Glucocorticoids-Induced Neuropsychiatric Disorders in Patients With Inflammatory Bowel Disease: A Systematic Review

Abstract

Inflammatory bowel disease (IBD) is a globally rising chronic intestinal disease that affects individuals in many parts of the world. Immunosuppressive medications such as corticosteroids are used to manage flareups and to induce remission in IBD. Corticosteroids are said to cause several systemic symptoms, but they are also associated with drug-induced neuropsychiatric disorders. This article examines the existing data on psychiatric and cognitive effects associated with corticosteroid therapy in relation to IBD. Many studies have found that corticosteroids appear to cause mood disturbances such as mania, hypomania, depression, and cognitive problems in the first few weeks of therapy, but these effects are dose-dependent and often mild. The purpose of this literature review is to shed light on the impact corticosteroids can have on individuals' mental health, which will aid physicians in the future when treating patients with IBD. Healthcare professionals should advise patients of this risk and assess the need for intervention. While there is evidence that corticosteroids can elicit neuropsychiatric symptoms, more data on people with IBD who are on corticosteroid therapy is needed to determine the prevalence of glucocorticoid-induced mood changes in this population.

Steroid-induced Psychosis in a Patient without a Previous Psychiatric History

“…There is not much knowledge on the pathophysiology of the neuropsychiatric complications of corticosteroids, however, there is an established correlation between corticosteroids and impairment in cognitive function. 1,2,3,4,5 It is thought to be related to abnormalities of the hypothalamic-pituitary-adrenal axis, particularly glucocorticoid negative feedback dysfunction. 1,2,3,5 The most common and expected side effects of corticosteroid use are an increased risk of infections, leukocytosis, hyperglycemia, gastritis, and weight gain, among others.…”

“…1,2,3,4,5 It is thought to be related to abnormalities of the hypothalamic-pituitary-adrenal axis, particularly glucocorticoid negative feedback dysfunction. 1,2,3,5 The most common and expected side effects of corticosteroid use are an increased risk of infections, leukocytosis, hyperglycemia, gastritis, and weight gain, among others. 3 Less frequently, neuropsychiatric manifestations may occur, including steroid-induced psychosis (delusions and hallucinations) as well as, mania, depression, anxiety, insomnia, and irritability.…”

“…3,7 There is no correlation between the presentation of the glucocorticoid, or the onset of symptoms. 3,4,5,7,10 In patients receiving glucocorticosteroids, mania, and delirium are more common among men, while depression is more likely in women. 10 The chance of developing psychiatric symptoms is decreased overall with subsequent glucocorticosteroid exposure, but individuals who had symptoms during a previous course of glucocorticosteroids are more likely to develop psychiatric symptoms during a second course.…”

The dichotomy of glucocorticosteroid treatment in immuneinflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice

“…Besides the daily dosages, the cumulative exposure and duration of treatment should be taken into account. As per consensus, long-term GC usage refers to an assumption period > 3-6 months [25] Reduced grade of damage GC-related adverse events Increased grade of damage Healthy diet, exercise, absence of prior history of cardiovascular disease or diabetes, younger age, normal blood pressure and lipid serum concentrations [96] Cardiovascular events/ effects Smoking, physical inactivity, systemic arterial hypertension, obesity, atherosclerosis, coronary heart disease, previous history of myocardial infarction and/or heart failure [96] Absent history of previous neuropsychiatric disorders, traumatic brain injuries, substance abuse or addiction [97] Neuropsychiatric involvement…”

“…Concurrent medications affecting the central nervous system (opioids, benzodiazepines or antipsychotics), presence of the risk factors mentioned in the left column [97] Absence of prior history of cataracts or glaucoma, younger age [98] Cataract and glaucoma Presence of prior history of cataracts or glaucoma, older age, family history of cataract/ glaucoma, smoking, systemic arterial hypertension, diabetes [98] Absence of prior history of ulcers, gastrointestinal bleeding, Helicobacter pylori infection, comorbidities (diabetes, heart failure) Prophylaxis with PPI [99] Ulcers/gastrointestinal bleeding Concomitant use of NSAIDs, antiaggregant and/or anticoagulant treatment. Previous history of ulcers, Helicobacter pylori infection, comorbidities (diabetes, heart failure) [99]…”