336. PSYCHIATRIC RISKS OF CORTICOSTEROIDS: FINDINGS FROM A SYSTEMATIC REVIEW AND META-ANALYSIS
Notice bibliographique
Résumé
Abstract Background Corticosteroids (CSs) are widely used to treat autoimmune diseases, allergic conditions, and cancers, but they are often associated with psychiatric side effects, such as insomnia, anxiety, depression, mania, and psychosis. Comprehensive evaluations of psychiatric risks, including acute and long-term effects, as well as their associations with dose and cumulative exposure, remain limited. Understanding these relationships is crucial for optimizing therapeutic strategies and minimizing psychiatric risks. Aims & Objectives This study aimed to systematically evaluate the psychiatric risks associated with corticosteroid use, focusing on both acute and long-term settings. The primary objectives included assessing the risks of depression, mania, and psychosis, and examining their associations with dose, and duration. Method A systematic literature search was conducted in MEDLINE and Embase databases up to March 22, 2024, using keywords related to corticosteroids and psychiatric symptoms. Observational studies with clearly defined psychiatric outcomes and quantifiable data were included. Data were analyzed using a random-effects model, and heterogeneity was assessed with the I² statistic. For studies reporting multiple non-independent outcomes, we conducted a three-level meta-analysis to account for the dependency between effect sizes within studies. In addition, qualitative data were synthesized to explore patterns of symptom progression and their relationship with treatment characteristics. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Results A total of 69 studies were included, comprising cross-sectional, cohort, pre-post, case-control, and other observational study designs. The three-level meta-analysis of depressive symptoms, based on six studies with seven groups and 10 effect sizes, revealed a pooled standardized mean difference (SMD) of 1.01 (95%Confidence Interval (CI)=0.40–1.61, p<0.01) with significant heterogeneity (I²=84%). Six acute-phase studies on mania and depressive symptoms demonstrated that mania was more frequently reported than depressive symptoms, with a pooled odds ratio (OR) of 2.37 (95%CI=1.52–3.69, p<0.01) and low heterogeneity (I²=0%). For psychosis, a meta-analysis of six studies reported a pooled proportion of 3.0% (95%CI=1.0%–8.6%), with high heterogeneity (I²=92%) indicating variability across studies. Qualitative assessments suggested that high doses and prolonged use of CSs were consistently associated with an increased risk of psychiatric symptoms. Acute symptoms, such as mania and psychosis, were often reported within 3–14 days of treatment initiation, whereas depressive symptoms were more frequently associated with long-term exposure. Discussion & Conclusions This meta-analysis highlighted the differential risks of psychiatric symptoms associated with CS use. Mania and psychosis were more frequent during acute treatment, particularly at high doses, while depression was predominantly observed in long-term use. These findings underscore the importance of early monitoring and individualized treatment strategies, especially for patients receiving high-dose or prolonged CS treatment. The high heterogeneity observed in studies on depression and psychosis reflects the complexity of these risks and the need for further research to explore contributing factors. This study provides new insights into the dose- and time-dependent effects of CS-induced psychiatric symptoms, offering effective risk management strategies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,021 | 0,055 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,014 | 0,051 |
| Bibliométrie | 0,009 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».