Today’s pearl reviews the adverse neuropsychiatric effects associated with the use of steroids.
Can steroids alter mentation? What is the incidence? Are there any risk factors?
Types of neuropsychiatric effects: Depression; mania; panic disorder; suicide or suicide attempt; delirium, confusion, or disorientation; psychosis (Janes 2019); insomnia
Incidence: 15.7 per 100 person-years of glucocorticoid exposure for all glucocorticoid courses (22.2 per 100 person-years at risk for first courses, 14.0 for second courses, and 11.7 for third or later courses) (Judd 2014)
|Neuropsychiatric Outcome||Adjusted Hazard Ratio||95% CI|
|Suicide or suicide attempt||6.89||4.52, 10.50|
|Delirium, confusion, or disorientation||5.14||4.54, 5.82|
|Mania (nonpsychotic)||4.35||3.67, 5.16|
|Depression (nonpsychotic)||1.83||1.72, 1.94|
|Panic disorder||1.45||1.15, 1.85|
|>5 neuropsychiatric outcomes||2.26||2.15, 2.37|
Onset: 3-4 days after initiation (up to 2 weeks)
Duration: Few days to few weeks
Risk Factors: Age, dose, timing/duration of course
Treatment: Dose reduction or discontinuation; medications used for anxiety/depression/mania; close monitoring