Adverse consequences of glucocorticoid medication: Psychological, cognitive, and behavioral effects

Lewis L. Judd, Pamela J. Schettler, E. Sherwood Brown, Owen M. Wolkowitz, Esther M. Sternberg, Bruce G. Bender, Karen Bulloch, John A. Cidlowski, E. Ronald De Kloet, Laurence Fardet, Marian Joëls, Donald Y M Leung, Bruce S. McEwen, Benno Roozendaal, Elisabeth F C Van Rossum, Junyoung Ahn, David W. Brown, Aaron Plitt, Gagandeep Singh

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Glucocorticoids are the most commonly prescribed anti-inflammatory/immunosuppressant medications worldwide. This article highlights the risk of clinically significant and sometimes severe psychological, cognitive, and behavioral disturbances that may be associated with glucocorticoid use, as well as ways to prevent and treat these disturbances. An illustrative case vignette is presented describing a patient's experience of cycles of manic-like behavior and depression while on high-dosage prednisone, with long-term cognitive disorganization, vulnerability to stress, and personality changes. Severe neuropsychiatric consequences (including suicide, suicide attempt, psychosis, mania, depression, panic disorder, and delirium, confusion, or disorientation) have been reported to occur in 15.7 per 100 person-years at risk for all glucocorticoid courses, and 22.2 per 100 person-years at risk for first courses. The majority of patients experience less severe but distressing and possibly persistent changes in mood, cognition, memory, or behavior during glucocorticoid treatment or withdrawal. Although prediction of such effects is difficult, risks vary with age, gender, dosage, prior psychiatric history, and several biological markers. Key mechanisms thought to underlie these risk factors are briefly described. Recommendations are given for identifying individual risk factors and for monitoring and managing adverse neuropsychiatric effects of glucocorticoids.

Original languageEnglish (US)
Pages (from-to)1045-1051
Number of pages7
JournalAmerican Journal of Psychiatry
Volume171
Issue number10
DOIs
StatePublished - Oct 1 2014

Fingerprint

Glucocorticoids
Psychology
Confusion
Suicide
Depression
Delirium
Panic Disorder
Immunosuppressive Agents
Prednisone
Bipolar Disorder
Psychotic Disorders
Cognition
Psychiatry
Personality
Anti-Inflammatory Agents
Biomarkers
Psychological
Medication
Person
Risk Factors

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Arts and Humanities (miscellaneous)
  • Medicine(all)

Cite this

Judd, L. L., Schettler, P. J., Brown, E. S., Wolkowitz, O. M., Sternberg, E. M., Bender, B. G., ... Singh, G. (2014). Adverse consequences of glucocorticoid medication: Psychological, cognitive, and behavioral effects. American Journal of Psychiatry, 171(10), 1045-1051. https://doi.org/10.1176/appi.ajp.2014.13091264

Adverse consequences of glucocorticoid medication : Psychological, cognitive, and behavioral effects. / Judd, Lewis L.; Schettler, Pamela J.; Brown, E. Sherwood; Wolkowitz, Owen M.; Sternberg, Esther M.; Bender, Bruce G.; Bulloch, Karen; Cidlowski, John A.; De Kloet, E. Ronald; Fardet, Laurence; Joëls, Marian; Leung, Donald Y M; McEwen, Bruce S.; Roozendaal, Benno; Van Rossum, Elisabeth F C; Ahn, Junyoung; Brown, David W.; Plitt, Aaron; Singh, Gagandeep.

In: American Journal of Psychiatry, Vol. 171, No. 10, 01.10.2014, p. 1045-1051.

