Fischer Matt, Kim Peggy Y
Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
WMJ. 2019 Jul;118(2):91-94.
Neuropsychiatric symptoms are a well-described side effect of systemic corticosteroid therapy and can range from mild to severe.
We describe a case of substance-induced psychosis following epidural injection of 10 mg dexamethasone. Three days after the procedure, the patient developed symptoms including anger, hostility, insomnia, paranoia, and delusions. Symptoms resolved between 7 and 17 days.
In the past 50 years, there have been several case reports of severe neuropsychiatric effects following intraarticular or other interventional pain injections with various corticosteroids. More recent reviews have identified possible risk factors, including corticosteroid dose, patient age, sex, and history of neuropsychiatric disorder, among others, although these conclusions are not duplicated across all studies.
Recommendations for practice include patient and family education on possible adverse effects of corticosteroid administration, utilization of minimum effective doses for interventional procedures, and the consideration of close follow-up and multidisciplinary coordination, especially in high-risk patients.
神经精神症状是全身性皮质类固醇治疗中一种广为人知的副作用，其严重程度可轻可重。
我们描述了一例硬膜外注射10毫克地塞米松后出现物质所致精神病的病例。该操作三天后，患者出现愤怒、敌意、失眠、偏执和妄想等症状。症状在7至17天内缓解。
在过去50年里，有几例关于各种皮质类固醇进行关节内或其他介入性疼痛注射后出现严重神经精神效应的病例报告。最近的综述确定了可能的风险因素，包括皮质类固醇剂量、患者年龄、性别和神经精神疾病史等，尽管并非所有研究都重复得出这些结论。
实践建议包括对患者及其家属进行关于皮质类固醇给药可能产生的不良反应的教育，在介入性操作中使用最小有效剂量，并考虑密切随访和多学科协调，尤其是在高危患者中。
