Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan.
Department of Psychiatry, Sakuragaoka Memorial Hospital, Tokyo, Japan.
J Psychosom Res. 2023 Apr;167:111179. doi: 10.1016/j.jpsychores.2023.111179. Epub 2023 Feb 1.
Corticosteroids can cause psychiatric symptoms known as corticosteroid-induced psychiatric disorders (CIPDs). Little is known regarding the relationship between intravenous pulse methylprednisolone (IVMP) and CIPDs. Therefore, we aimed to examine the relationship between corticosteroid use and CIPDs in this retrospective study.
Patients who were prescribed corticosteroids during their hospitalization at a university hospital and referred to our consultation-liaison service were selected. Patients diagnosed with CIPDs according to the ICD-10 codes were included. The incidence rates were compared between patients receiving IVMP and those receiving any other corticosteroid treatment. The association between IVMP and CIPDs was examined by classifying patients with CIPD into three groups according to the use of IVMP and timing of CIPD onset.
Of the 14,585 patients who received corticosteroids, 85 were diagnosed with CIPDs, with an incidence rate of 0.6%. Among the 523 patients who received IVMP, the incidence rate of CIPDs was 6.1% (n = 32), which was significantly higher than that in patients receiving any other corticosteroid treatment. Among the patients with CIPDs, 12 (14.1%) developed CIPDs during IVMP, 19 (22.4%) developed CIPDs after IVMP, and 49 (57.6%) developed CIPDs without IVMP. There was no significant difference in the doses at the time of CIPD improvement among the three groups when we excluded one patient whose CIPD improved during IVMP.
Patients receiving IVMP were more likely to develop CIPDs than those who did not receive IVMP. Furthermore, corticosteroid doses at the time of improvement of CIPDs were constant, regardless of IVMP use.
皮质类固醇可引起已知的皮质类固醇诱导性精神障碍（CIPD）的精神症状。关于静脉脉冲甲泼尼龙（IVMP）与 CIPD 之间的关系知之甚少。因此，我们旨在通过回顾性研究来检查皮质类固醇使用与 CIPD 之间的关系。
选择在一所大学医院住院期间被开具皮质类固醇处方并被转介到我们联络会诊服务的患者。根据 ICD-10 编码诊断为 CIPD 的患者被纳入研究。比较接受 IVMP 与接受任何其他皮质类固醇治疗的患者之间的发病率。根据 CIPD 发病时间和 IVMP 的使用情况，将 CIPD 患者分为三组，以检查 IVMP 与 CIPD 之间的关系。
在接受皮质类固醇治疗的 14585 名患者中，有 85 名被诊断为 CIPD，发病率为 0.6%。在接受 IVMP 的 523 名患者中，CIPD 的发病率为 6.1%（n=32），明显高于接受任何其他皮质类固醇治疗的患者。在患有 CIPD 的患者中，12 名（14.1%）在接受 IVMP 期间发生 CIPD，19 名（22.4%）在接受 IVMP 后发生 CIPD，49 名（57.6%）在未接受 IVMP 的情况下发生 CIPD。当排除一名在接受 IVMP 期间 CIPD 改善的患者后，三组患者在 CIPD 改善时的剂量无显著差异。
接受 IVMP 的患者比未接受 IVMP 的患者更有可能发生 CIPD。此外，无论是否使用 IVMP，CIPD 改善时的皮质类固醇剂量是恒定的。
