Wada K, Yamada N, Suzuki H, Lee Y, Kuroda S
Department of Neuropsychiatry, Okayama University Medical School, Japan.
J Clin Psychiatry. 2000 Apr;61(4):261-7. doi: 10.4088/jcp.v61n0404.
Corticosteroids often induce steroid psychosis, a collection of heterogeneous syndromes with different pathophysiologic mechanisms. To date, no study has focused specifically on recurrent corticosteroid-induced mood disorders and considered their long-term outcome and treatment strategies.
Nine patients whose initial clinical presentation met DSM-IV criteria for a substance-induced mood disorder were identified by a review of medical records. Their clinical characteristics and treatments were examined.
All 9 corticosteroid-treated patients had a clinical course of bipolar disorder. Seven patients initially developed a manic or hypomanic state with subacute onset ranging from 1 to 3 months. Six patients had manic episodes accompanied by psychotic features. The proportion of manic episodes relative to total mood episodes of the 9 patients was 65.6%, suggesting manic predominance. Seven patients showed mood episodes that had no direct relationship to corticosteroid therapy and were preceded by various psychosocial stressors. Four of 5 patients who received steroid pulse therapy rapidly became manic or hypomanic. Antidepressants as well as mood stabilizers were useful for treatment of the present 9 patients.
Recurrent cases of corticosteroid-induced mood disorder have interesting clinical features, such as subacute onset, manic predominance, frequent accompanying psychotic features, and similar recurrent episodes in association with psychosocial stressors and corticosteroid use. Management, including psychopharmacologic intervention, should be indicated by a consideration of the underlying illnesses and psychosocial stressors.
皮质类固醇常常诱发类固醇精神病，这是一组具有不同病理生理机制的异质性综合征。迄今为止，尚无研究专门聚焦于复发性皮质类固醇诱发的情绪障碍，也未考虑其长期预后及治疗策略。
通过查阅病历，确定了9例初始临床表现符合《精神疾病诊断与统计手册》第四版（DSM-IV）中物质诱发情绪障碍标准的患者。对其临床特征及治疗情况进行了检查。
所有9例接受皮质类固醇治疗的患者均有双相情感障碍的临床病程。7例患者最初出现躁狂或轻躁狂状态，亚急性起病，病程1至3个月。6例患者的躁狂发作伴有精神病性症状。9例患者中躁狂发作相对于总情绪发作的比例为65.6%，提示以躁狂为主。7例患者出现与皮质类固醇治疗无直接关系的情绪发作，且发作前有各种社会心理应激源。5例接受类固醇冲击治疗的患者中有4例迅速出现躁狂或轻躁狂。抗抑郁药和心境稳定剂对目前这9例患者的治疗均有效。
复发性皮质类固醇诱发的情绪障碍病例具有有趣的临床特征，如亚急性起病、以躁狂为主、常伴有精神病性症状，以及与社会心理应激源和皮质类固醇使用相关的类似复发发作。管理措施，包括心理药物干预，应根据潜在疾病和社会心理应激源来确定。
