Warrington Thomas P, Bostwick J Michael
Mayo Medical School, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2006 Oct;81(10):1361-7. doi: 10.4065/81.10.1361.
Psychiatric adverse effects during systemic corticosteroid therapy are common. Two large meta-analyses found that severe reactions occurred in nearly 6% of patients, and mild to moderate reactions occurred in about 28%. Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania. Conversely, long-term therapy tends to induce depressive symptoms. Dosage is directly related to the incidence of adverse effects but is not related to the timing, severity, or duration of these effects. Neither the presence nor the absence of previous reactions predicts adverse responses to subsequent courses of corticosteroids. Corticosteroid-induced symptoms frequently present early in a treatment cycle and typically resolve with dosage reduction or discontinuation of corticosterolds. In severe cases or situations in which the dose cannot be reduced, antipsychotics or mood stabilizers may be required. This review offers an approach to identifying and managing corticosteroid-induced psychiatric syndromes based on the type of symptoms and anticipated duration of corticosteroid treatment.
全身用皮质类固醇治疗期间的精神科不良反应很常见。两项大型荟萃分析发现，近6%的患者出现严重反应，约28%的患者出现轻至中度反应。尽管可能出现情绪、认知、睡眠和行为障碍以及明显的谵妄甚至精神病，但短期皮质类固醇治疗最常见的不良反应是欣快和轻躁狂。相反，长期治疗往往会诱发抑郁症状。剂量与不良反应的发生率直接相关，但与这些反应的发生时间、严重程度或持续时间无关。既往有无反应均不能预测对后续皮质类固醇疗程的不良反应。皮质类固醇诱发的症状通常在治疗周期早期出现，通常随着皮质类固醇剂量的减少或停用而缓解。在严重病例或无法降低剂量的情况下，可能需要使用抗精神病药物或心境稳定剂。本综述提供了一种基于症状类型和皮质类固醇治疗预期持续时间来识别和管理皮质类固醇诱发的精神综合征的方法。
