Corticosteroid-Induced Psychotic and Mood Disorders

Psychosomatics 42:461-466, December 2001


© 2001 The Academy of Psychosomatic Medicine



Corticosteroid-Induced Psychotic and Mood Disorders

Diagnosis Defined by DSM-IV and Clinical Pictures

Ken Wada, M.D., Norihito Yamada, M.D., Toshiki Sato, M.D., Hiroshi Suzuki, M.D., Masahito Miki, M.D., Yomei Lee, M.D., Kazufumi Akiyama, M.D., and Shigetoshi Kuroda, M.D.

Received November 15, 2000; revised March 23, 2001; accepted March 12, 2001. From the Department of Neuropsychiatry, Okayama University Medical School 2-5-1, Shikata-cho, Okayama 700-8558, Japan, Department of Psychiatry, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. Address correspondence and reprint requests to Dr. Wada Department of Psychiatry, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. E-mail: kenwada@do3.enjoy.ne.jp

The authors investigated long-term outcome and treatment strategy of corticosteroid-induced psychotic and mood disorders as defined by DSM-IV. Review of medical records of 2,069 referral patients revealed 18 applicable patients. Their clinical characteristics, longitudinal courses, and treatments were studied. The authors identified 15 patients with mood disorder and 3 patients with psychotic disorder. Increasing doses or resumption of corticosteroids had the strongest influence on the psychiatric course. These two corticosteroid-induced psychiatric disorders may have different pathophysiological substrates closely related to patient vulnerability. Effective psychopharmacological treatment options were indicated with consideration being given to the underlying diseases.


Key Words: Cortiscosteroid • Mood Disorder • Psychotic Disorder

Behavioral approaches to toluene intoxication

Environ Res. 1993 Jul;62(1):53-62.


Behavioral approaches to toluene intoxication.

Saito K, Wada H.
Department of Hygiene and Preventive Medicine, Hokkaido University, School of Medicine, Sapporo, Japan.

Abstract

Toluene is a chemical that is very useful in our lives but harmful to our health. Behavioral toxicology has the merit of providing an accurate indication of functional toxicity to the CNS through the analysis of learned behavior and use of behavioral analysis techniques that give us various learning paradigms for investigating the effects of chemicals on memory, stimulus discrimination, attention, time perception, etc. Learning is a common ability among various species and it is possible to predict toxicity to human health from animals. Behavioral toxicology is assumed to play an important role in occupational and environmental health. Using typical test batteries such as shuttle, Sidman, and pole-climb avoidance, and FI, FR, DRL, and DMS tasks, the effects of toluene were investigated and the results were reviewed. One important objective of a test battery is to be able to detect already-known toxicity. Behavioral toxicology research indicated such effects of toluene toxicity as hyperactivity, ataxia, addiction, insomnia, and memory disturbances. Some excellent results which might indicate clinically unknown effects of toluene such as hearing loss, impairments of time discrimination, and improvements of STM were also demonstrated. Introduction of blood and brain toluene levels as an index of toluene exposure and more sophisticated learning tasks which reflect specific higher nervous functions of the CNS has been proposed.



PMID: 8325266 [PubMed - indexed for MEDLINE]

Toxicant exposure and mental health--individual, social, and public health considerations.

J Forensic Sci. 2009 Mar;54(2):474-7. Epub 2009 Jan 31.

Toxicant exposure and mental health--individual, social, and public health considerations.

Genuis SJ.

Faculty of Medicine, University of Alberta, 2935-66 Street, Edmonton, AB, Canada. sgenuis@ualberta.ca

Abstract

Thoughts and moods are the result of biological processes; disordered thoughts and moods may be the result of disordered biological processes. As brain dysfunction can manifest with emotional symptoms or behavioral signs, the etiology of some mental health afflictions and some abnormal conduct is pathophysiological rather than pathopsychological. Various studies confirm that some chemical toxicants which modify brain physiology have the potential to affect mood, cognitive function, and to provoke socially undesirable outcomes. With pervasive concern about myriad chemical agents in the environment and resultant toxicant bioaccumulation, human exposure assessment has become a clinically relevant area of medical investigation. Adverse exposure and toxicant body burden should routinely be explored as an etiological determinant in assorted health afflictions including disordered thinking, moods, and behavior. The impact of toxicant bioaccumulation in a patient with neuropsychiatric symptoms is presented for consideration as an example of the potential benefit of recognizing and implementing exposure assessment.

