Seurs L, Mierzejewska A, Claes S J
Universitair Psychiatrisch Centrum KU Leuven, Kortenerg, Belgium.
Tijdschr Psychiatr. 2011;53(1):37-47.
Our study focuses on a 30-year-old man who was hospitalised against his will because of his agitated psychotic state. His symptoms were indicative of a paranoid psychotic disorder resulting from the use of corticosteroids. We considered it important to report this case because corticosteroids have been widely prescribed since about 1950 to treat a broad spectrum of somatic illnesses and because there have been many reports of both mild and acute psychiatric side-effects.
To obtain answers to the following questions: what is the incidence of steroid-induced psychotic symptoms? Do patients with a psychiatric history run a greater risk of developing a steroid-induced psychosis? What are the most important risk factors and how can we prevent the development of steroid-induced psychotic symptoms?
After discussing the case, we studied the literature systematically using Medline.
Up till now, very little reliable evidence has been available relating to steroidinduced psychosis. Therefore there has been a lack of information about the incidence of psychotic symptoms caused by steroids, about the risks involved when the patient has a psychiatric history and about the preventive measures that can be taken.
The most important risk factor seems to be the dose. Thus, if a patient requires treatment with steroid, it seems advisable to prescribe the lowest possible dose.
我们的研究聚焦于一名30岁男性，他因躁狂性精神病状态被强制住院。他的症状表明是使用皮质类固醇导致的偏执型精神病性障碍。我们认为报告该病例很重要，因为自1950年左右以来，皮质类固醇已被广泛用于治疗多种躯体疾病，且已有许多关于其轻度和急性精神副作用的报告。
回答以下问题：类固醇所致精神病性症状的发生率是多少？有精神病史的患者发生类固醇所致精神病的风险更高吗？最重要的风险因素有哪些，以及如何预防类固醇所致精神病性症状的发生？
在讨论该病例后，我们使用Medline系统地研究了文献。
到目前为止，关于类固醇所致精神病的可靠证据非常少。因此，缺乏关于类固醇所致精神病性症状的发生率、患者有精神病史时所涉及的风险以及可采取的预防措施的信息。
最重要的风险因素似乎是剂量。因此，如果患者需要用类固醇进行治疗，开具尽可能低的剂量似乎是明智的。
