title: Corticosteroid-induced psychiatric disturbances: It is time for pharmacists to take notice.
abstract: Corticosteroids are widely used to relieve signs and symptoms arising from many diseases, including common inflammatory and autoimmune disorders affecting a number of organ systems. However, corticosteroids also induce significant adverse effects; in particular, a range of severe psychiatric adverse effects may occur including delirium, depression, mania, psychosis and cognitive/memory impairment. These adverse effects occur in up to 60% of patients taking corticosteroids and recent studies show an increased rate of psychopathologies in this population. Long-term adverse effects on mood and behavior are severely debilitating, thereby influencing the quality of life, employment and health status of individuals taking corticosteroids. Strategies used to manage corticosteroid-induced psychiatric disturbances through psychotropic drugs vary significantly. This commentary summarizes existing literature on mechanisms underlying corticosteroid-induced psychiatric adverse effects and evidence associated with using psychotropic drugs to manage these effects. Despite its importance, there is an absolute dearth in the literature examining pharmacists' understanding and perceptions of psychiatric adverse effects of corticosteroids. Educational programs need to be implemented so that pharmacists can counsel patients about how to recognize corticosteroid-induced psychiatric disturbances. Physicians do not consistently alert patients to watch for behavioral changes, and patients may feel that mood changes they experience fall within the category of 'normal behavior,' and thus are less likely to report them. Given that patients taking corticosteroids usually have complex medical histories, discussions of adverse effects with pharmacists are vital to improve health outcomes in this population.
authors.affiliation: Department of Nursing, The University of Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Australia. Electronic address: skusljic@unimelb.edu.au.
authors.forename: Snezana
authors.initials: S
authors.lastname: Kusljic
authors.affiliation: Department of Nursing, The University of Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia; School of Nursing and Midwifery, Deakin University, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.affiliation: The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gogos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000818:Animals; D001921:Brain / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D001523:Mental Disorders / Q000139:chemically induced*; D010595:Pharmacists; D012701:Serotonin / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D012701:Serotonin
keywords: Corticosteroids; Psychiatric disturbances; Psychotropic drugs