Assessment of mood states in patients receiving long-term corticosteroid therapy and in controls with patient-rated and clinician-rated scales.
BACKGROUND
Corticosteroids have been used for many years for inflammatory diseases. Mood changes are common during short-term, high-dose, corticosteroid therapy. Virtually no data are available on the mood effects of long-term corticosteroid therapy.


OBJECTIVE
To evaluate mood during corticosteroid therapy using standard clinician-rated and patient-rated measures.


METHODS
Outpatients receiving prednisone therapy (7.5 mg/d for 6 months) and similar controls were enrolled. Current mood was evaluated using the Hamilton Rating Scale for Depression (HRSD), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), Internal State Scale (ISS), and a diagnostic interview.


RESULTS
Twenty patients and 14 controls were enrolled in the study. Depressive symptom severity as evaluated by the HRSD and ISS depression and well-being subscales and global psychiatric symptom severity as evaluated by the BPRS and ISS perceived conflict subscale were greater in patients receiving prednisone than controls. Manic symptom severity as evaluated by the ISS activation subscale but not the YMRS was higher in patients receiving prednisone. Twelve (60%) of 20 corticosteroid-treated patients met diagnostic criteria for a lifetime prednisone-induced mood disorder. Activation subscale scores did not correlate with YMRS scores. Other ISS subscales showed expected correlations with clinician-rated assessments.


CONCLUSIONS
Mood symptoms and disorders are common in corticosteroid-dependent patients. Unlike short-term prednisone therapy, long-term therapy may be more associated with depressive than manic symptoms based on the clinician-rated assessments. The ISS may be more sensitive to mood symptoms with prednisone than clinician-rated scales.
Bolanos
Sandra H
SH
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-8849, USA.
Khan
David A
DA
Hanczyc
Margaret
M
Bauer
Mark S
MS
Dhanani
Nafisa
N
Brown
E Sherwood
ES
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000339:Affect / Q000187:drug effects*; D000368:Aged; D001714:Bipolar Disorder / Q000139:chemically induced; D003863:Depression / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology*; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D013997:Time Factors
D000305:Adrenal Cortex Hormones