Hodgins Gabrielle E, Saltz Samantha B, Gibbs Eric P, Gonzalez Rolando, Regan Judith, Nemeroff Charles
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami, Florida.
J Child Adolesc Psychopharmacol. 2018 Jun;28(5):354-359. doi: 10.1089/cap.2018.0017. Epub 2018 Apr 11.
Iatrogenic steroid-induced psychosis is a rare but serious adverse side effect seen largely in the adult population that less commonly affects children and adolescents. Given the significant distress steroid-induced psychosis may cause, recommendations are needed for effective management. Here we conducted a systematic review of the literature and report a new case of steroid-induced psychosis in a 12-year-old patient.
We performed a systematic search using Embase, PubMed, Scopus, and PsychInfo. Key terms included ("steroid induced" or "corticosteroid induced" or "glucocorticoid induced") and ("psychosis" or "hallucinations" or "delusions") and ("child" or "adolescent" or "pediatric"). A total of 15 articles of steroid-induced psychosis in children and adolescents were found in the scientific literature. This report includes those articles and a novel case of steroid-induced psychosis.
Children with asthma, autoimmune diseases, and cancer have been reported to experience steroid-induced psychosis. The mean age of children with steroid-induced psychosis was 12 ± 3.6 years. Our team presents a report of steroid-induced psychosis in a 12-year-old patient with discoid-type lupus erythematosus. Within days of treatment with 40 mg prednisone daily, this patient began to drool, became mute, and was responding to internal stimuli. Treatment was difficult secondary to the acute exacerbation of lupus, requiring ongoing therapy. It was initially unclear whether the acute psychosis was a manifestation of lupus, a side effect of medication, or a combination of the two risk factors. Neurology consultation ruled out lupus cerebritis. Psychosis was treated with haloperidol 5 mg. Psychosis did not resolve until the steroid taper was complete and the patient was no longer taking any prednisone.
Given the common use of glucocorticoid therapy in children, it is important that physicians and parents recognize the signs of steroid-induced psychosis and are aware of the data on treating this complication.
医源性类固醇诱导的精神病是一种罕见但严重的不良副作用，主要见于成人，较少影响儿童和青少年。鉴于类固醇诱导的精神病可能造成严重痛苦，需要有关有效管理的建议。在此，我们对文献进行了系统综述，并报告了一例12岁患者类固醇诱导的精神病新病例。
我们使用Embase、PubMed、Scopus和PsychInfo进行了系统检索。关键词包括（“类固醇诱导”或“皮质类固醇诱导”或“糖皮质激素诱导”）以及（“精神病”或“幻觉”或“妄想”）以及（“儿童”或“青少年”或“儿科”）。在科学文献中总共发现了15篇关于儿童和青少年类固醇诱导的精神病的文章。本报告包括这些文章以及一例类固醇诱导的精神病新病例。
据报道，患有哮喘、自身免疫性疾病和癌症的儿童会出现类固醇诱导的精神病。类固醇诱导的精神病患儿的平均年龄为12±3.6岁。我们的团队报告了一例12岁盘状红斑狼疮患者类固醇诱导的精神病。在每天服用40毫克泼尼松治疗数天内，该患者开始流口水、变得沉默不语，并对内部刺激有反应。由于狼疮急性加重，治疗困难，需要持续治疗。最初尚不清楚急性精神病是狼疮的表现、药物的副作用还是这两种危险因素的综合作用。神经科会诊排除了狼疮性脑病。用5毫克氟哌啶醇治疗精神病。直到类固醇逐渐减量完成且患者不再服用任何泼尼松，精神病才得以缓解。
鉴于糖皮质激素疗法在儿童中常用，医生和家长认识到类固醇诱导的精神病的症状并了解治疗这一并发症的数据非常重要。
