Abstract

OBJECTIVE
The incidence and the risk of suicidal behaviors and severe neuropsychiatric disorders in people treated with systemic glucocorticoids are poorly known. The authors assessed the incidence rates of depression, mania, delirium, panic disorder, and suicidal behaviors in patients treated with glucocorticoids in primary care settings and the risk factors for developing these outcomes.
METHOD
Data were obtained for all adult patients registered between 1990 and 2008 at U.K. general practices contributing to The Health Improvement Network (THIN) primary care database. The incidence rates for the outcomes of interest were assessed in patients who received prescriptions for oral glucocorticoids and compared with those in patients who did not receive such prescriptions. The predictors of these outcomes in exposed patients were ascertained using Cox proportional hazards models.
RESULTS
Overall, 786,868 courses of oral glucocorticoids were prescribed for 372,696 patients. The authors identified 109 incident cases of suicide or suicide attempt and 10,220 incident cases of severe neuropsychiatric disorders in these patients. The incidence of any of these outcomes was 22.2 per 100 person-years at risk for first-course treatments. Compared to people with the same underlying medical disease who were not treated with glucocorticoids, the hazard ratio for suicide or suicide attempt in exposed patients was 6.89 (95% CI=4.52–10.50); for depression, 1.83 (95% CI=1.72–1.94); for mania, 4.35 (95% CI=3.67–5.16); for delirium, confusion, or disorientation, 5.14 (95% CI=4.54–5.82); and for panic disorder, 1.45 (95% CI=1.15–1.85). Older men were at higher risk of delirium/confusion/disorientation and mania, while younger patients were at higher risk of suicide or suicide attempt. Patients with a previous history of neuropsychiatric disorders and those treated with higher dosages of glucocorticoids were at greater risk of neuropsychiatric outcomes.
CONCLUSIONS
Glucocorticoids increase the risk of suicidal behavior and neuropsychiatric disorders. Educating patients and their families about these adverse events and increasing primary care physicians' awareness about their occurrence should facilitate early monitoring.

Links

Publisher Full Text

Authors

Fardet L, Petersen I, Nazareth I

Institution

Medical Research Council General Practice Research Framework, London, UK. laurence.fardet@sat.aphp.fr

Source

The American journal of psychiatry 169:5 2012 May pg 491-7

MeSH

Bipolar Disorder
Confusion
Delirium
Depression
Female
Glucocorticoids
Great Britain
Humans
Male
Mental Disorders
Middle Aged
Panic Disorder
Primary Health Care
Proportional Hazards Models
Risk Factors
Suicide
Suicide, Attempted

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22764363