scholarly journals Steroid induced psychiatric adverse effects: an overview of risk factors, clinical features and management

2020 ◽  
Vol 8 (6) ◽  
pp. 2365
Author(s):  
Anant Parasher ◽  
Jeplin Bez
Keyword(s):  
Adverse Effects ◽  
Steroid Therapy ◽  
Wound Repair ◽  
Glucocorticoid Receptors ◽  
Psychiatric Symptoms ◽  
Immunosuppressive Drugs ◽  
Psychotic Symptoms ◽  
Metabolic Disturbances ◽  
Duration Of Treatment

Corticosteroids have been in use since the past five decades as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Adverse effects include growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. The psychiatric effects of steroids are due to the wide expression of Glucocorticoid Receptors in the brain, and their long-term modulation can lead to functional and anatomical alterations along with hippocampal dysfunction. In most cases, the psychiatric symptoms disappear on cessation of steroid therapy; others may require some form of therapeutic management. A search was conducted for clinically relevant articles from 1971 to 2016 by including the terms corticosteroids, mania, depression, psychosis and cognitive defects. About one-fifth of patients receiving high doses of corticosteroids develop psychiatric symptoms. These symptoms are observed to be dose-dependent and generally occur during the first few weeks of therapy. Lithium has a preventive as well as therapeutic role, while antipsychotics are reserved for high risk cases with predominant psychotic symptoms. Psychiatric effects of long term steroid therapy have become increasingly common nowadays due to long duration of treatment of many chronic respiratory and orthopedic illnesses. Reduction in the dose or complete discontinuation of steroid therapy has been proven beneficial in many patients. Among the therapeutic options, lithium has a definitive role, both in the prevention as well as treatment of psychiatric symptoms. Better co-ordination between the physician and psychiatrist can go a long way to improve the quality of life in these patients. 

scholarly journals Analysis of response of vitiligo to treatment with NBUVB

2019 ◽  
Vol 5 (1) ◽  
pp. 37
Author(s):  
J. Madhava Praveen ◽  
Jatin Sidhwa
Keyword(s):  
Adverse Effects ◽  
Skin Disorder ◽  
Environmental Risks ◽  
Treatment Modalities ◽  
Duration Of Treatment ◽  
Autoimmune Attack ◽  
Self Worth ◽  
Good Treatment Response ◽  
Dynamic Interplay

<p class="abstract"><strong>Background:</strong> Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The disease can have devastating consequences on an individual’s relationships with others and internal feelings of self-worth. Vitiligo is caused by a dynamic interplay between genetic and environmental risks that initiates an autoimmune attack on melanocytes in the skin. Long term phototherapy has shown good response in the management of vitiligo. In this study we explore the efficacy of phototherapy in management of our vitiligo patients.</p><p class="abstract"><strong>Methods:</strong> 30 subjects were included in the study. Subjects were started on NBUVB at 300mj/cm<sup>2</sup>. Weekly 3 doses were given. Doses were increased after every 3<sup>rd</sup> sitting by 10%. In case of adverse effects treatment is withheld till resolution of symptoms following which NBUVB is given at 50% of the last dose and patient managed based on the response.<strong></strong></p><p class="abstract"><strong>Results:</strong> A majority of the subjects showed significant and persistent improvement within the first 3 months of initiation of treatment. The proportion of the patients showing improvement increased with duration of treatment.</p><p class="abstract"><strong>Conclusions:</strong> Our study has revealed the standard and significant role the phototherapy plays in the treatment of vitiligo as a monotherapy or as an adjuvant with other treatment modalities. With good treatment response and minimal side effect incidence, phototherapy is an important treatment modality in the management of vitiligo.</p><p> </p>

scholarly journals P709 Is azathioprine safe as long-term treatment in paediatric patients with inflammatory bowel disease?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S573-S573
Author(s):  
M A Martínez Ibeas ◽  
I Bacelo Ruano ◽  
S Rodríguez Manchón ◽  
M Velasco Rodríguez-Belvís ◽  
J F Viada Bris ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Adverse Effects ◽  
Term Treatment ◽  
Tpmt Activity ◽  
Duration Of Treatment ◽  
Median Dosage ◽  
Long Term Treatment ◽  
Inflammatory Bowel

