Managing Steroid-induced Neuropsychiatric Side Effects Across the Lifespan

Corticosteroids are an essential treatment for hematologic malignancies and are used as immunosuppressants in a range of other medical conditions. They can also have significant neuropsychiatric side effects that decrease patient quality of life. Steroid neurotoxicity affects the hippocampus and frontal lobes, which have increased steroid receptor density and regulate mood and behavior. Side effects may therefore include insomnia, mood swings, irritability, depression, anxiety, aggression, mania, psychosis, and delirium. Consultation Liaison psychiatrists must be able to identify and manage these side effects in a range of treatment settings.
This workshop will review the use of corticosteroids in diseases spanning pediatrics, young adulthood, adulthood, and older adulthood, and provide evidence and clinical guidance for the psychiatric management of these side effects. Child, adolescent, and adult psychiatrists from a variety of medical centers and backgrounds will share their expertise. Depending on the audience size and populations served, we will have general questions and answers, or break into small groups by adult and pediatric/ AYA for small group discussion with panelists.
Dr. Muriel will serve as moderator for the program. She will also describe the use of steroids in the curative treatment of Pediatric Acute Lymphoblastic Leukemia (ALL). She will review the literature and reference specialized clinical practice in managing neuropsychiatric side effects in pediatric oncology, describing observed symptom patterns and effective management. In addition, she will describe the mixed method development of a validated parent/ teen report tool that can identify corticosteroid toxicity in clinical and research settings and be used to measure the impact of interventions.
Dr. Nadkarni will speak on the use of corticosteroids for immunosuppression in Inflammatory Bowel Disease, a chronic intestinal disease commonly diagnosed in pediatric and young adult populations. She will discuss the psychiatric disorders caused by chronic glucocorticoid therapy to manage flare-ups and achieve remission in this population and will provide practical tips and guidelines for the psychiatric management of these patients.
Dr. Greenberg will provide a summary of current patterns of steroid use in adult oncology, including as an anti-neoplastic and antiemetic agent, and to address the autoimmune toxicity of the new immunologic therapies. She will review the evidence for medications that quell or prevent psychiatric side effects of steroids in adults.
Dr. Raza will discuss the prophylactic use of medications, particularly atypical antipsychotics, in avoiding steroid-related neuro-psychiatric symptoms. There is limited evidence on the use of haloperidol prophylaxis in critically ill older adults at high risk of delirium with mixed results on its efficacy. She will present a case series of oncology patients with lymphoma undergoing chemotherapy trials (including steroid therapy) at a medical research hospital and provide recommendations for using antipsychotic prophylaxis for oncology patients considered to be a higher risk of developing delirium.
Dr. Brown will describe research on the impact of corticosteroids on the hippocampus and trials of an NMDA receptor antagonist and lamotrigine to treat these effects. He will also serve as the discussant, summarizing the presentations and integrating neurobiological data with implications for clinical practice.