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1.
Acad Med ; 95(3): 357-360, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31567156

RESUMO

Diversity initiatives in U.S. medical education, following the passage of the Civil Rights Act of 1964, were geared toward increasing the representation of African Americans-blacks born in the United States whose ancestors suffered under slavery and Jim Crow laws. Over time, blacks and, subsequently, underrepresented minorities in medicine (URMs), became a proxy for African Americans, Puerto Ricans, Mexican Americans, and Native Americans, thus obscuring efforts to identify and recruit specifically African Americans. Moreover, demographic shifts resulting from the recent immigration of black people from Africa and the Caribbean have both expanded the definition of "African American medical students" and shifted the emphasis from those with a history of suffering under U.S. oppression and poverty to anyone who meets a black phenotype.Increasingly, research indicates that African American patients fare better when their physicians share similar historical and social experiences. While all people of color risk discrimination based on their skin color, not all have the lived experience of U.S.-based, systematic, multigenerational discrimination shared by African Americans. In the high-stakes effort to increase URM representation in medical school classes, admissions committees may fail to look beyond the surface of phenotype, thus missing the original intent of diversity initiatives while simultaneously conflating all people of color, disregarding their divergent historical and social experiences. In this Perspective, the authors contend that medical school admissions committees must show greater discernment in their holistic reviews of black applicants if historical wrongs and continued underrepresentation of African Americans in medicine are to be redressed.

2.
Mayo Clin Proc ; 94(10): 1983-1993, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31427140

RESUMO

OBJECTIVE: To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population. PATIENTS AND METHODS: Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls. RESULTS: In the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls. CONCLUSION: Compared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
3.
J Am Acad Child Adolesc Psychiatry ; 58(9): 919-920, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31445620

RESUMO

Dr. Brent's Master Clinician Review: Saving Holden Caulfield: Suicide Prevention in Children and Adolescents is a timely synthesis of evidence-based approaches to suicide reduction, including prevention strategies and programs, increased access to mental health care, changes in systems of care delivery, and means restriction.1 Although this review appears in what is predominantly a journal for clinicians working in their offices or on hospital units, it is notable that most of the approaches he describes operate at primary or secondary prevention levels. That is, they use population-level strategies to prevent the development of suicide risk (primary prevention), or devise programs to detect and treat individuals before they become dangerously symptomatic (secondary prevention).

4.
Psychosomatics ; 60(6): 574-581, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31202442

RESUMO

BACKGROUND: Acetaminophen, the ubiquitous over-the-counter analgesic and antipyretic, is the most common drug used in intentional overdoses in the United States. Inadvertent self-poisoning is also a surprisingly common unintended consequence of acetaminophen misuse for pain management. OBJECTIVE: The primary goal of this naturalistic study was to substantiate outcomes that were previously described in other large cohorts of patients with acetaminophen overdoses. METHODS: The Rochester Epidemiology Project yielded a cohort of 207 patients of age 18 years or older treated at the Mayo Clinic between January 1, 2004 and December 31, 2010 for excessive acetaminophen exposure. Patients with a diagnosis of acetaminophen overdose, acetaminophen ingestion, and/or acetaminophen toxicity were characterized according to demographics, treatment location, overdose intentionality, identities of the drugs and amounts taken, mental health and addiction history, previous suicide attempts, and current alcohol intake. Outcomes included N-acetylcysteine treatment, emergence of serious clinical syndromes, and admission to the liver transplant unit (LTU), liver transplant, and death. Data were analyzed using the JMP statistical program. RESULTS: Of 140 females and 67 males treated in the emergency department (ED), 184 (89%) were admitted, including 116 (56%) to the intensive care unit, 26 (13%) to medicine services, 18 (9%) directly to LTU, 23 (11%) directly to psychiatry services, and 1 (0.5%) to off-campus detox. The consultation-liaison (C-L) psychiatry service evaluated 175 patients (85%). Eighteen intensive care unit/medicine patients were eventually transferred to the LTU, and 104 of the 184 patients not immediately admitted to psychiatry were ultimately transferred there. Of all, 158 (76.3%) overdoses were intentional, but in the chronic pain subset of 14 patients, only 4 (29%) were. One hundred twenty-seven (61%) patients had no previous suicide attempt history. Twenty-one percent of the intentional overdose group versus 12.5% of the unintentional overdose group was intoxicated at the time of overdose. One hundred thirty-five (65%) patients received N-acetylcysteine, but barely a third (33%) were treated within the recommended 8 hours of overdose. Nonetheless, most outcomes were benign: only 36 (17.6%) required LTU admission because of serious medical complications. Only 12 received consideration for transplant, and only 5 (2.7%) were listed for transplant. Three (1.5%) ultimately received new livers. Two (1.0%) died awaiting transplant. Two of the 3 transplanted patients had unintentionally overdosed while treating chronic pain. CONCLUSIONS: A vast majority of patients survived and recovered without lasting medical sequelae, including liver transplant. Half of the patients received N-acetylcysteine, and only a third received it within the recommended 8-hour window after ingestion. Serious medical consequences were concentrated in the 17% of patients requiring LTU admission. With a transplant rate of 1.5% and a death rate of less than 1%, we conclude that the risk of serious medical outcomes from this frequent overdose modality is rare, even as the majority of both intentional and unintentional overdose patients received both inpatient medical and psychiatric treatment.

