Printer FriendlyArticle Index and Abstracts
The Neuropsychiatric Sequelae of Steroid Treatment
Benjamin H. Flores, MD and
Heather Kenna Gumina, MA
Department of Psychiatry and Behavioral Sciences, Stanford
University, Stanford, CA
“...the specific types of neuropsychiatric impairments comprise a range of symptoms from anxiety, irritability and impaired cognition to depression, mania, psychosis, and suicidality. ”
The following review of the topic of the neurpsychiatric sequelae of steroid treatment is based on a review of the PubMed database. Over 80 scientific articles on this topic were found and they encompass approximately the last 30 years of published research. In reviewing these articles, several conclusions can be made. First, the neuropsychiatric complications of steroid treatment are quite common. Second, the specific types of neuropsychiatric impairments comprise a range of symptoms from anxiety, irritability and impaired cognition to depression, mania, psychosis, and suicidality. Third, although the available literature fails to reveal a uniform approach to the treatment of these specific side effects, it is clear that these symptoms are common enough and potentially very severe so as to warrant aggressive and early intervention by psychiatric consultants. Lastly, given the overall lack of published scientific literature on this topic, it behooves patients, family, and care-providers to work to improve public knowledge with the goals of stimulating further research on this subject as well as improving the quality of care for patients with this condition.
A Review of Clinical Research and Pain Management in Women
Witney G. McKiernan, RN
University of California, San Francisco
“Over the past forty years, the role of women as subjects in clinical trials for the study of new drugs has been undervalued and their participation limited. ”
The involvement of women in clinical research has fluctuated in the course of recent medical history. Over the past fifteen years, the enactment of federal policies supporting gender-based research reflects a new appreciation of the importance of including women in clinical research. Women are increasingly participating in clinical trials for new drugs; however, gender-specific clinical data are lacking, suggesting the absence of data analysis to determine sex-related differences in the pharmacokinetics and pharmacodynamics of drugs. In this report, clinical trial data, meta-analyses, and literature reviews from the past 25 years are used to explore the barriers to in-depth clinical research on women and examine the implications of a research bias for pain management in women. While an extensive body of research on women and pain pharmaceuticals is currently being developed, there are myriad untapped opportunities for future research and policy that have the potential to supplement the knowledge base in this area and provide critical information to clinicians and patients.
Giovanni Cizza, Andrea H. Marques, Farideh Eskandari, Israel C. Christie, Sara Torvik, Marni N. Silverman, Terry M. Phillips, and Esther M. Sternberg, for the POWER Study Group
Background: Major depressive disorder (MDD) is inconsistently associated with elevations in proinflammatory cytokines and neuropeptides. We used a skin sweat patch, recently validated in healthy control subjects, and recycling immunoaffinity chromatography to measure neuroimmune biomarkers in patients with MDD mostly in remission.
Methods: We collected blood at 8:00 AM and applied skin sweat patches for 24 hours in 21- to 45-year-old premenopausal women with MDD and age-matched healthy controls participating in the POWER (Premenopausal, Osteopenia/ Osteoporosis, Women, Alendronate, Depression) Study.
Results: Proinflammatory cytokines, neuropeptide Y, substance P, and calcitonin-gene-related peptide were significantly higher and vasoactive intestinal peptide, a marker of parasympathetic activity, was significantly lower in patients compared to controls, and depressive symptomatology strongly correlated with biomarker levels. All analytes were strongly correlated in the skin sweat patch and plasma in patients.
Conclusions: The skin sweat patch allows detection of disrupted patterns of proinflammatory cytokines and neuropeptides inwomenwith MDDin clinical remission, which could predispose to medical consequences such as cardiovascular disease, osteoporosis, and diabetes. This method permits measurement of cytokines in ambulatory settings where blood collection is not feasible.