieve signs and symptoms arising from many diseases, including common inflammatory and autoimmune disorders affecting a number of organ systems. However, corticosteroids also induce significant adverse effects; in particular, a range of severe psychiatric adverse effects may occur including delirium, depression, mania, psychosis and cognitive/memory impairment. These adverse effects occur in up to 60% of patients taking corticosteroids and recent studies show an increased rate of psychopathologies in this population. Long-term adverse effects on mood and behavior are severely debilitating, thereby influencing the quality of life, employment and health status of individuals taking corticosteroids. Strategies used to manage corticosteroid-induced psychiatric disturbances through psychotropic drugs vary significantly. This commentary summarizes existing literature on mechanisms underlying corticosteroid-induced psychiatric adverse effects and evidence associated with using psychotropic drugs to manage these effects. Despite its importance, there is an absolute dearth in the literature examining pharmacists' understanding and perceptions of psychiatric adverse effects of corticosteroids. Educational programs need to be implemented so that pharmacists can counsel patients about how to recognize corticosteroid-induced psychiatric disturbances. Physicians do not consistently alert patients to watch for behavioral changes, and patients may feel that mood changes they experience fall within the category of 'normal behavior,' and thus are less likely to report them. Given that patients taking corticosteroids usually have complex medical histories, discussions of adverse effects with pharmacists are vital to improve health outcomes in this population.

Acute psychotic disorder associated with immunosuppressive agent use after renal transplantation: a case report

“…Physicians consistently alert patients about these potentially severe psychiatric side effects. Identification of findings of immunosuppressive agents in the early stages will help in preventing occurrence of more severe psychiatric side effects and psychopathology [4].…”

“…While depression tends to occur with long-term use of corticosteroids, mania can occur much earlier during treatment and is associated with high-dose preparations. Psychiatric adverse effects are twice as likely to occur during the first five days of corticosteroid treatment; however, it also depends on the dosage [4]. The reported incidence of serious psychiatric side effects of corticosteroids is low, 5-6%, and includes a wide range of cognitive (diminished memory, concentration, attention, mental speed, and distractibility), affective (depression, anxiety, irritability, emotional lability, hypomania, and mania), psychotic (visual and auditory hallucinations, delusions, thought confusion, and racing thoughts), and behavioural (restlessness, agitation, hypervigilance, and aggression) symptoms [8].…”

“…Aripiprazole, was identified as one of the most effective psychotropic medications in managing steroid-induced mania without causing excessive sedation. It has been shown that electroconvulsive theraphy (ECT) is highly effective in the treatment of steroidinduced symptoms in a small number of studies [4,8,9].…”

“…However, transplantation and life-long immunosuppressant treatment have their own problems [3]. Many psychiatric disorders such as major depressive disorder, mania, anxiety disorder, adjustment disorder and psychotic disorder, cognitive and memory impairment can be seen in any postoperative period in renal transplantation patients [4,5]. In this paper, we present an acute psychotic disorder case where psychosis occurred 4 years after the kidney transplantation.…”

Psychological Stress and Diabetes Mellitus As Complicating Factors in Management of Pemphigus Vulgaris

“…2,3 Corticosteroids can cause several side effects like hyperglycemia, skin atrophy, osteoporosis, muscle atrophy, eye cataracts, glaucoma, increase of blood pressure, delay in wound healing, cushingoid changes, peptic ulcers, adrenal suppression, and psychiatric effects. 5,6 Specifically, corticosteroids may increase the risk and severity of diabetes mellitus (DM) whether in diabetic or non-diabetic patients. 7 This case report discusses the roles of psychological stress and DM as complicating factors in the treatment of PV.…”