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December 10, 1982, Vol 248, No. 22 >
ARTICLE | December 10, 1982

Relationship Between Alternate-Day Corticosteroid Therapy and Behavioral Abnormalities FREE

Steven S. Sharfstein, MD; David S. Sack, MD; Anthony S. Fauci, MD
[+] Author Affiliations

Reprint requests to National Institutes of Health Clinical Center, Bldg 10, Room 11B-09, Bethesda, MD 20205 (Dr Fauci).


JAMA. 1982;248(22):2987-2989. doi:10.1001/jama.1982.03330220031031
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References

Three patients with inflammatory or immunologically mediated disease manifested striking behavioral abnormalities in association with long-term alternate-day prednisone regimens. Of particular note was the fact that differences in the abnormalities depended on the day that the patients received their drug: the symptoms that appeared on a treatment day were opposite those present on a day of no therapy. These symptoms were reminiscent of rapid mood cycling in some patients with manic-depressive affective disorder. The phenomenon was dose related and markedly diminished in two patients as the dosage of corticosteroid was decreased, despite the fact that the alternate-day regimen was continued.

(JAMA 1982;248:2987-2989)

REFERENCES

1 +
Rimbaud L:  Maladie de Cushing et troubles psychiques . Ann Med Psychol 1947;;102:459.
2 +
Derves VJ, Weiss TE: Untoward Reactions of Cortisone and ACTH . Springfield, Ill, Charles C Thomas Publisher, 1951;.
3 +
Rome HP, Braceland FJ:  The psychological response to ACTH, cortisone, hydrocortisone, and related steroid substances . Am J Psychiatry 1952;;108:641-651.
4 +
Clark LD, Bauer W, Cobb S:  Preliminary observations on mental disturbances occurring in patients under therapy with cortisone and ACTH . N Engl J Med 1952;;246:205-216.
5 +
Glaser TH:  Psychotic reactions induced by corticotropin (ACTH) and cortisone . Psychosom Med 1953;;15:281-291.
6 +
 Boston Collaborative Drug Surveillance Program: Acute adverse reaction to prednisone in relation to dosage . Clin Pharmacol Ther 1972;;13:694-697.
7 +
Harter JG, Reedy WJ, Thorn GW:  Studies on an intermittent corticosteroid dosage regimen . N Engl J Med 1963;;269:591-596.
8 +
Fauci AS:  Alternate-day corticosteroid therapy . Am J Med 1978;;64:729-731.
9 +
Fauci AS, Dale DC, Balow JE:  Glucocorticosteroid therapy: Mechanisms of action and clinical considerations . Ann Intern Med 1976;; 84:304-315.
10 +
Soyka LF:  Alternate-day corticosteroid therapy . Adv Pediatr 1972;;19:47-70.
11 +
Melby JF:  Systemic corticosteroid therapy: Pharmacology and endocrinologic considerations . Ann Intern Med 1974;;81:505-512.
12 +
Dixon RB, Christy NP:  On the various forms of corticosteroid withdrawal syndrome . Am J Med 1980;;68:224-230.
13 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
14 +
Krauthammer C, Klerman GL:  Secondary mania . Arch Gen Psychiatry 1978;;35:1333-1339.
15 +
Goolker P, Schein J:  Psychic effects of ACTH and cortisone . Psychosom Med 1953;; 15:589-613.
16 +
Kimball CP:  Psychological dependency on steroids? Ann Intern Med 1971;;75:111-113.
17 +
Carroll BJ:  Psychiatric disorders and steroids , in Usdin E, Hamburg DA, Barchas JD (eds): Neuroregulators and Psychiatric Disorders . New York, Oxford University Press, 1977;, pp 276-283.
18 +
Hall RCW, Popkin MK, Stickney SK, et al:  Presentation of the steroid psychoses . J Nerv Ment Dis 1979;;167:229-236.
19 +
Starkman MN, Schteingaret DE, Schork MA:  Depressed mood and other psychiatric manifestations of Cushing's syndrome: Relationship to hormone levels . Psychosom Med 1981;; 43:3-18.
20 +
Pflug B, Tolle R:  Disturbance of 24-hour rhythm, endogenous depression and the treatment of endogenous depression by sleep deprivation . Int Pharmacopsychiatry 1971;;6:187-196.
21 +
Gerner RH, Post RM, Gillin JL, et al:  Biological and behavioral effects of one night's sleep deprivation in depressed patients and normals . J Psychiatr Res 1979;;15:21-40.
22 +
Bunney WE, Hartmann EL:  Study of a patient with 48-hour manic-depressive cycles: I. An analysis of behavioral factors . Arch Gen Psychiatry 1965;;12:619-625.
23 +
Carpenter WT, Bunney WE:  Behavioral effects of cortisol in man . Sem Psychiatry 1971;; 3:421-434.
24 +
Falk WE, Mahnke MW, Poskanzer DC:  Lithium prophylaxis of corticotropin-induced psychosis . JAMA 1979;;241:1011-1012.