5.
Acad Med ; 94(2): 274-280, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30157089

RESUMO

PURPOSE: Physician suicide rates are reportedly higher than those of the general population, but medical student suicide rates are not well studied. It is difficult to determine whether physician suicide rates can be predicted by medical student risk factors for suicide and difficult to identify those risk factors without knowing medical student suicide rates. The authors systematically reviewed the literature to collate data on medical student suicide rates. METHOD: The authors searched the PubMed, Web of Science, and Library of Congress databases for papers published in any language before November 11, 2017. They identified 3,429 papers; after the initial screening process, they assessed 82 full-text articles for eligibility. Twelve ultimately met the full inclusion criteria; meta-analysis was not possible. Data regarding medical student suicide numbers and rates were extracted and compared with contemporaneous general population suicide rates using public epidemiological data, when available. RESULTS: Medical student suicide rates were infrequently reported in the historical and international literature, and data collection techniques were inconsistent. Generally, U.S. medical student suicide rates were lower than those of the contemporaneous general population. Proportionate mortality of medical students (number of deaths by a particular cause such as suicide divided by total number of deaths) was not reported in the literature. CONCLUSIONS: Gaps exist in knowledge of medical student suicide rates, risk factors, and targets for intervention. Significant barriers have impeded information collection. Yet, more comprehensive data collection is needed to understand suicide risk in this population and to implement and improve effective intervention strategies.


Assuntos
Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Humanos , Fatores de Risco
7.
J Am Acad Child Adolesc Psychiatry ; 57(10): 786-791, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30274653

RESUMO

OBJECTIVE: Although suicide is the second most frequent cause of death in American youth, suicide research has heretofore been confined to convenience samples that represent neither psychiatric nor general populations and that fail to include individuals dying at their first attempts. These limitations were addressed by assembling a youth cohort followed from the first medically recorded attempt (index attempt [IA]). It was hypothesized this approach would more accurately represent the prevalence of completed suicide after an attempt and underscore lethality based on method. METHOD: This study draws from a previously reported retrospective-prospective all-age cohort identified through the Rochester Epidemiology Project. The original 1,490-subject sample included 813 Olmsted County youth 10 to 24 years old (n = 258 male, n = 555 female; 54.6% of total cohort) with IAs from January 1, 1986 through December 31, 2007 and followed until December 31, 2010. RESULTS: Twenty-nine of 813 subjects (3.6%) killed themselves during the study period, with 28 of 29 dying before their 25th birthday and 20 of 28 (71.4%) dying at their first attempt. Despite composing only 31.7% of the cohort (258 of 813), male subjects composed most suicides: 23 of 29 (79.3% of suicides; 8.9% of male subjects) versus 6 of 29 female subjects (20.7% of suicides; 1.1% of female subjects). Eighty-five percent of all IA deaths involved firearms. More than a third of youth-41.2%-lacked a psychiatric history prior to IA. CONCLUSION: These data show that more than half the IAs occurred in youth, with approximately three-fourths of completed youth suicides occurring at the IAs. In parsing cause of IA death in the all-age cohort, the contribution of firearms figured even more prominently in the subsample of youth (85.0%) than in those at least 25 years old (64.3%). The high IA lethality suggests that prevention efforts commencing after the IA are too late for most victims.


