Neuropsychiatric complications of corticosteroids in older people

Abstract

The neuropsychiatric effects of corticosteroids are well described in the literature but relatively little is known specifically about their effects among older people. As the population ages, and increasing numbers of older people receive assertive medical treatment for physical conditions, more patients are likely to present to psychiatric services suffering from adverse neuropsychiatric effects associated with corticosteroid use. A review of the effects of corticosteroids among older people was carried out through Medline and PubMed searches and a review of article references. Very little has been specifically written about steroid use and the effects on older people. This paper briefly outlines the current level of knowledge of neuropsychiatric effects of steroids, and relates this to general treatment considerations for older subjects. Recommendations for further research and early identification of complications are made.

Behavioral, Psychiatric, and Cognitive Adverse Events in Older Persons Treated with Glucocorticoids

“…The most consistent finding relating to treatment since the very early reports is the effect of GC dose on the risk of developing BPAEs, with the risk increasing with higher GC doses [ 10 , 12 ]. Although most large studies are not necessarily focused on older adults, it is not clear whether in this group the risk is the same, bearing in mind what has been mentioned earlier in relation to the special considerations to be had in older people.…”

“…The presence of a previous psychiatric history cannot be a risk factor (and hence this should not be a contraindication to GC therapy [ 10 ]. However, the presence of previous GC-induced psychiatric adverse events may predispose to further episodes when re-challenged with these drugs, and a sensitization mechanism has been suggested [ 10 ].…”

“…It has been reported that suffering from an illness that is frequently associated with neuropsychiatric manifestations may increase the risk of GC-induced BPAEs [ 10 ]. This would refer to conditions such as SLE [ 14 , 15 , 16 ].…”

“…As previously mentioned, the dose of GCs is related to the risk of BPAEs, but there does not seem to exist a safe low dose of GCs [ 10 , 12 ].…”

“…Although age in itself has been reported to be unrelated to the incidence of BPAEs in those taking GCs [ 7 , 9 ], it has been suggested that the assessment of psychiatric symptoms in older persons requires a number of special considerations such as those relating to the presence of comorbid physical health disorders, the accrual of cognitive impairment, and even dementia, and the fact that older adults are more likely to be subject to polypharmacy, using drugs that in themselves may be associated with behavioral and psychiatric disturbances [ 9 , 10 , 11 , 12 , 13 ].…”