Prevention of Steroid-Induced Neuropsychiatric Complications With Neuroleptic Drugs: A Review.

Corticosteroids are used for a multitude of indications in palliative patients. In this narrative review, we aim to review literature on the treatment and prevention of neuropsychiatric complications of steroids. For prevention, only lamotrigine had a positive effect in a small number of studies. For treatment, olanzapine appears to be nearly universally effective at low doses, but randomized trial evidence is lacking. Further randomized clinical trials are necessary to elucidate data-driven guidelines for prevention and treatment of corticosteroid-induced neuropsychiatric symptoms. Until further data are available, it is reasonable to consider low dose olanzapine for any patient taking 40 mg of prednisone or its equivalent, especially those with a history of depression or neuropsychiatric symptoms.

Bone Health.

The gold standard for diagnosis of osteoporosis is measurement of an individual's bone mineral density on dual-energy x-ray absorptiometry scan. If this value is less than or equal to 2.5 standard deviations less than that of an adult female reference population, a person is said to have osteoporosis, with this risk increasing as a person ages. Female gender is a large risk factor in developing osteoporosis, regardless of ethnic or racial group. Frailty is another key factor in determining likelihood to develop osteoporotic fractures. Bisphosphonates are the first line agents for treatment of osteoporosis.