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Erschienen in: Journal of Neurology 11/2014

01.11.2014 | Original Communication

New-onset psychiatric disorders after corticosteroid therapy in systemic lupus erythematosus: an observational case-series study

verfasst von: Katsuji Nishimura, Masako Omori, Eri Sato, Yasuhiro Katsumata, Takahisa Gono, Yasushi Kawaguchi, Masayoshi Harigai, Hisashi Yamanaka, Jun Ishigooka

Erschienen in: Journal of Neurology | Ausgabe 11/2014

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Abstract

The objective of this study was to clarify the incidence, clinical characteristics, and courses of new-onset psychiatric manifestations after corticosteroid therapy in patients with systemic lupus erythematosus (SLE), including possible ways of differentiating between corticosteroid-induced psychiatric disorders (CIPDs) and central nervous system manifestations of SLE (CNS-SLE). We prospectively followed for 8 weeks 139 consecutive episodes in 135 in-patients who had a non–CNS-SLE flare treated with corticosteroids. Psychiatric events were evaluated once a week using DSM-IV criteria. We then conducted a post hoc etiological analysis of any newly developed psychiatric events during this follow-up period. In the 8 weeks of corticosteroid administration, new psychiatric events occurred in 20 (14.4 %) of the 139 episodes. The mean dosage of corticosteroids administered was prednisolone at 0.98 (range 0.24–1.39) mg/kg/day. Of the 20 psychiatric events, 14 (10.1 %) were suitable for the strict definition of CIPDs, accompanied by mood disorders in 13 (depressive in 2, manic in 9, and mixed in 2) and psychotic disorder in one. Two (1.4 %), both presenting delirium, were diagnosed as CNS-SLE on the basis of evidence of abnormal CNS findings even before psychiatric manifestations, all of which improved in parallel with these patients’ recoveries through augmentation of immunosuppressive therapy. The other four events (2.9 %) could not be etiologically identified. This study suggests that corticosteroid therapy triggers CIPDs and CNS-SLE in patients with SLE. Delirium may be suggestive of CNS-SLE, while mood disorders may be more suggestive of CIPDs. Electroencephalographic abnormalities may possibly be predictive of CNS-SLE.
Literatur
1.
Zurück zum Zitat Ainiala H, Loukkola J, Peltola J, Korpela M, Hietaharju A (2001) The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology 57:496–500CrossRefPubMed Ainiala H, Loukkola J, Peltola J, Korpela M, Hietaharju A (2001) The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology 57:496–500CrossRefPubMed
2.
Zurück zum Zitat Brey RL, Holliday SL, Saklad AR et al (2002) Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology 58:1214–1220CrossRefPubMed Brey RL, Holliday SL, Saklad AR et al (2002) Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology 58:1214–1220CrossRefPubMed
3.
Zurück zum Zitat Hanly JG, McCurdy G, Fougere L, Douglas JA, Thompson K (2004) Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance. J Rheumatol 31:2156–2162PubMed Hanly JG, McCurdy G, Fougere L, Douglas JA, Thompson K (2004) Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance. J Rheumatol 31:2156–2162PubMed
4.
Zurück zum Zitat Unterman A, Nolte JE, Boaz M et al (2011) Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum 41:1–11CrossRefPubMed Unterman A, Nolte JE, Boaz M et al (2011) Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum 41:1–11CrossRefPubMed
5.
Zurück zum Zitat Kohen M, Asherson RA, Gharavi AE, Lahita RG (1993) Lupus psychosis: differentiation from the steroid-induced state. Clin Exp Rheumatol 11:323–326PubMed Kohen M, Asherson RA, Gharavi AE, Lahita RG (1993) Lupus psychosis: differentiation from the steroid-induced state. Clin Exp Rheumatol 11:323–326PubMed
6.
Zurück zum Zitat Denburg SD, Carbotte RM, Denburg JA (1994) Corticosteroids and neuropsychological functioning in patients with systemic lupus erythematosus. Arthritis Rheum 37:1311–1320CrossRefPubMed Denburg SD, Carbotte RM, Denburg JA (1994) Corticosteroids and neuropsychological functioning in patients with systemic lupus erythematosus. Arthritis Rheum 37:1311–1320CrossRefPubMed
7.
Zurück zum Zitat Wolkowitz OM, Reus VI, Canick J, Levin B, Lupien S (1997) Glucocorticoid medication, memory and steroid psychosis in medical illness. Ann NY Acad Sci 823:81–96CrossRefPubMed Wolkowitz OM, Reus VI, Canick J, Levin B, Lupien S (1997) Glucocorticoid medication, memory and steroid psychosis in medical illness. Ann NY Acad Sci 823:81–96CrossRefPubMed
