Glucocorticoid preparations are used commonly in the treatment of many diseases in children and adolescents. Although their physiologic side of effects have been described well, the psychiatric side effects of these medications have received little attention. Limited data suggest that disturbances of affect and behavior may occur in 25-50% of children receiving glucocorticoid. These steroid-induced mental changes may be underrecognized in children, and yet these changes can have considerable impact on social and psychological functioning and treatment outcome. An enhanced awareness and reporting of this phenomenon by clinicians, parents, and teachers would likely lead to better compliance with treatment, improved outcomes, and greater understanding of emotional concomitants of illness.
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References
1.
Goolker P., Schein J.Psychic effects of ACTH and cortisone. Psychosom Med1953;15:589-613.
2.
Hall Rcw, Popkin MK, Stickney SK, et al. Presentation of the steroid psychoses. J Nerv Ment Dis1979;167:229-36.
3.
Ling Mhm, Perry PJ, Tsuang MTSide effects of corticosteroid therapy-psychiatric aspects. Arch Gen Psychiatr1981 ;38:471-7.
4.
Cushing H.The basophil adenomas of the pituitary body and their clinical manifestations . Bull Johns Hopkins Hosp1932;50:137-95.
5.
de laRiva GEPsychic and somatic changes observed in allergic children after prolonged steroid therapy. South Med J1958 ;51:865-8.
6.
Lerner JA, Mrazek DA, Strunk RCPrednisone use is associated with psychiatric disturbance in asthmatic children . Abstracted 33rd Annual Meeting of the American Academy of Child and Adolescent Psychiatry 1986, UCLA, Los Angeles, p.14.
7.
Lerner JA, Bender BGPsychiatric and neuropsychological side effects of steroid medication. Abstracted 34th Annual Meeting of the American Academy of Child and Adolescent Psychiatry1987, Washington, DC.
8.
Bender BG, Lerner JAKollasch E.Mood and memory changes in asthmatic children receiving corticosteroids. J Amer Acad Child Adolesc Psychiatry1988;27:720-5.
9.
Harris JC, Carel CA, Rosenberg LA, et al. Intermittent high dose corticosteroid treatment in childhood cancer:behavioral and emotional consequences. J Am Acad Child Adolesc Psychiatry1986;24:120-4.
10.
Taran LM, Gulotta GA, Szilagyi N., et al. Effect of cortisone and ACTH on the protracted phase of rheumatic carditis in children. Am J Med1953; 14:275-83.
11.
Stillman JS, Bayles TBThe effect of ACTH on juvenile rheumatoid arthritis. In Mote JR, ed, Proceedings of the First Clinical ACTH ConferenceOxford: Blackiston, 1950:393-404.
12.
Wilkins L., Crigler JF, Silverman SH, et al. Further studies on the treatment of congenital hyperplasia with cortisone. J Clin Endocrinol Metab1952;122:1015-30.
13.
Wilkins L., Lewis RA, Klein R., et al. Treatment of congenital hyperplasia with cortisone. J Clin Endocrinol Metab1951;11:1-25.
14.
Gillies Ahb , Shellshear IDUnwanted corticosteroid effects in childhood bone marrow failure, renal failure, and brain damage:case report. NZ Med J1975 ;81:424-7.
15.
Stefanini M. , Roy CA, Zannos L., et al. Therapeutic effect of ACTH in a case of Henoch-Schonlein vascular purpura. JAMA1950;144:1372-4.
16.
Rome HP, Braceland BJThe psychological response to ACTH, cortisone, hydrocortisone and related steroid substances. Am J Psychiatr1952; 108: 641-51.
17.
Marx FW, Barker WFSurgical results in patients with ulcerative colitis treated with and without corticosteroids. Am J Surg1969;113:157-64.
18.
Cade R., Spoone G., Schlein E., et al. Comparison of azathioprine, prednisone and heparin alone or combined in the treatment of lupus nephritis. Nephron1973; 10:37-56.
19.
Glaser GHPsychotic reactions induced by corticotropin (ACTH) and cortisone. Psychosom Med1953;15:280-91.
20.
