Strategies to prevent the neuropsychiatric side-effects of corticosteroids

Abstract

There is a lack of large randomized controlled studies to inform clinical practice. At present, lithium and olanzapine probably represent the best choices for prophylaxis. Patients with a prior history of steroid-related psychosis or mania should be considered for prophylaxis when future courses of steroids are prescribed as limited data, and our clinical experience suggests that this can reduce the future episodes of neuropsychiatric side-effects.

The neural diathesis-stress model of schizophrenia revisited: An update on recent findings considering illness stage and neurobiological and methodological complexities

“…The accumulating body of literature on secondary effects of glucocorticoid treatment of illnesses (e g., allergic, inflammatory or autoimmune disorders) (Dubovsky et al, 2012, Ross and Cetas, 2012, Judd et al, 2014, West and Kenedi, 2014 and research on neuropsychiatric complications associated with hypercortisolemia in Cushing's disease (Pivonello et al, 2015) support this view. The incidence of severe psychiatric symptoms following treatment with corticosteroids is estimated to be about 6%, and the incidence of any symptoms about 20% (Dubovsky et al, 2012, Ross andCetas, 2012).…”

A new era for giant cell arteritis

“…Six percent of patients receiving steroid therapy develop serious neuropsychiatric complications [72]. This effect is dose dependent, with the incidence rapidly rising once at 40 mg/day of steroid [73]. Other adverse effects include the development of a cushingoid appearance, weight gain and skin atrophy.…”

Psychiatric sequelae of corticosteroid use in hematology in Australia: A qualitative study

“…We also suggest that a multidisciplinary team, including oncology, pharmacology, psychiatry, psychology, nursing, social work, pastoral care, and music therapy, needs to be involved in dealing with potential adverse repercussions of cancer related steroid use. An effective strategy would encompass: Health professionals’ effective education of hematology patients/families about why steroids are needed, potential side‐effects, management strategies, and instruction to seek psychiatry consultation liaison or specialist psycho‐oncology services if serious psychiatric sequelae occur (West & Kenedi, ). Health professionals’ abilities to clarify patients/families’ possible misunderstandings about steroids, and identify steroid side‐effects in order to provide “in the moment” education and support to those struggling to understand them. Provision of hard‐copy and online resources for patients/families further explaining steroid effects and management, and information about community supports; for example, telephone helplines and consumer support networks. …”

“…Assessment of psychiatric complications is difficult due to unpredictable, idiosyncratic manifestations of side‐effects experienced (Kusljic, Manias, & Gogos, ), and the variable time of onset following steroid administration (from hours to following cessation of therapy) (Dubovsky et al, ). Studies examining side‐effect risk factors have yielded mixed results (Dubovsky et al, ), except for the association of higher doses with an increased likelihood of adverse psychiatric events (Fardet et al, ; West & Kenedi, ). The recommended management of psychiatric side‐effects include the involvement of liaison psychiatry; steroid reduction or cessation; and pharmacological strategies, including antipsychotics, selective serotonin reuptake inhibitors, and mood stabilizers (Judd et al, ; Warrington & Bostwick, ; West & Kenedi, ).…”

“…Studies examining side‐effect risk factors have yielded mixed results (Dubovsky et al, ), except for the association of higher doses with an increased likelihood of adverse psychiatric events (Fardet et al, ; West & Kenedi, ). The recommended management of psychiatric side‐effects include the involvement of liaison psychiatry; steroid reduction or cessation; and pharmacological strategies, including antipsychotics, selective serotonin reuptake inhibitors, and mood stabilizers (Judd et al, ; Warrington & Bostwick, ; West & Kenedi, ). The sevenfold increase of suicidal behavior associated with glucocorticosteroid treatments (Fardet et al, ) warrants further investigation in cancer populations.…”