title: Strategies to prevent the neuropsychiatric side-effects of corticosteroids: a case report and review of the literature.
abstract: OBJECTIVE
  The use of corticosteroids is increasing, and while the physical complications of their use are well known, the neuropsychiatric consequences are not. This review focuses on preventing these neuropsychiatric complications. Although there are limited data on this subject, it is a problem that clinicians face on a regular basis.
  
  
  RESULTS
  The incidence of neuropsychiatric complications rises rapidly once the daily dose of prednisone is greater than 40 mg. Other risk factors for neuropsychiatric symptoms are damaged blood-brain barrier and hypoalbuminemia. All patients receiving corticosteroids and their caregivers should be warned about the potential neuropsychiatric complications. Small trials have supported the use of various agents as prophylaxis. The development of neuropsychiatric symptoms secondary to corticosteroids should lead to prompt involvement of liaison psychiatry.
  
  
  CONCLUSIONS
  There is a lack of large randomized controlled studies to inform clinical practice. At present, lithium and olanzapine probably represent the best choices for prophylaxis. Patients with a prior history of steroid-related psychosis or mania should be considered for prophylaxis when future courses of steroids are prescribed as limited data, and our clinical experience suggests that this can reduce the future episodes of neuropsychiatric side-effects.
authors.affiliation: aDepartment of Liaison Psychiatry and General Medicine, Auckland City Hospital, Grafton, Auckland, New Zealand bDivision of Internal Medicine and Division of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: West
authors.forename: Chris
authors.initials: C
authors.lastname: Kenedi
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D005938:Glucocorticoids / Q000009:adverse effects*; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy*; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008140:Lorazepam / Q000627:therapeutic use; D008775:Methylprednisolone / Q000009:adverse effects*; D000077152:Olanzapine; D010488:Polyarteritis Nodosa / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects*; D011605:Psychoses, Substance-Induced / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D005938:Glucocorticoids; D018020:Lithium Compounds; D001569:Benzodiazepines; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000077152:Olanzapine; D008140:Lorazepam; D011241:Prednisone; D008775:Methylprednisolone