8.
Zurück zum Zitat ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42:599–608CrossRef ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42:599–608CrossRef
9.
Zurück zum Zitat Patten SB, Neutel CI (2000) Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf 22:111–122CrossRefPubMed Patten SB, Neutel CI (2000) Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf 22:111–122CrossRefPubMed
10.
Zurück zum Zitat West SG (2013) Clinical Aspects of the Nervous System. In: Wallace DJ, Hahn BH (eds) Dubois’ lupus erythematosus and related syndromes. Elsevier Saunders, Philadelphia, pp 368–381CrossRef West SG (2013) Clinical Aspects of the Nervous System. In: Wallace DJ, Hahn BH (eds) Dubois’ lupus erythematosus and related syndromes. Elsevier Saunders, Philadelphia, pp 368–381CrossRef
11.
Zurück zum Zitat Postal M, Costallat LT, Appenzeller S (2011) Neuropsychiatric manifestations in systemic lupus erythematosus: epidemiology, pathophysiology and management. CNS Drugs 25:721–736CrossRefPubMed Postal M, Costallat LT, Appenzeller S (2011) Neuropsychiatric manifestations in systemic lupus erythematosus: epidemiology, pathophysiology and management. CNS Drugs 25:721–736CrossRefPubMed
12.
Zurück zum Zitat Bhangle SD, Kramer N, Rosenstein ED (2013) Corticosteroid-induced neuropsychiatric disorders: review and contrast with neuropsychiatric lupus. Rheumatol Int 33:1923–1932CrossRefPubMed Bhangle SD, Kramer N, Rosenstein ED (2013) Corticosteroid-induced neuropsychiatric disorders: review and contrast with neuropsychiatric lupus. Rheumatol Int 33:1923–1932CrossRefPubMed
13.
Zurück zum Zitat Nishimura K, Harigai M, Omori M, Sato E, Hara M (2008) Blood-brain barrier damage as a risk factor for corticosteroid-induced psychiatric disorders in systemic lupus erythematosus. Psychoneuroendocrinology 33:395–403CrossRefPubMed Nishimura K, Harigai M, Omori M, Sato E, Hara M (2008) Blood-brain barrier damage as a risk factor for corticosteroid-induced psychiatric disorders in systemic lupus erythematosus. Psychoneuroendocrinology 33:395–403CrossRefPubMed
14.
Zurück zum Zitat Tan EM, Cohen AS, Fries JF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277CrossRefPubMed Tan EM, Cohen AS, Fries JF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277CrossRefPubMed
15.
Zurück zum Zitat American Psychiatric Association (1994) diagnostic and statistical manual of mental disorders, 4th ed. DSM-IV. American Psychiatric Association, Washington American Psychiatric Association (1994) diagnostic and statistical manual of mental disorders, 4th ed. DSM-IV. American Psychiatric Association, Washington
16.
Zurück zum Zitat Chau SY, Mok CC (2003) Factors predictive of corticosteroid psychosis in patients with systemic lupus erythematosus. Neurology 61:104–107CrossRefPubMed Chau SY, Mok CC (2003) Factors predictive of corticosteroid psychosis in patients with systemic lupus erythematosus. Neurology 61:104–107CrossRefPubMed
17.
Zurück zum Zitat Dubovsky AN, Arvikar S, Stern TA, Axelrod L (2012) The neuropsychiatric complications of glucocorticoid use: steroid psychosis revisited. Psychosomatics 53:103–115CrossRefPubMed Dubovsky AN, Arvikar S, Stern TA, Axelrod L (2012) The neuropsychiatric complications of glucocorticoid use: steroid psychosis revisited. Psychosomatics 53:103–115CrossRefPubMed
18.
Zurück zum Zitat The Boston Collaborative Drug Surveillance Program (1972) Acute adverse reaction to prednisolone in relation to dosage. Clin Pharmacol Ther 13:694–698 The Boston Collaborative Drug Surveillance Program (1972) Acute adverse reaction to prednisolone in relation to dosage. Clin Pharmacol Ther 13:694–698
19.
Zurück zum Zitat Toledano P, Sarbu N, Espinosa G, Bargalló N, Cervera R (2013) Neuropsychiatric systemic lupus erythematosus: magnetic resonance imaging findings and correlation with clinical and immunological features. Autoimmun Rev 12:1166–1170CrossRefPubMed Toledano P, Sarbu N, Espinosa G, Bargalló N, Cervera R (2013) Neuropsychiatric systemic lupus erythematosus: magnetic resonance imaging findings and correlation with clinical and immunological features. Autoimmun Rev 12:1166–1170CrossRefPubMed
20.
