PDF(Pubmed)
Abstract：
Steroid-induced neuropsychiatric sequelae are common, and pose significant risks to people usually receiving glucocorticoids in the context of physical illness. Steroid-induced mania and hypomania are the most common of the acute complications, yet despite great progress in understandings in neurophysiology there are no recent studies which review the factors which might predict who will experience this severe complication, nor are there consensus guidelines on management. We report the unusual case of a woman in her 50s admitted to a psychiatric unit with steroid-induced mania despite compliance with two mood stabilisers, several days after the administration of a Dexamethasone and Docetaxel chemotherapy regime adjunctive to lumpectomy for breast cancer. She had previously been diagnosed with an organic affective disorder (with classical bipolar 1 pattern) following severe ventriculitis related to ventricular drain insertion for obstructive hydrocephalus secondary to a colloid cyst. She had no psychiatric illness before this brain injury, but has a maternal history of idiopathic bipolar 1 affective disorder. Her episode of steroid-induced mania resolved following use of sedative medications, continuation of her existing mood stabilisers, and reductions of the steroid dosing in collaboration with her oncology team, which also protected her from further manic relapses during continued chemotherapy. Established mental illness, a family history, and acquired brain injury may reflect risk factors for steroid-induced mania through currently unclear pathways. Future epidemiological studies could better confirm these observations, and basic neuroscience may look to further explore the role of extrinsic glucocorticoids in the pathophysiology of affective disorders.
摘要：
类固醇诱导的神经精神后遗症很常见，并对通常在身体疾病背景下接受糖皮质激素的人构成重大风险。类固醇引起的躁狂和轻躁狂是最常见的急性并发症，然而，尽管在神经生理学的理解方面取得了很大进展，但最近没有研究回顾可能预测谁会经历这种严重并发症的因素，也没有关于管理的共识准则。我们报告了一个不寻常的病例，一名50多岁的妇女因类固醇引起的躁狂症入院精神病院，尽管遵守了两种情绪稳定剂，在给予地塞米松和多西他赛化疗方案辅助乳腺癌肿块切除术后几天。先前，她曾被诊断出患有与继发于胶体囊肿的阻塞性脑积水的脑室引流有关的严重脑室炎后，患有器质性情感障碍（具有经典的双极1型）。在这次脑损伤之前她没有精神病,但有特发性双相情感障碍1的母体病史。使用镇静药物后，她的类固醇引起的躁狂症发作得以解决，继续她现有的情绪稳定剂，和她的肿瘤团队合作减少类固醇的剂量，这也保护了她在继续化疗期间免受进一步躁狂复发。既定的精神疾病，家族史,获得性脑损伤可能通过目前尚不清楚的途径反映了激素性躁狂的危险因素。未来的流行病学研究可以更好地证实这些观察结果，基础神经科学可能会进一步探索外源性糖皮质激素在情感障碍病理生理学中的作用。
