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How we approach steroid-induced affective disorder in pediatric oncology

D Andrew Elliott1, Jennifer L Harman2

  • 1Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Pediatric Blood & Cancer
|September 23, 2024
PubMed

Insights

High-dose corticosteroids are crucial for treating pediatric cancers but can cause psychiatric issues like steroid-induced affective disorder (SIAD). This study presents cases and a framework to manage SIAD symptoms in children undergoing cancer treatment.

Area of Science:

  • Pediatric Oncology
  • Psychiatry
  • Pharmacology

Background:

  • High-dose corticosteroids are vital in pediatric cancer treatment.
  • These medications frequently induce psychiatric disturbances, including sleep disruption, psychosis, and steroid-induced affective disorder (SIAD).
  • SIAD, a medication-induced mental disorder, presents with diverse symptoms like mania, depression, and irritability, often leading to underdiagnosis.

Purpose of the Study:

  • To highlight three pediatric oncology cases of SIAD.
  • To discuss recommendations for managing SIAD in pediatric cancer patients.
  • To introduce a tiered intervention framework for stratifying SIAD responses based on symptom severity.

Main Methods:

  • Case study review of three pediatric oncology patients with SIAD.
  • Literature review on corticosteroid-induced psychiatric disturbances.
  • Adaptation of a tiered intervention framework (Kazak) for SIAD management.

Main Results:

  • Detailed presentation of three distinct pediatric cases illustrating SIAD's varied clinical manifestations.
  • Identification of challenges in diagnosing and managing SIAD due to its heterogeneous presentation.
  • Development of a tiered intervention framework to guide clinical responses to SIAD.

Conclusions:

  • SIAD is an underrecognized complication of corticosteroid therapy in pediatric oncology.
  • A structured, tiered approach can aid in managing SIAD symptoms effectively.
  • Further research and standardized protocols are needed to improve care for these patients.

Keywords:
corticosteroidsoncologysteroid psychosissteroid‐induced affective disorder

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