Abstract Background The toxicity of azathioprine (AZA) includes myelosuppression, infections, pancreatitis, photosensitivity, and hepatotoxicity. The aim of this study was to describe the adverse effects profile of azathioprine as long-term treatment in paediatric inflammatory bowel disease (IBD). Methods An observational, descriptive and retrospective study was performed in the paediatric IBD Unit of a tertiary care hospital from September 2008 to December 2018. It was included patients under 18 diagnosed with IBD who were treated with AZA during their follow-up. We recorded epidemiological data, thiopurine methyltransferase (TPMT) enzyme activity, AZA side effects, and the dosage the patients were receiving when these effects took place. Bone marrow suppression (BMS) was defined as leukopenia, thrombocytopenia and/or anaemia. Acute pancreatitis (AP) induced by azathioprine was considered when two of these criteria (Atlanta 2012) were met: lipase increase (&gt; 3 times normal value), congruent signs and symptoms and/or echographic findings, without other possible aetiology and with complete recovery after AZA withdrawal. Results We included 52 patients, being 31 men (59.6%). They were diagnosed with Crohn′s disease (CD) (73%), ulcerative colitis (UC) (21%) and IBD-unclassified (6%). The median TPMT activity was 17 U/ml (14.2–19.2). Up to 63.5% developed adverse effects by AZA with a median time from the beginning of treatment of 11.4 months (2.6–26.4) and a median dosage of 2 mg/kg/day (1.7–2.3). The most frequent side effect was BMS (52%). These patients had a median TPMT activity of 16.9 U/ml (14.2–18.9), the median duration of treatment was 14 months (3.9–27.7), and the median dosage was 2 mg/kg/d (1.8–2.5). BMS was more frequent in patients with UC (p 0.04) and longer treatment (p 0.08). No differences were found according to age, sex or TPMT activity. Up to 11.5% developed AP, the median duration of treatment until its appearance was 1.5 months (0.7–43.3) and the median dosage was 2 mg/kg/d (1.5–2.5). No differences were found related to age, sex, diagnosis or dosage. Other side effects were: 3 flu-like symptoms, 3 opportunistic infections, 2 hypertransaminasemia, and 1 patient with elevated pancreatic enzymes and hyperbilirubinemia. AZA was discontinued in 14 patients (43.8%): in 6 due to AP, in 4 due to severe lymphopenia, in 2 because of Epstein-Barr virus infection, in 1 due to flu-like symptoms and in 1 with several adverse effects. Conclusion More than half of the patients treated with AZA presented side effects, mainly BMS, although most of them were mild and temporary, and the withdrawal of the drug was not necessary. It seems that TPMT activity is not useful to predict BMS, but this adverse effect could be related to a longer treatment.

scholarly journals Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients

2019 ◽  
Vol 14 (3) ◽  
pp. 173-181 ◽  
Author(s):  
John Read ◽  
James Williams
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Antipsychotic Medication ◽  
Online Survey ◽  
Negative Effects ◽  
Duration Of Treatment ◽  
Direct To Consumer ◽  
Poor Outcomes

Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.

A Decreased Incidence of Necrotizing Enterocolitis After Prenatal Glucocorticoid Therapy

PEDIATRICS ◽  
1984 ◽  
Vol 73 (5) ◽  
pp. 682-688 ◽  
Author(s):  
Charles R. Bauer ◽  
John C. Morrison ◽  
W. Kenneth Poole ◽  
Sheldon B. Korones ◽  
John J. Boehm ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Necrotizing Enterocolitis ◽  
Steroid Therapy ◽  
Short Term ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Intestinal Maturation ◽  
Blinded Trial ◽  
Long Term Adverse Effects

In a large multicentered, collaborative randomized and blinded trial utilizing antenatal corticosteroids, the goals included determining the effectiveness of these agents in accelerating lung maturation, as well as monitoring any short-term or long-term adverse effects of this treatment on the parturient, fetus, and/or infant. More than 100 specific items, pertaining to diagnoses, complications, and outcomes were recorded for the 696 mothers enrolled in the study and their 745 infants. A significantly decreased incidence of necrotizing enterocolitis (P = .002) was found in the infants treated with steroids. The possibility of accelerated intestinal maturation induced by antenatal maternal steroid therapy exists. This treatment regimen is particularly attractive as adverse aspects of steroid therapy at the dosage utilized have not been demonstrated.

scholarly journals Effectiveness of Tocilizumab in the Treatment of Fasciitis with Eosinophilia: Two Case Reports

2020 ◽  
Author(s):  
Guiomar Pinheiro ◽  
Ana Rita Costa ◽  
Ana Campar ◽  
Teresa Mendonça
Keyword(s):  
Side Effects ◽  
Partial Response ◽  
Adverse Effects ◽  
Large Scale ◽  
Case Reports ◽  
Immunosuppressive Drugs ◽  
Systemic Corticosteroids ◽  
First Case ◽  
Symptom Relapse