Assuntos
Armas de Fogo/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Adulto Jovem
8.
Mayo Clin Proc ; 93(6): 731-738, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29678323

RESUMO

OBJECTIVE: To explore what percentage of suicide decedents (SDs) vs controls were assessed for suicidality at medical appointments in the year before death. PATIENTS AND METHODS: Using the Rochester Epidemiology Project, 66 SDs dying in Olmsted County, Minnesota, between January 1, 2000, and December 31, 2009, were identified and matched with 141 age- and sex-matched controls. Blinded chart review determined how often providers screened and subjects endorsed suicidal ideation (SI). Positive indicators included chart notes recording SI and/or Patient Health Questionnaire-9 scored more than 0 on question 9. RESULTS: We found that only 29 of 66 (43.9%) SDs and 14 of 141 (9.9%) controls had been screened at any point by any means (P < .001). Only 25.8% (17 of 66) of SDs expressed SI, whereas 58.6% of screened SDs (17 of 29) did so, though none at final appointments before death. No control ever expressed SI. While the majority of both cases and controls went unscreened, providers were more likely to screen SDs (P < .001; odds ratio [OR], 9.0; 95% CI, 3.6-22.0), even with controlling for mental health diagnoses (P = .02; OR, 3.6; 95% CI, 1.2-10.6). CONCLUSIONS: With providers screening less than half of SDs at any point in the year before death, and less than 60% of SDs ever endorsing SI, including none at final appointments, the findings of this naturalistic study bring into question both current screening practices and screening effectiveness. Nonetheless, when SDs were screened, they were significantly more likely to endorse SI than were controls, not 1 of whom ever expressed SI. Taken together, these data suggest that patients expressing SI at any point are at elevated risk for eventual suicide.


Assuntos
Comunicação , Saúde Mental , Ideação Suicida , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Minnesota , Questionário de Saúde do Paciente , Prevalência
9.
Sleep Med Rev ; 38: 131-140, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28822709

RESUMO

Restless legs syndrome is commonly co-morbid with medical conditions that are treated with antidepressant medications, such as depression, anxiety, fibromyalgia, and chronic insomnia disorder. Evidence from case reports and cross-sectional studies suggests that antidepressants may induce or worsen restless legs syndrome and increase periodic limb movements. We undertook a systematic review of the literature to identify and collate all prospective studies that measured restless legs syndrome symptoms and/or periodic limb movements following the introduction of an antidepressant. Eighteen studies were eligible for inclusion. Current data indicate that onset or exacerbation of restless legs syndrome and rise in frequency of periodic limb movements are uncommon following the initiation of an antidepressant. Among the various antidepressants, mirtazapine may be associated with higher rates of restless legs syndrome and periodic limb movements. One small study of normal volunteers suggested that venlafaxine may be associated with an increase in restless legs syndrome symptoms and periodic limb movements. Sertraline, fluoxetine, and amitriptyline appear to increase periodic limb movements that do not disrupt sleep and are thus unlikely to be clinically significant. On the other hand, bupropion may reduce restless legs syndrome symptoms, at least in the short term. Sedating antidepressants such as trazodone, nefazodone, and doxepin do not seem to aggravate periodic limb movements. The current evidence is limited by poor study design, inadequate use of standardized questionnaires, and heterogeneous populations studied for variable lengths of time. Future research should attempt to remedy these shortcomings.


Assuntos
Antidepressivos/efeitos adversos , Comorbidade , Síndrome das Pernas Inquietas/complicações , Estudos Transversais , Humanos , Estudos Prospectivos , Sono/efeitos dos fármacos
12.
Am J Psychiatry ; 173(11): 1094-1100, 2016 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-27523496

RESUMO

OBJECTIVE: While suicide attempt history is considered to robustly predict completed suicide, previous studies have limited generalizability because of using convenience samples of specific methods/treatment settings, disregarding previous attempts, or overlooking first-attempt deaths. Eliminating these biases should more accurately estimate suicide prevalence in attempters. METHOD: This observational retrospective-prospective cohort study using the Rochester Epidemiology Project identified 1,490 (males, N=555; females, N=935) Olmsted County residents making index suicide attempts (first lifetime attempts reaching medical attention) between January 1, 1986, and December 31, 2007. The National Death Index identified suicides between enrollment and December 31, 2010 (follow-up 3-25 years). Medical records were queried for sex, age, method, and follow-up care for index attempt survivors. Coroner records yielded data on index attempt deaths. RESULTS: During the study period, 81/1,490 enrollees (5.4%) died by suicide. Of the 81, 48 (59.3%) perished on index attempt; 27 of the surviving 33 index attempt survivors (81.8%) killed themselves within a year. Males were disproportionately represented: 62/81 (11.2% of men, 76.5% of suicides) compared with 19/81 (2.0% of women, 23.5% of suicides). Of dead index attempters, 72.9% used guns, yielding an odds ratio for gunshot death, compared with all other methods, of 140 (95% CI=60-325). When adjusted for covariates, survivors given follow-up psychiatric appointments had significantly lower likelihood of subsequent suicide (odds ratio=0.212, 95% CI=0.089-0.507). CONCLUSIONS: At 5.4%, completed suicide prevalence in this community cohort of suicide attempters was almost 59% higher than previously reported. An innovative aspect of this study explains the discrepancy: by including index attempt deaths-approximately 60% of total suicides-suicide prevalence more than doubled. We contend that counting both index and subsequent attempt deaths more accurately reflects prevalence. Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought. Research should focus on identifying risk factors for populations vulnerable to making first attempts and target risk reduction in those groups.