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1 +
Rimbaud L:  Maladie de Cushing et troubles psychiques . Ann Med Psychol 1947;;102:459.
2 +
Derves VJ, Weiss TE: Untoward Reactions of Cortisone and ACTH . Springfield, Ill, Charles C Thomas Publisher, 1951;.
3 +
Rome HP, Braceland FJ:  The psychological response to ACTH, cortisone, hydrocortisone, and related steroid substances . Am J Psychiatry 1952;;108:641-651.
4 +
Clark LD, Bauer W, Cobb S:  Preliminary observations on mental disturbances occurring in patients under therapy with cortisone and ACTH . N Engl J Med 1952;;246:205-216.
5 +
Glaser TH:  Psychotic reactions induced by corticotropin (ACTH) and cortisone . Psychosom Med 1953;;15:281-291.
6 +
 Boston Collaborative Drug Surveillance Program: Acute adverse reaction to prednisone in relation to dosage . Clin Pharmacol Ther 1972;;13:694-697.
7 +
Harter JG, Reedy WJ, Thorn GW:  Studies on an intermittent corticosteroid dosage regimen . N Engl J Med 1963;;269:591-596.
8 +
Fauci AS:  Alternate-day corticosteroid therapy . Am J Med 1978;;64:729-731.
9 +
Fauci AS, Dale DC, Balow JE:  Glucocorticosteroid therapy: Mechanisms of action and clinical considerations . Ann Intern Med 1976;; 84:304-315.
10 +
Soyka LF:  Alternate-day corticosteroid therapy . Adv Pediatr 1972;;19:47-70.
11 +
Melby JF:  Systemic corticosteroid therapy: Pharmacology and endocrinologic considerations . Ann Intern Med 1974;;81:505-512.
12 +
Dixon RB, Christy NP:  On the various forms of corticosteroid withdrawal syndrome . Am J Med 1980;;68:224-230.
13 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
14 +
Krauthammer C, Klerman GL:  Secondary mania . Arch Gen Psychiatry 1978;;35:1333-1339.
15 +
Goolker P, Schein J:  Psychic effects of ACTH and cortisone . Psychosom Med 1953;; 15:589-613.
16 +
Kimball CP:  Psychological dependency on steroids? Ann Intern Med 1971;;75:111-113.
17 +
Carroll BJ:  Psychiatric disorders and steroids , in Usdin E, Hamburg DA, Barchas JD (eds): Neuroregulators and Psychiatric Disorders . New York, Oxford University Press, 1977;, pp 276-283.
18 +
Hall RCW, Popkin MK, Stickney SK, et al:  Presentation of the steroid psychoses . J Nerv Ment Dis 1979;;167:229-236.
19 +
Starkman MN, Schteingaret DE, Schork MA:  Depressed mood and other psychiatric manifestations of Cushing's syndrome: Relationship to hormone levels . Psychosom Med 1981;; 43:3-18.
20 +
Pflug B, Tolle R:  Disturbance of 24-hour rhythm, endogenous depression and the treatment of endogenous depression by sleep deprivation . Int Pharmacopsychiatry 1971;;6:187-196.
21 +
Gerner RH, Post RM, Gillin JL, et al:  Biological and behavioral effects of one night's sleep deprivation in depressed patients and normals . J Psychiatr Res 1979;;15:21-40.
22 +
Bunney WE, Hartmann EL:  Study of a patient with 48-hour manic-depressive cycles: I. An analysis of behavioral factors . Arch Gen Psychiatry 1965;;12:619-625.
23 +
Carpenter WT, Bunney WE:  Behavioral effects of cortisol in man . Sem Psychiatry 1971;; 3:421-434.
24 +
Falk WE, Mahnke MW, Poskanzer DC:  Lithium prophylaxis of corticotropin-induced psychosis . JAMA 1979;;241:1011-1012.

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