Zurück zum Zitat Hirohata S, Miyamoto T (1990) Elevated levels of interleukin-6 in cerebrospinal fluid from patients with systemic lupus erythematosus and central nervous system involvement. Arthritis Rheum 33:644–649CrossRefPubMed Hirohata S, Miyamoto T (1990) Elevated levels of interleukin-6 in cerebrospinal fluid from patients with systemic lupus erythematosus and central nervous system involvement. Arthritis Rheum 33:644–649CrossRefPubMed
21.
Zurück zum Zitat Shiozawa S, Kuroki Y, Kim M et al (1992) Interferon-alpha in lupus psychosis. Arthritis Rheum 35:417–422CrossRefPubMed Shiozawa S, Kuroki Y, Kim M et al (1992) Interferon-alpha in lupus psychosis. Arthritis Rheum 35:417–422CrossRefPubMed
22.
Zurück zum Zitat Trysberg E, Carlsten H, Tarkowski A (2000) Intrathecal cytokines in systemic lupus erythematosus with central nervous system involvement. Lupus 9:498–503CrossRefPubMed Trysberg E, Carlsten H, Tarkowski A (2000) Intrathecal cytokines in systemic lupus erythematosus with central nervous system involvement. Lupus 9:498–503CrossRefPubMed
23.
Zurück zum Zitat Bonfa E, Golombek SJ, Kaufman LD et al (1987) Association between lupus psychosis and anti-ribosomal P protein antibodies. N Engl J Med 317:265–271CrossRefPubMed Bonfa E, Golombek SJ, Kaufman LD et al (1987) Association between lupus psychosis and anti-ribosomal P protein antibodies. N Engl J Med 317:265–271CrossRefPubMed
24.
Zurück zum Zitat Nishimura K, Omori M, Horikawa N et al (2003) Risperidone in the treatment of acute confusional state (delirium) due to neuropsychiatric lupus erythematosus: case report. Int J Psychiatr Med 33:299–303CrossRef Nishimura K, Omori M, Horikawa N et al (2003) Risperidone in the treatment of acute confusional state (delirium) due to neuropsychiatric lupus erythematosus: case report. Int J Psychiatr Med 33:299–303CrossRef
25.
Zurück zum Zitat Wysenbeek AJ, Leibovici L, Zoldan J (1990) Acute central nervous system complications after pulse steroid therapy in patients with systemic lupus erythematosus. J Rheumatol 17:1695–1696PubMed Wysenbeek AJ, Leibovici L, Zoldan J (1990) Acute central nervous system complications after pulse steroid therapy in patients with systemic lupus erythematosus. J Rheumatol 17:1695–1696PubMed
26.
Zurück zum Zitat Tabata Y, Ichiro K, Kawamura N, Okano M, Kobayashi K (2002) Central nervous system manifestations after steroid pulse therapy in systemic lupus erythematosus. Eur J Pediatr 161:503–504CrossRefPubMed Tabata Y, Ichiro K, Kawamura N, Okano M, Kobayashi K (2002) Central nervous system manifestations after steroid pulse therapy in systemic lupus erythematosus. Eur J Pediatr 161:503–504CrossRefPubMed
27.
Zurück zum Zitat Naber D, Sand P, Heigl B (1996) Psychopathological and neuropsychological effects of 8 days’ corticosteroid treatment. A prospective study. Psychoneuroendocrinology 21:25–31CrossRefPubMed Naber D, Sand P, Heigl B (1996) Psychopathological and neuropsychological effects of 8 days’ corticosteroid treatment. A prospective study. Psychoneuroendocrinology 21:25–31CrossRefPubMed
28.
Zurück zum Zitat Brown ES, Suppes T, Khan DA, Carmody TJ 3rd (2002) Mood changes during prednisone bursts in outpatients with asthma. J Clin Psychopharmacol 22:55–61CrossRefPubMed Brown ES, Suppes T, Khan DA, Carmody TJ 3rd (2002) Mood changes during prednisone bursts in outpatients with asthma. J Clin Psychopharmacol 22:55–61CrossRefPubMed
29.
Zurück zum Zitat Brown ES (2009) Effects of glucocorticoids on mood, memory, and the hippocampus treatment and preventive therapy. Ann NY Acad Sci 1179:41–55CrossRefPubMed Brown ES (2009) Effects of glucocorticoids on mood, memory, and the hippocampus treatment and preventive therapy. Ann NY Acad Sci 1179:41–55CrossRefPubMed
30.
Zurück zum Zitat Wada K, Yamada N, Suzuki H, Lee Y, Kuroda S (2000) Recurrent cases of corticosteroid-induced mood disorder: clinical characteristics and treatment. J Clin Psychiatry 61:261–267CrossRefPubMed Wada K, Yamada N, Suzuki H, Lee Y, Kuroda S (2000) Recurrent cases of corticosteroid-induced mood disorder: clinical characteristics and treatment. J Clin Psychiatry 61:261–267CrossRefPubMed
Metadaten
Titel
New-onset psychiatric disorders after corticosteroid therapy in systemic lupus erythematosus: an observational case-series study
verfasst von
Katsuji Nishimura
Masako Omori
Eri Sato
Yasuhiro Katsumata
Takahisa Gono
Yasushi Kawaguchi
Masayoshi Harigai
Hisashi Yamanaka
Jun Ishigooka
Publikationsdatum
01.11.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Neurology / Ausgabe 11/2014
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-014-7472-y

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