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1.
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
2.
J Reprod Med ; 59(5-6): 306-12, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24937974

RESUMO

OBJECTIVE: To determine removal rates for unacceptable bleeding in etonogestrel subdermal implant (ESI) users treated with reassurance alone as well as in those receiving reassurance plus medical interventions including doxycycline and ibuprofen, and to compare removal rates between ESI users treated with reassurance alone with those receiving the medical interventions listed above in addition to reassurance. STUDY DESIGN: Medical records of 391 women receiving ESI for contraception within the period June 2007-April 2011 were abstracted for patient characteristics and interventions including reassurance, doxycycline, and ibuprofen. Removal rates were compared between intervention groups using the chi2 test and multivariable logistic regression. RESULTS: Contact for bleeding occurred in 128 women (32.7%). Of those, 83 women (21.2% of entire cohort) requested removalfor bleeding (median, 381 days; range, 29-1,078 days). Of 53 women receiving reassurance alone, 40 (75.5%) requested removal, whereas fewer (15 of 33 [45.5%]) women receiving reassurance plus doxycycline requested removal (p = 0.005), even after adjusting for prior contraception use and body mass index at ESI insertion (p = 0.006). Of 10 women receiving ibuprofen and 19 women receiving doxycycline plus ibuprofen, 7 (70.0%) and 11(57.9%), respectively, requested removal for bleeding. CONCLUSION: Reassurance plus doxycycline is associated with lower removal rates for ESI-related bleeding than is reassurance alone.


Assuntos
Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Femininos/efeitos adversos , Desogestrel/administração & dosagem , Desogestrel/efeitos adversos , Hemorragia Uterina/induzido quimicamente , Hemorragia Uterina/terapia , Adulto , Aconselhamento , Remoção de Dispositivo , Doxiciclina/uso terapêutico , Implantes de Medicamento , Feminino , Humanos , Ibuprofeno/uso terapêutico
3.
Contraception ; 87(3): 370-4, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22959901

RESUMO

BACKGROUND: Bleeding irregularities represent the most common etonogestrel subdermal implant (ESI) removal indication. STUDY DESIGN: ESI placements (n=304) from June 2007 to April 2011 were grouped by removal indications. Group characteristics were compared using one-way analysis of variance, Kruskal-Wallis and χ(2) test. RESULTS: Of 304 insertions, 30.6% reported irregular bleeding. Removal indications included bleeding (Group 1, n=50), side effects (Group 2, n=17) and desired pregnancy/no need (Group 3, n=25). Group 4 kept (n=198) or reinserted (n=14) ESI. Median body mass index was lower for Group 1 compared to other groups (p=.012). Group 3 was older than Group 1 or 4 (p=.021), and more likely parous (p<.001) and postpartum (p=.001) than other groups. Lactational placement was more common in Group 3 than 4 (p<.001). Obese women were 2.6 times less likely to remove ESI for bleeding vs. normal-weight or overweight women (95% confidence interval, 1.2-5.7; p=.014). CONCLUSIONS: After adjusting for age and parity, obese women were less likely to have ESI removal for bleeding.


Assuntos
Índice de Massa Corporal , Anticoncepcionais Femininos/efeitos adversos , Desogestrel/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Distúrbios Menstruais/induzido quimicamente , Adolescente , Adulto , Anticoncepcionais Femininos/administração & dosagem , Desogestrel/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Uterina/induzido quimicamente , Adulto Jovem
4.
J Heart Lung Transplant ; 31(10): 1102-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22975100

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH) is a complex disease with variable clinical manifestations; nevertheless, morbidity and mortality associated with PAH are considerable. This study examined quality of life (QOL) in PAH patients and assessed use of palliative care (PC) for addressing QOL issues and what barriers might exist regarding early PC implementation for patients with PAH. METHODS: An Internet-based survey was distributed to Pulmonary Hypertension Association patient-related listservs. Symptom burden and QOL were assessed using Linear Analog Self Assessment (LASA) QOL items and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). RESULTS: Of 774 eligible patients with active e-mail addresses, 315 returned surveys (41% overall response), and 276 (88%) contained analyzable responses. Responders (mean age, 48.9 years ± 16.0) were predominantly white (85%), female (86%), and with idiopathic PAH (42%). Profound deficiency in overall QOL (40%), fatigue (57%), physical well-being (56%), social activity (49%), emotional well-being (49%), and pain (38%) were reported. Most patients believed their PAH physician had excellent understanding of PAH progression/plan of care (92%), but less were satisfied with care regarding QOL management (77%). Few patients considered PC (8%), or had pain management (4%) or PC involved (1%). Most common reasons were beliefs that patients were doing well/not sick (63%) or that PC had not been suggested (22%). CONCLUSIONS: PAH may result in symptoms or QOL impairment persisting despite optimal PAH therapy. However, PC awareness or use by PAH patients and providers is low. Opportunities may exist to integrate PC into care for PAH patients.


Assuntos
Atitude Frente a Saúde , Efeitos Psicossociais da Doença , Inquéritos Epidemiológicos , Hipertensão Pulmonar/terapia , Cuidados Paliativos/métodos , Satisfação do Paciente , Qualidade de Vida/psicologia , Adulto , Planejamento Antecipado de Cuidados , Estudos Transversais , Progressão da Doença , Hipertensão Pulmonar Primária Familiar , Feminino , Humanos , Hipertensão Pulmonar/psicologia , Internet , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
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