Assuntos
Tentativa de Suicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Biomed Res Int ; 2015: 506327, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26576425

RESUMO

Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored.


Assuntos
Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Manejo da Dor/estatística & dados numéricos , Dor/epidemiologia , Dor/prevenção & controle , Compostos Fitoquímicos/uso terapêutico , Causalidade , Comorbidade , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Neoplasias/diagnóstico , Dor/diagnóstico , Manejo da Dor/métodos , Prevalência , Resultado do Tratamento
16.
Mayo Clin Proc ; 90(11): 1475-81, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26455886

RESUMO

OBJECTIVE: To compare the type and frequency of health care visits in the year before suicide between decedents and controls. PATIENTS AND METHODS: Cases (n=86) were Olmsted County, Minnesota, residents whose death certificates listed "suicide" as the cause of death from January 1, 2000, through December 31, 2009. Each case had 3 age- and sex-matched controls (n=258). Demographic, diagnostic, and health care usage data were abstracted from medical records. Conditional logistic regression was used to analyze differences in the likelihood of having had psychiatric and nonpsychiatric visits in the year before death, as well as in visit types and frequencies 12 months, 6 months, and 4 weeks before death. RESULTS: Cases and controls did not significantly differ in having had any health care exposure (P=.18). Suicide decedents, however, had a significantly higher number of total visits in the 12 months, 6 months, and 4 weeks before death (all P<.001), were more likely to have carried psychiatric diagnoses in the previous year (odds ratio [OR], 8.08; 95% CI, 4.31-15.17; P<.001), and were more likely to have had outpatient and inpatient mental health visits (OR, 1.24; 95% CI, 1.05-1.47; P=.01 and OR 6.76; 95% CI, 1.39-32.96; P=.02, respectively). Only cases had had emergency department mental health visits; no control did. CONCLUSION: Given that suicide decedents did not differ from controls in having had any health care exposure in the year before death, the fact alone that decedents saw a doctor provides no useful information about risk. Compared with controls, however, decedents had more visits of all types including psychiatric ones. Higher frequencies of health care contacts were associated with elevated suicide risk.


Assuntos
Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Suicídio , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Casos e Controles , Causas de Morte , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Minnesota/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Medição de Risco/métodos , Medição de Risco/normas , Suicídio/prevenção & controle , Suicídio/psicologia , Suicídio/estatística & dados numéricos
17.
Gen Hosp Psychiatry ; 37(6): 620.e3-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26219484

RESUMO

OBJECTIVE: Late HIV diagnosis occurs in up to 45% of new HIV cases in the developed world and is linked to worse health outcomes, including more hospitalizations, higher health care resource utilization and less robust responses to highly active antiretroviral therapy. METHOD: Case report RESULTS: A 70-year-old woman with an obscure constellation of medical and psychiatric complaints ultimately proved to have end-stage acquired immunodeficiency syndrome discovered much too late. Curiously, she had no obvious risk factors for HIV infection. CONCLUSION: This tragic case underscores the importance of keeping HIV infection in the differential for a patient with diverse vague complaints. Let this story caution its readers: when you hear hoof beats, do not look for zebras - even when you are least expecting a horse.


Assuntos
Síndrome de Imunodeficiência Adquirida/diagnóstico , Diagnóstico Tardio , Síndrome de Imunodeficiência Adquirida/complicações , Idoso , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/etiologia , Evolução Fatal , Feminino , Humanos , Leucopenia/etiologia , Transtornos do Humor/etiologia , Carga Viral
18.
Rambam Maimonides Med J ; 6(2): e0013, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25973265

RESUMO

Suicidal phenomena in the general hospital can take a variety of forms that can be parsed by taking into account whether or not the patient 1) intended to hasten death, and 2) included collaborators, including family and health care providers, in the decision to act. These two criteria can be used to distinguish entities as diverse as true suicide, non-compliance, euthanasia/physician-assisted suicide, and hospice/palliative care. Characterizing the nature of "suicide" events facilitates appropriate decision-making around management and disposition.

