Abstract
Psychiatrie complications are frequent side effects of corticosteroid therapy in pediatrie and adult patients. Cortisol plays an important role in the cell metabolism and in maintaining the homeostasis.
Administration of exogenous corticosteroids leads to the suppression of endogenous cortisol secretion and causes an imbalance between glucocorticoid and mineralocorticoid receptor activity. It is hypothesized that this is the underlying mechanism of the disruption of cognitive functions and emotional dysregulation.
Adverse events are manifested by a wide range of psychiatric symptoms and syndromes, of varying degrees of severity. These include disruption of cognitive functions, affective and anxiety disorders, psychotic disorders and delirious states.
They also significantly increase the risk of suicidal behavior. They may onset at any time during corticosteroids use with the most frequent occurrence during the first two weeks of treatment.
Younger children and the elderly patients are at highest risk. The main risk factor is a high dose of corticosteroids, however complications cannot be ruled out even when administering very low doses.
Somatic risk factors include hypoalbu-minemia (eg. nephrotic syndrome) and the disruption of the blood-brain barrier (eg. Systemic Lupus Erythematosus).
Other predisposing factors include a history of primary psychiatric disorder, previous psychiatric complications after corticosteroid use, and concomitant medication causing the interactions on the cytochrome P450. Long-acting corticosteroids (eg. dexamethasone) are likely to cause more frequent psychiatrie complications than those with shorter half-life (eg. prednisone).
Treatment strategies are based largely on individual case reports or case series. The first step is to reduce the dose or withdraw the corticosteroid if the primary illness allows.
If corticosteroid dose reduction is not possible or not sufficient to cope with psychiatric symptoms, the initiation of specific psychopharmacological treatment is indicated. For depression, it is advisable to use SSRI antidepressants, in the case of psychotic depression, the effect of both atypical antipsychotics and electrocon-vulsive therapy has been demonstrated.
When bipolar disorder is suspected, the use of mood stabilizers or atypical antipsychotics is recommended. Prophylactic use of medication is reserved for patients with a history of steroid psychosis or episodes of mania.
A key component of prevention is the adequate awareness of professionals and consistent education of patients about the risk of developing side effects.