Fasciitis with eosinophilia (FE) is a rare connective tissue disease. Due to its rarity, large-scale studies are lacking, which makes its treatment challenging. Systemic corticosteroids (SCSs) are the cornerstone of treatment; however, additional immunosuppressive drugs (ISDs) are frequently necessary (usually methotrexate). We report 2 patients, for whom an SCS and methotrexate were not a viable long-term option. In the first case, we were unable to taper the SCS dose without symptom relapse, the patient showed only a partial response to methotrexate and presented side effects. The second case never fully responded to the SCS and methotrexate and demonstrated serious SCS adverse effects. Both patients were started on tocilizumab with extremely favourable results, making this drug a potential therapeutic weapon for these patients.

scholarly journals Psychotic Symptoms after Long Term Using Diazepam and Alprazolam Medication; Depend Syndrome of Alprazolam

2019 ◽  
Vol 4 (10) ◽  
Keyword(s):  
Adverse Effects ◽  
Brain Tissue ◽  
Half Life ◽  
Withdrawal Syndrome ◽  
Psychotic Symptoms ◽  
Negative Consequences ◽  
Experimental Conditions ◽  
Alprazolam Withdrawal ◽  
The Brain

Alprazolam and Diazepam two most prescribed benzodiazepine in the Kosovo have been potential for addictive use. Both drugs are rapidly absorbed and enter the brain tissue rapidly, leading to reinforcement. Alprazolam has a short half – life that may lead to more withdrawal symptoms than Diazepam. In experimental conditions, they are among the most reinforcing benzodiazepines. Each causes a withdrawal syndrome, but Alprazolam withdrawal may be more severe and may occur after a shorter period of use. Adverse effects from their use are rare, yet negative consequences may be seen with some regularly. Alprazolam deserves special caution, because of its relative newness great popularity-reinforcing capabilities relatively sense withdrawal syndrome, and reports of addiction and negative consequences of use.

Functional psychoses

2017 ◽  
pp. 1057-1064
Author(s):  
Luis Agüera-Ortiz
Keyword(s):  
Adverse Effects ◽  
Older People ◽  
Atypical Antipsychotics ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Psychotic Symptoms ◽  
Younger Adults ◽  
Psychological Management ◽  
Concomitant Medications

Psychotic symptoms are more common in older people than in any other age. The most frequent psychotic disorders in older people are juvenile-onset schizophrenia in ageing patients, psychosis in Alzheimer’s disease, and the late- and very late-onset schizophrenia-like psychosis. Drug treatment of all types of psychosis is essential and often achieves similar levels of efficacy than in younger adults. The treatment of choice for any psychotic condition is atypical antipsychotics. Rather than being based on specific diagnosis, the choice of drug must be highly personalized, depending on the efficacy for the particular patient, drug’s profile of adverse effects, medical comorbidities, and concomitant medications. Attention should be paid to the emergence of adverse effects that are in general more frequently found with conventional than with atypical antipsychotics. Clinical and psychological management includes the need to establish a therapeutic alliance with the patient and ensure adherence to treatment in the long term.

Plasma homovanillic acid, noradrenaline and psychotic symptoms in chronically medicated schizophrenic in patients

2001 ◽  
Vol 13 (2) ◽  
pp. 49-52
Author(s):  
Y. Kaneda ◽  
A. Fujii
Keyword(s):  
Informed Consent ◽  
Patient Group ◽  
Homovanillic Acid ◽  
Psychiatric Symptoms ◽  
Chronic Schizophrenia ◽  
Normal Subjects ◽  
Psychotic Symptoms ◽  
Neuroleptic Medication ◽  
Dsm Iv

SummaryObjective:The authors investigated plasma homovanillic acid (HVA) levels and noradrenaline (NA) in chronically medicated schizophrenic inpatients.Methods:The subjects were 55 inpatients who were diagnosed according to the DSM-IV criteria for schizophrenia. Nine normal subjects were compared to the patient group. Each patient gave informed consent for the research involved in this study. Psychiatric symptoms were assessed using the BPRS.Results:(1) The medicated schizophrenic inpatients had significantly greater plasma NA levels, and higher but nonsignificant plasma HVA levels than the normal subjects.(2) In patients, there was a positive but nonsignificant correlation between the plasma NA levels and positive symptomatology. In contrast, plasma HVA levels were not correlated with either positive or negative symptomatology.Conclusion:On the basis of these results, we hypothesize that, mainly because of their catecholaminergic dysfunction, there is an increase in plasma NA and a tendency for increased plasma HVA in patients with chronic schizophrenia, regardless of long-term neuroleptic medication.

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