Fani-Molky Parisa, Bradley Jarrod, Cooper Mark S
University of Sydney School of Medicine, Sydney, Australia.
Concord Clinical School, Concord Repatriation General Hospital, Sydney, Australia.
J Child Adolesc Psychopharmacol. 2023 Apr;33(3):78-90. doi: 10.1089/cap.2022.0077.
Knowledge is limited regarding the adverse effects of therapeutic glucocorticoids on pediatric mental health outcomes. Glucocorticoid-induced psychosis (GIP) is a rare but severe side effect of high-dose glucocorticoid therapy in children and adolescents. This study identified reported pediatric cases of GIP, based on DSM-5 criteria, and defined its presentation, treatments, and outcomes. A systematic review was completed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including pediatric patients with incident psychosis following glucocorticoid treatment. Patient demographics, clinical presentation, interventions, outcomes, and long-term management were extracted from individual cases. Of 1131 articles screened, 28 reports were included, comprising of 31 patients. The mean age was 13 years, and 61% of patients were male. The most common medical illnesses requiring administration of high dose glucocorticoids were asthma (23%) and acute lymphoblastic leukemia (23%). The most common glucocorticoid used was prednisone (35%), and most patients (91%) received doses greater than or equal to 40 mg/day of prednisone. The range of time to symptom onset was 1 day to 7 months. Hallucinations alone (45%) were the most reported feature of GIP. Glucocorticoids were discontinued in 52% of cases, reduced in dosage in 32%, and 81% of affected patients were prescribed psychotropic medications. Long-term management plans and prophylactic psychotropic use were not mentioned in 52% of cases. Symptoms resolved in 90% of patients, and the majority (71%) had no recurrence of psychiatric symptoms. GIP can generally be managed by tapering the causative agent with adjunctive second-generation antipsychotics if psychotic symptoms persist. All patients in this review had complete resolution or improvement of their psychotic symptoms; however, there is likely reporting bias due to the expected underreporting of negative outcomes. Managing clinicians must take a circumspect approach when prescribing high-dose glucocorticoids to minimize the risk of serious but preventable side effects.
关于治疗性糖皮质激素对儿童心理健康结局的不良影响，目前所知有限。糖皮质激素诱发的精神病（GIP）是儿童和青少年高剂量糖皮质激素治疗罕见但严重的副作用。本研究根据《精神疾病诊断与统计手册》第5版（DSM-5）标准，识别已报告的儿童GIP病例，并明确其表现、治疗方法及结局。按照系统评价与Meta分析的首选报告项目（PRISMA）指南完成了一项系统评价，纳入接受糖皮质激素治疗后出现新发精神病的儿科患者。从各个病例中提取患者人口统计学信息、临床表现、干预措施、结局及长期管理情况。在筛选的1131篇文章中，纳入了28份报告，共31例患者。平均年龄为13岁，61%的患者为男性。需要使用高剂量糖皮质激素治疗的最常见疾病是哮喘（23%）和急性淋巴细胞白血病（23%）。最常用的糖皮质激素是泼尼松（35%），大多数患者（91%）接受的泼尼松剂量大于或等于40毫克/天。症状出现的时间范围为1天至7个月。仅出现幻觉（45%）是GIP最常报告的特征。52%的病例停用了糖皮质激素，32%的病例减少了剂量，81%的受影响患者开具了精神药物。52%的病例未提及长期管理计划和预防性使用精神药物。90%的患者症状得到缓解，大多数（71%）未复发精神症状。如果精神病症状持续，GIP通常可通过逐渐减少致病药物剂量并辅以第二代抗精神病药物进行管理。本评价中的所有患者精神病症状均完全缓解或改善；然而，由于预期负面结局报告不足，可能存在报告偏倚。临床医生在开具高剂量糖皮质激素时必须采取谨慎的方法，以尽量降低严重但可预防的副作用风险。