PMID: 19187449 [PubMed - indexed for MEDLINE]

Hyperbaric Oxygen Therapy and TBI

Arsenic Induced Delirium

J Occup Med. 1987 Jun;29(6):500-3.

Neuropsychological impairment following inorganic arsenic exposure.

Bolla-Wilson K, Bleecker ML.

Abstract

A 50-year-old chemical engineer, routinely screened for occupational arsenic exposure, was admitted with a delirium for which no known etiology was found. Elevated levels of arsenic were found in the urine and hair. The patient received chelation treatment with British anti-Lewisite; substantial amounts of arsenic were excreted and the toxic encephalopathy improved gradually over the 8-month follow-up period. The patient was tested at 6 weeks, 4 months, and 8 months postdelirium with a battery of neuropsychological tasks. The pattern of results showed verbal learning and memory to be severely impaired while tests of general intellectual abilities and language remained unaffected. Follow-up examinations with no subsequent reexposure revealed improvements on specific cognitive tasks. It is unclear whether recovery of cortical functions occurred or if compensatory strategies were developed. It is proposed that a subacute exposure to arsenic may have contributed to the neuropsychological deficits.

PMID: 3612324 [PubMed - indexed for MEDLINE]

PANDAS: Pediatric Autoimmune Neuropsychiatric Disease Associated with Streptococcal Infection.

J Pediatr (Rio J). 2007 May-Jun;83(3):201-8. Epub 2007 May 4.

PANDAS: a new disease?

de Oliveira SK.

Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. sheila_knupp@hotmail.com

Abstract

OBJECTIVE: To establish the diagnostic criteria for PANDAS and to analyze the existing evidence regarding its etiopathogenesis, treatment and prophylaxis. SOURCES: Review of the scientific literature through a MEDLINE search carried out between 1989 and 2006. SUMMARY OF THE FINDINGS: The diagnostic criteria for PANDAS were established nearly 10 years ago, but a lot of controversy still exists over the actual existence of this new pediatric disease. The name of this new disease, supposedly of poststreptococcal etiology, derives from an acronym that stands for pediatric autoimmune neuropsychiatric disease associated with streptococcal infection. Tics and obsessive-compulsive symptoms are the major clinical signs of the disease, which develop after streptococcal infections, probably through autoimmune mechanisms. Even though these neuropsychiatric symptoms are common in rheumatic chorea, whose etiology is also poststreptococcal, the classic choreiform movements and other symptoms of rheumatic fevers are absent in PANDAS. The use of antimicrobial and immunologic therapy has been investigated and considered feasible in some cases. CONCLUSIONS: Further research is still necessary in order to answer the question posed in the title of this article. In the meantime, the identification of tic disorders and obsessive-compulsive disorders in children should include the possibility of PANDAS, seeking to provide evidence of previous streptococcal infection.

PMID: 17486197 [PubMed - indexed for MEDLINE]

Toxicant Exposure and Mental Health

J Forensic Sci. 2009 Mar;54(2):474-7. Epub 2009 Jan 31.

Toxicant exposure and mental health--individual, social, and public health considerations.

Genuis SJ.

Faculty of Medicine, University of Alberta, 2935-66 Street, Edmonton, AB, Canada. sgenuis@ualberta.ca

Abstract

Thoughts and moods are the result of biological processes; disordered thoughts and moods may be the result of disordered biological processes. As brain dysfunction can manifest with emotional symptoms or behavioral signs, the etiology of some mental health afflictions and some abnormal conduct is pathophysiological rather than pathopsychological. Various studies confirm that some chemical toxicants which modify brain physiology have the potential to affect mood, cognitive function, and to provoke socially undesirable outcomes. With pervasive concern about myriad chemical agents in the environment and resultant toxicant bioaccumulation, human exposure assessment has become a clinically relevant area of medical investigation. Adverse exposure and toxicant body burden should routinely be explored as an etiological determinant in assorted health afflictions including disordered thinking, moods, and behavior. The impact of toxicant bioaccumulation in a patient with neuropsychiatric symptoms is presented for consideration as an example of the potential benefit of recognizing and implementing exposure assessment.

PMID: 19187449 [PubMed - indexed for MEDLINE]