19.
J Hosp Med ; 10(1): 32-5, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25274180

RESUMO

BACKGROUND: Munchausen syndrome by proxy (MSBP), more formally known as factitious disorder imposed on another, is a form of abuse in which a caregiver deliberately produces or feigns illness in a person under his or her care so that the proxy will receive medical care that gratifies the caregiver. Although well documented in the pediatric literature, few cases of MSBP with adult proxies (MSB-AP) have been reported. This study reviews existing literature on MSB-AP to provide a framework for clinicians to recognize this disorder. METHODS: We searched Ovid MEDLINE, Ovid EMBASE, PubMed, Web of Knowledge, and PsychINFO, supplemented by bibliographic examination. RESULTS: We identified 13 cases of MSB-AP. Perpetrators were caregivers, most (62%) were women, and many worked in healthcare. The age range of the victims was 21 to 82 years. Most were unaware of the abuse, although in 2 cases the victim may have colluded with the perpetrator. Disease fabrication most often resulted from poisoning. CONCLUSIONS: MSB-AP should be included in the differential diagnosis of patients presenting with a complex constellation of symptoms without a unifying etiology and an overly involved caregiver with suspected psychological gain. Early identification is necessary so that healthcare providers do not unknowingly perpetuate harm through treatments that satisfy the perpetrator's psychological needs at the proxy's expense.


Assuntos
Cuidadores/psicologia , Síndrome de Munchausen Causada por Terceiro/diagnóstico , Síndrome de Munchausen Causada por Terceiro/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Mayo Clin Proc ; 89(6): 817-34, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24943696

RESUMO

Corticosteroids, highly effective drugs for myriad disease states, have considerable neuropsychiatric adverse effects that can manifest in cognitive disorders, behavioral changes, and frank psychiatric disease. Recent reviews have summarized these effects in adults, but a comprehensive review on corticosteroid effects in children has not been published since 2005. Here, we systematically review articles published since then that, we find, naturally divide into 3 main areas: (1) chronic effects of acute prenatal and neonatal exposure associated with prematurity and congenital conditions; (2) immediate behavioral effects of acute exposure via oncological protocols; and (3) acute behavioral effects of sporadic use in children and adolescents with other conditions. PsycInfo, MEDLINE, Embase, and Scopus were queried to identify articles reporting psychiatric adverse effects of corticosteroids in pediatric patients. Search terms included corticosteroids, adrenal cortex hormones, steroid psychosis, substance-induced psychoses, glucocorticoids, dexamethasone, hydrocortisone, prednisone, adverse effects, mood disorders, mental disorders, psychosis, psychotic, psychoses, side effect, chemically induced, emotions, affective symptoms, toxicity, behavior, behavioral symptoms, infant, child, adolescent, pediatric, paediatric, neonatal, children, teen, and teenager. Following guidelines for systematic reviews from the Potsdam Consultation on Meta-Analysis, we have found it difficult to draw specific conclusions that are more than general impressions owing to the quality of the available studies. We find a mixed picture with neonates exposed to dexamethasone, with some articles reporting eventual deficits in neuropsychiatric functioning and others reporting no effect. In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions, adverse effects have been observed both during treatment and after cessation, although the data from article to article are not consistent enough to establish dose relationships. By and large, inhaled corticosteroids are considered safe and free of severe neuropsychiatric effects. Although both antipsychotic medications and benzodiazepines have been used to treat corticosteroid-induced mania and psychosis, no unified management strategy has emerged. Large-scale standardized investigations are needed to clarify the psychiatric effect of corticosteroids on children in all these conditions. Meanwhile, there is general agreement that patients as well as caregivers should be warned of the potential for behavioral adverse effects when patients receive these drugs.


Assuntos
Corticosteroides/efeitos adversos , Transtornos Mentais/induzido quimicamente , Administração por Inalação , Administração Intravenosa , Administração Oral , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Criança , Relação Dose-Resposta a Droga , Feminino , Doença de Hodgkin/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/induzido quimicamente , Transtornos Mentais/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente
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