Villared S. , Escoude M., Level C.A propos des psychoses cortisoniques. Annales Medico-PsychologiquesParis1974;1:523-31.
21.
Hench PS, Slocum CH, Polley HF, et al. Effect of cortisone and ACTH on rheumatic diseases. JAMA1950;144:1327-9.
22.
Rome HP, Braceland FJUse of cortisone and ACTH in certain diseases-psychiatric aspects. Proc Staff Mtg Mayo Clin1950;25:495-7.
23.
Siegel FPLithium for steroid induced psychosis. N Eng J Med1978;239:155.
Goggans FC, Weisberg LJ, Koran LMLithium prophylaxis of prednisone psychosis:a case report. J Clin Psychiatr1983;44:111-2.
26.
Sergent JS, Lockshin MD, Klempner MS, et al. Central nervous system disease in systemic lupus erythematosus . Am J Med1975;58:644-54.
27.
Hall Rcw, Popkin MK, Kirkpatrick B.Tricyclic exacerbation of steroid psychosis. J Nerv Ment Dis1983; 166:738-42.
28.
Glaser GHThe pituitary gland in relation to cerebral metabolism and metabolic disorders of the nervous system. Res Publ Ass Res Nerv Ment Dis1953;32:21-39.
29.
Copeman Wcs, Dodds C., Savage O.Management of rheumatoid arthritis with prolonged cortisone administration . Br Med J1954;1:109-13.
30.
Sharfstein SS , Sack DS, Fauci ASRelationships between alternate day corticosteroid therapy and behavioral abnormalities. JAMA1982;248:2987-9.
31.
Varney NR, Alexander B., MacIndoe JHReversible steroid dementia in patients without steroid psychosis. Am J Psychiatr1984; 141:369-72.
Rodin G., Voshart K.Depression in the medically ill:an overview. Am J Psychiatr1986; 143:696-705.
34.
Miller BDDepression and asthma:a potentially lethal mixture. J Allergy Clin Immunol1987;80:481-6.
35.
Pless IB, Roghmann KJChronic illness and its consequences:observations based on three epidemiologic surveys. J Pediatr1971;79:351-9.
36.
Rutter M.Psychological development predictions from infancy. J Child Psychol Psychiatry1970;2:49-62.
37.
McNichols KN , Williams HE, Allan J., et al. Spectrum of asthma in children. Br Med J1973;4:16-20.
38.
Kim SP, Ferrara A., Chess S.Temperament of asthmatic children. J Pediatr1980;97:483-6.
39.
Ogilive R.Clinical pharmacokinetics of theophylline. Clin Pharmocokinet1978;3:267-93.
40.
Weinberger M., Hendeles L., Ahrens R.Clinical pharmacology of drugs used in the treatment of asthma. Pediatr Clin N Am1981 :28:47-72.
41.
Schraa J., Dirks J.The influence of corticosteroids and theophylline on cerebral function. Chest1982;82:181-5.
42.
Brumback RA , Wilson H., Staton RDBehavioral problems in children taking theophylline (letter). Lancetii1984;958.
43.
Furukawa CT , Shapiro GG, DuHamel T., et al. Learning and behavior problems associated with theophylline therapy (letter). Lancetii1984:957.
44.
Kay Hem, Knapton PJ, O'Sullivan DG, et al. Encephalopathy in acute leukemia associated with methotrexate therapy. Arch Dis Child1972;47:344-54.
45.
Rubinstein LJ, Herman MM, Long TF, et al. Disseminated necrotinizing leukoencephalopathy: a complication of treated CNS leukemia. Cancer1985;35:291-305.
46.
Kashani JH, Holcomb WR, Orvaschel H.Depression and depressive symptoms in preschool children from the general population. Am J Psychiatr1986;143:1138-41.
47.
Pearce JBThe recognition of depressive disorder in children. J R Soc Med1978;71:494-500.
48.
Poznanski EO , Mokros HB, Grossman J., et al. Diagnostic criteria in childhood depression . Am J Psychiatr1985;142:1168-73.
49.
Angold A., Weissman MM, John K., et al. Parent and child reports of depressive symptoms. J Child Psychol Psychiatr1987;28:901-15.
