Oral corticosteroid dosage and clinical presentation of psychiatric conditions after steroid use: A consultation-liaison psychiatry service’s experience

• Main Authors: Ichihashi, K. (Author), Kasai, K. (Author), Kondo, S. (Author), Kumakura, Y. (Author), Ogata, Y. (Author), Takahashi, Y. (Author), Yagi, Y. (Author), Yamana, H. (Author)
• Format: Article
• Language: English
• Published: John Wiley and Sons Inc 2021
• Subjects: Adrenal Cortex Hormones; adult; aged; agitation; Article; bipolar disorder; clinical assessment; clinical feature; cognitive defect; consultation; consultation-liaison psychiatry; controlled study; corticosteroid; corticosteroid therapy; delirium; depression; drug induced psychosis; drug megadose; female; hospital patient; human; Humans; incidence; Inpatients; insomnia; liaison psychiatry; low drug dose; major clinical study; male; medical record review; mental disease; mental health; patient referral; prednisolone; psychiatry; Psychiatry; psychology; psychosis; Referral and Consultation; Retrospective Studies; retrospective study; steroid psychosis; steroid-induced psychiatric disorder
• Online Access: View Fulltext in Publisher

 Aim: Psychiatric disturbances are the major adverse effects of corticosteroids. There are no consistent conclusions regarding changes in steroid dosage and the incidence of psychiatric conditions, due in part to the lack of consistent evaluation criteria. The purpose of this research was to determine the incidence and dose-dependency of psychiatric conditions as assessed by trained psychiatrists. Methods: A retrospective chart review was conducted at a university hospital in Japan. We identified inpatients receiving oral prednisolone treatment, who were referred to the consultation-liaison psychiatry team from April 2015 to March 2018. Patients were divided into high-dose (≥0.5 mg/kg/day) and low-dose (<0.5 mg/kg/day) groups. We investigated the associations between steroid dosage and incidence of psychiatric conditions. Results: A total of 93 patients (35 in the high-dose group, 58 in the low-dose group) were included. Various psychiatric conditions, such as insomnia, delirium, depression, and psychosis, occurred during steroid therapy. The most common condition was insomnia (72%). We observed no significant differences in the patient background characteristics and the incidence of most psychiatric conditions between the high-dose and low-dose groups. However, there were more patients with delirium in the low-dose group than in the high-dose group. Conclusions: Based on the accurate assessment of psychiatric conditions by psychiatrists, our analysis suggests that, among inpatients referred to a consultation-liaison psychiatry team, the incidence of psychiatric conditions, with the exception of delirium, is independent of the dose of oral prednisolone. © 2021 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.