Steroids Induced Psychiatric Side Effects

STEROIDS & NEUROPSYCHIATRIC ADVERSE EVENTS

Neuropsychiatric Adverse Events from Non-Psychiatric Medications

Patients on higher doses of steroids can present with affective, behavioral, and cognitive symptoms. Mood symptoms (mania) are more common than psychotic symptoms.

Steroid Dose is one of the most critical risk factors for steroid-induced psychiatric symptoms.

  • J Affect Disord 1983; 5:319 –332. (pubmed)

[FOR ACADEMY MEMBERS]

Psychiatry Education Forum Academy’s chapter will discuss this topic in the following sections:

  • What is the dose equivalency among steroids?
  • What doses of steroids are known to cause these psychiatric symptoms?
  • How long does it take from initiation of steroid to development of neuropsychiatric manifestations?
  • How long does it take for a patient to recover?
  • How do you manage these neuropsychiatric symptoms?

NON-PSYCHIATRIC MEDICATIONS: NEUROPSYCHIATRIC ADVERSE EVENTS

(1) STEROIDS

  • What is the dose equivalency among steroids?
  • What doses of steroids are known for cause these psychiatric symptoms?
  • How long does it take from initiation of steroid to development of neuropsychiatric manifestations?
  • How long does it take for patient to recover?
  • How do you manage these neuropsychiatric symptoms?

(2) INTERFERON

  • Does prophylactic treatment with antidepressant prevent future episodes of depression?
  • Does type of Interferon (PEG Interferon a2a and 2b) affects this prophylactic SSRI response?
  • Which SSRI should be considered for prophylactic treatment?
  • Which risk factors are predictive variables of major depression episode during interferon treatment.

(3) LEVETIRACETAM

  • Behavioral symptoms associated with Levetiracetam.
  • Risk factors.
  • Treatment options.

(4) ISOTRETINOIN

  • Behavioral symptoms associated with Isotretinoin.
  • Management options.

(5) FLUOROQUINOLONES

  • Serious central nervous system side effects.
  • Risk factors.
  • Clinical tips.

(6) MEFLOQUINE

  • Neurological and psychiatric side effects
  • Clinical recommendations.

(7) MONTELUKAST

  • Neurological and psychiatric side effects
  • Underlying mechanism
  • Is history of psychiatric disorder a risk factor?
  • When to avoid montelukast use?
  • Reserve Montelukast Use for?
  • Clinical recommendations.
  • Do Neuropsychiatric Symptoms resolve on Montelukast Discontinuation?

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