Adverse psychological effects of corticosteroids in children and adolescents
ABSTRACT Children and adolescents treated with oral, inhaled, and intravenous corticosteroids (CS) may experience adverse psychological side effects (APSE), including psychotic symptoms. These can occur at any point during treatment, including withdrawal. In this paper the literature on these effects in children and adults is reviewed. From the evidence available, it is not possible to give reliable estimates for incidence or prevalence of APSE, nor clear risk factors. Some evidence is reported to suggest that oral dexamethasone treatment may carry a higher risk of APSE than other CS, but this requires further investigation. There is evidence from the adult literature that higher CS doses increase the risk of APSE. However, the dose response effect is not straightforward or predictable for individuals or groups. This is likely to be a reflection of the complex effects of CS on the central nervous system and the probable interplay between individual susceptibility, disease factors, and external environmental stressors in the emergence of APSE. More research is required to further our understanding of the adverse effects of these clinically valuable agents.
Full-textDOI: · Available from: Terry Y Segal, Jan 13, 2015
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ABSTRACT: Individuals with classic congenital adrenal hyperplasia (CAH) experience impaired glucocorticoid production and are treated postnatally with glucocorticoids. Prior research with animals and other human populations indicates that glucocorticoids can influence memory, particularly working memory. We tested the hypothesis that children with CAH would show reduced working memory. Children in the United Kingdom, aged 7-11 years, with classical CAH (31 girls, 26 boys) were compared to their unaffected relatives (30 girls, 20 boys) on a test of working memory, the Digit Span test. Vocabulary was also assessed to measure verbal intelligence for control purposes. Children with CAH showed reduced working memory performance compared to controls, on both components of the Digit Span test: p=.008 for Digit Span Forward, and p=.027 for Digit Span Backward, and on a composite score, p=.004. These differences were of moderate size (d=.53 to .70). Similar differences were also seen in a subset of 23 matched pairs of children with CAH and their relatives (d=.78 to .92). There were no group differences on Vocabulary. Glucocorticoid abnormality, including treatment effects, could be responsible for the reduced Digit Span performance in children with CAH. Other factors related to CAH, such as salt-wasting crises, could also be involved. Additional research is needed to identify the cause of the memory reduction, which will help to determine if more rapid diagnosis or more precise glucocorticoid treatment would help prevent memory reduction. Educational interventions might also be considered for children with CAH. Copyright © 2014. Published by Elsevier Inc.Hormones and Behavior 12/2014; 67. DOI:10.1016/j.yhbeh.2014.11.014 · 4.51 Impact Factor
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ABSTRACT: The aim of this study was to examine the relationship between asthma and behaviour, between children with asthma (mean age= 6.11), and their siblings without asthma (mean age= 6.03). Maternal reports of children’s behaviour with asthma (N=10) and their siblings without asthma (N=10) were measured using the Strengths and Difficulties Questionnaire. Additional questions on asthma severity and general health were also included. Using a Chi-square method for matched pairs, the findings indicated that children with asthma did not have more behaviour problems than their siblings who did not have asthma. However, children with asthma were more likely to have tantrums and problems with attention than were their siblings without asthma. The total behaviour score indicated that for seven of the sibling pairs their behaviour was similar, in that there were no problems. Additionally, children who had asthma and took preventer medication were less likely to have behaviour problems than children who did not use asthma preventers. This study was limited by the small sample size and the reliance on maternal reported measure of behaviour. Important factors that might affect behaviour in children with asthma and their siblings were identified, and directions for future research and clinical practice have been proposed.
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ABSTRACT: Psychiatric adverse effects during systemic corticosteroid therapy are common. Two large meta-analyses found that severe reactions occurred in nearly 6% of patients, and mild to moderate reactions occurred in about 28%. Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania. Conversely, long-term therapy tends to induce depressive symptoms. Dosage is directly related to the incidence of adverse effects but is not related to the timing, severity, or duration of these effects. Neither the presence nor the absence of previous reactions predicts adverse responses to subsequent courses of corticosteroids. Corticosteroid-induced symptoms frequently present early in a treatment cycle and typically resolve with dosage reduction or discontinuation of corticosterolds. In severe cases or situations in which the dose cannot be reduced, antipsychotics or mood stabilizers may be required. This review offers an approach to identifying and managing corticosteroid-induced psychiatric syndromes based on the type of symptoms and anticipated duration of corticosteroid treatment.Mayo Clinic Proceedings 11/2006; 81(10):1361-7. DOI:10.4065/81.10.1361 · 5.81 Impact Factor