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
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The PharmERToxGuy 