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UK researchers investigated the incidence and risk of suicidal behaviour and severe neuropsychiatric disorders in people treated with systemic glucocorticoids.
In total, 786,868 courses of oral glucocorticoids were prescribed for 372,696 patients.
The study authors identified 109 incident cases of suicide or attempted suicide and 10,220 incident cases of severe neuropsychiatric disorders in these patients.
The incidence of either outcome was 22.2 per 100 person-years at risk for the first course of treatment.
Compared with people with the same underlying medical illness who were not treated with glucocorticoids, the hazard ratio for suicide or attempted suicide in exposed patients was 6.89; for depression 1.83; for mania, 4.35.
Older men were at higher risk of delirium/confusion/disorientation and mania, while younger patients were at higher risk of suicide or attempted suicide.
Patients with a previous history of neuropsychiatric disorders and those treated with higher doses of glucocorticoids were at higher risk of neuropsychiatric outcomes.
The authors concluded that glucocorticoids increase the risk of suicidal behaviour and neuropsychiatric disorders.
Educating patients and their families about these adverse events and increasing physicians’ awareness of their occurrence should facilitate early monitoring.
The conclusion of this study leaves no room for doubt: there is an increased risk of neuropsychiatric disorders, including suicide attempts in patients prescribed systemic corticosteroids.
This is something that many experienced physicians have seen in their practices.
In addition to the risk of psychotic outbreaks, there is also a risk of maniac reversals in bipolar patients according to a psychiatrist friends of mine.
The conclusion of this study leaves no room for doubt: there is an increased risk of neuropsychiatric disorders, including suicide attempts in patients prescribed systemic corticosteroids. This is something that many experienced physicians have seen in their practice.
Avoiding excessive doses when this is not necessary or minimising doses in patients with a neuropsychiatric disorder seems to be an appropriate rationalisation in view of the important data from this large cohort study.
SOURCE: Fardet L, Petersen I, Nazareth I. Suicidal Behaviour and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. Am J Psychiatry 2012 May 1; 169:491
https://pubmed.ncbi.nlm.nih.gov/22764363/
My observation is that corticosteroid intake seems miraculous at first. The symptoms “disappear”. The point is that, as every disease has a function when the real cause of the disease is not harmonised or addressed, there will be manifestations in other aspects of the patient’s life.
Extrapolating this study to other fields, considering that about 75% of the population is infected with toxoplasma, I imagine that glucocorticoids immunosuppresses the Th1 response and facilitate the clinical expression of the pathogen and there are many people with infected with toxoplasma.
The patient should be approached as a whole, that is, through Bio-Psycho-Spiritual-Bodily.
This is an article for the intention to raise awareness. It is a public awareness broadcast.