Research output: Contribution to journalArticle

Judd, LL, Schettler, PJ, Brown, ES, Wolkowitz, OM, Sternberg, EM, Bender, BG, Bulloch, K, Cidlowski, JA, De Kloet, ER, Fardet, L, Joëls, M, Leung, DYM, McEwen, BS, Roozendaal, B, Van Rossum, EFC, Ahn, J, Brown, DW, Plitt, A & Singh, G 2014, 'Adverse consequences of glucocorticoid medication: Psychological, cognitive, and behavioral effects', American Journal of Psychiatry, vol. 171, no. 10, pp. 1045-1051. https://doi.org/10.1176/appi.ajp.2014.13091264
Judd, Lewis L. ; Schettler, Pamela J. ; Brown, E. Sherwood ; Wolkowitz, Owen M. ; Sternberg, Esther M. ; Bender, Bruce G. ; Bulloch, Karen ; Cidlowski, John A. ; De Kloet, E. Ronald ; Fardet, Laurence ; Joëls, Marian ; Leung, Donald Y M ; McEwen, Bruce S. ; Roozendaal, Benno ; Van Rossum, Elisabeth F C ; Ahn, Junyoung ; Brown, David W. ; Plitt, Aaron ; Singh, Gagandeep. / Adverse consequences of glucocorticoid medication : Psychological, cognitive, and behavioral effects. In: American Journal of Psychiatry. 2014 ; Vol. 171, No. 10. pp. 1045-1051.
@article{a6039c6a32494fcca210abdc39977066,
title = "Adverse consequences of glucocorticoid medication: Psychological, cognitive, and behavioral effects",
abstract = "Glucocorticoids are the most commonly prescribed anti-inflammatory/immunosuppressant medications worldwide. This article highlights the risk of clinically significant and sometimes severe psychological, cognitive, and behavioral disturbances that may be associated with glucocorticoid use, as well as ways to prevent and treat these disturbances. An illustrative case vignette is presented describing a patient's experience of cycles of manic-like behavior and depression while on high-dosage prednisone, with long-term cognitive disorganization, vulnerability to stress, and personality changes. Severe neuropsychiatric consequences (including suicide, suicide attempt, psychosis, mania, depression, panic disorder, and delirium, confusion, or disorientation) have been reported to occur in 15.7 per 100 person-years at risk for all glucocorticoid courses, and 22.2 per 100 person-years at risk for first courses. The majority of patients experience less severe but distressing and possibly persistent changes in mood, cognition, memory, or behavior during glucocorticoid treatment or withdrawal. Although prediction of such effects is difficult, risks vary with age, gender, dosage, prior psychiatric history, and several biological markers. Key mechanisms thought to underlie these risk factors are briefly described. Recommendations are given for identifying individual risk factors and for monitoring and managing adverse neuropsychiatric effects of glucocorticoids.",
author = "Judd, {Lewis L.} and Schettler, {Pamela J.} and Brown, {E. Sherwood} and Wolkowitz, {Owen M.} and Sternberg, {Esther M.} and Bender, {Bruce G.} and Karen Bulloch and Cidlowski, {John A.} and {De Kloet}, {E. Ronald} and Laurence Fardet and Marian Jo{\"e}ls and Leung, {Donald Y M} and McEwen, {Bruce S.} and Benno Roozendaal and {Van Rossum}, {Elisabeth F C} and Junyoung Ahn and Brown, {David W.} and Aaron Plitt and Gagandeep Singh",
year = "2014",
month = "10",
day = "1",
doi = "10.1176/appi.ajp.2014.13091264",
language = "English (US)",
volume = "171",
pages = "1045--1051",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "10",

}

TY - JOUR

T1 - Adverse consequences of glucocorticoid medication

T2 - Psychological, cognitive, and behavioral effects

AU - Judd, Lewis L.

AU - Schettler, Pamela J.

AU - Brown, E. Sherwood

AU - Wolkowitz, Owen M.

AU - Sternberg, Esther M.

AU - Bender, Bruce G.

AU - Bulloch, Karen

AU - Cidlowski, John A.

AU - De Kloet, E. Ronald

AU - Fardet, Laurence

AU - Joëls, Marian

AU - Leung, Donald Y M

AU - McEwen, Bruce S.

AU - Roozendaal, Benno

AU - Van Rossum, Elisabeth F C

AU - Ahn, Junyoung

AU - Brown, David W.

AU - Plitt, Aaron

AU - Singh, Gagandeep

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Glucocorticoids are the most commonly prescribed anti-inflammatory/immunosuppressant medications worldwide. This article highlights the risk of clinically significant and sometimes severe psychological, cognitive, and behavioral disturbances that may be associated with glucocorticoid use, as well as ways to prevent and treat these disturbances. An illustrative case vignette is presented describing a patient's experience of cycles of manic-like behavior and depression while on high-dosage prednisone, with long-term cognitive disorganization, vulnerability to stress, and personality changes. Severe neuropsychiatric consequences (including suicide, suicide attempt, psychosis, mania, depression, panic disorder, and delirium, confusion, or disorientation) have been reported to occur in 15.7 per 100 person-years at risk for all glucocorticoid courses, and 22.2 per 100 person-years at risk for first courses. The majority of patients experience less severe but distressing and possibly persistent changes in mood, cognition, memory, or behavior during glucocorticoid treatment or withdrawal. Although prediction of such effects is difficult, risks vary with age, gender, dosage, prior psychiatric history, and several biological markers. Key mechanisms thought to underlie these risk factors are briefly described. Recommendations are given for identifying individual risk factors and for monitoring and managing adverse neuropsychiatric effects of glucocorticoids.

AB - Glucocorticoids are the most commonly prescribed anti-inflammatory/immunosuppressant medications worldwide. This article highlights the risk of clinically significant and sometimes severe psychological, cognitive, and behavioral disturbances that may be associated with glucocorticoid use, as well as ways to prevent and treat these disturbances. An illustrative case vignette is presented describing a patient's experience of cycles of manic-like behavior and depression while on high-dosage prednisone, with long-term cognitive disorganization, vulnerability to stress, and personality changes. Severe neuropsychiatric consequences (including suicide, suicide attempt, psychosis, mania, depression, panic disorder, and delirium, confusion, or disorientation) have been reported to occur in 15.7 per 100 person-years at risk for all glucocorticoid courses, and 22.2 per 100 person-years at risk for first courses. The majority of patients experience less severe but distressing and possibly persistent changes in mood, cognition, memory, or behavior during glucocorticoid treatment or withdrawal. Although prediction of such effects is difficult, risks vary with age, gender, dosage, prior psychiatric history, and several biological markers. Key mechanisms thought to underlie these risk factors are briefly described. Recommendations are given for identifying individual risk factors and for monitoring and managing adverse neuropsychiatric effects of glucocorticoids.

UR - http://www.scopus.com/inward/record.url?scp=84907486834&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907486834&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.2014.13091264

DO - 10.1176/appi.ajp.2014.13091264

M3 - Article

C2 - 25272344

AN - SCOPUS:84907486834

VL - 171

SP - 1045

EP - 1051

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 10

ER -