Psychiatric adverse effects of pediatric corticosteroid use

Linda B. Drozdowicz, J. Michael Bostwick

Research output: Contribution to journalReview article

37 Citations (Scopus)

Abstract

Corticosteroids, highly effective drugs for myriad disease states, have considerable neuropsychiatric adverse effects that can manifest in cognitive disorders, behavioral changes, and frank psychiatric disease. Recent reviews have summarized these effects in adults, but a comprehensive review on corticosteroid effects in children has not been published since 2005. Here, we systematically review articles published since then that, we find, naturally divide into 3 main areas: (1) chronic effects of acute prenatal and neonatal exposure associated with prematurity and congenital conditions; (2) immediate behavioral effects of acute exposure via oncological protocols; and (3) acute behavioral effects of sporadic use in children and adolescents with other conditions. PsycInfo, MEDLINE, Embase, and Scopus were queried to identify articles reporting psychiatric adverse effects of corticosteroids in pediatric patients. Search terms included corticosteroids, adrenal cortex hormones, steroid psychosis, substance-induced psychoses, glucocorticoids, dexamethasone, hydrocortisone, prednisone, adverse effects, mood disorders, mental disorders, psychosis, psychotic, psychoses, side effect, chemically induced, emotions, affective symptoms, toxicity, behavior, behavioral symptoms, infant, child, adolescent, pediatric, paediatric, neonatal, children, teen, and teenager. Following guidelines for systematic reviews from the Potsdam Consultation on Meta-Analysis, we have found it difficult to draw specific conclusions that are more than general impressions owing to the quality of the available studies. We find a mixed picture with neonates exposed to dexamethasone, with some articles reporting eventual deficits in neuropsychiatric functioning and others reporting no effect. In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions, adverse effects have been observed both during treatment and after cessation, although the data from article to article are not consistent enough to establish dose relationships. By and large, inhaled corticosteroids are considered safe and free of severe neuropsychiatric effects. Although both antipsychotic medications and benzodiazepines have been used to treat corticosteroid-induced mania and psychosis, no unified management strategy has emerged. Large-scale standardized investigations are needed to clarify the psychiatric effect of corticosteroids on children in all these conditions. Meanwhile, there is general agreement that patients as well as caregivers should be warned of the potential for behavioral adverse effects when patients receive these drugs.

Original languageEnglish (US)
Pages (from-to)817-834
Number of pages18
JournalMayo Clinic Proceedings
Volume89
Issue number6
DOIs
StatePublished - Jan 1 2014

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Psychiatry
Adrenal Cortex Hormones
Pediatrics
Psychotic Disorders
Dexamethasone
Substance-Induced Psychoses
Behavioral Symptoms
Withholding Treatment
Affective Symptoms
Prednisone
Mood Disorders
Benzodiazepines
Bipolar Disorder
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Mental Disorders
MEDLINE
Pharmaceutical Preparations
Glucocorticoids
Caregivers
Antipsychotic Agents

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Psychiatric adverse effects of pediatric corticosteroid use. / Drozdowicz, Linda B.; Bostwick, J. Michael.

In: Mayo Clinic Proceedings, Vol. 89, No. 6, 01.01.2014, p. 817-834.

Research output: Contribution to journalReview article

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