期刊
CURRENT OPINION IN ORGAN TRANSPLANTATION
卷 19, 期 2, 页码 201-208出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MOT.0000000000000065
关键词
complications; corticosteroids; neuropsychiatric; prophylaxis
Purpose of reviewThe 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.Recent findingsThe incidence of neuropsychiatric complications rises rapidly once the daily dose of prednisone is greater than 40mg. 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.SummaryThere 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.
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