Mental disorders induced by steroids in the course of treatment for acute lymphoblastic leukemia in adolescents
Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 9
Abstract
Introduction. Glicokorticosteroids/GKS are an important element in children’s cancer treatment. However, they can lead to many adverse somatic and behavioral symptoms, including psychic disorders, also quality ones. Especially exposed are the patients with acute lymphoblastic leukemia/ALL treated with high doses of Prednisone/PRED and Dexamethasone/DEXA, as well as patients with Hodgkin Disease/HD treated with multiple DEXA cycles.Aim. Analysis of cases of mental disorders induced by taking steroids during treatment of acute lymphoblastic leukemia in children over 12 years of age.Material and methods. The subject of analysis was the course of transient episodes of mental disorders in two patients with ALL and evaluation of mental state at certain points in time during intensive care and during long-term follow-up after completion of maintenance therapy. Episodes of mental dysfunction occurred twice, in both treatment protocols, at the time of reduction of steroids.Results. Patient A (14.9 year-old boy) with ALL (BFM 97; Prot I: 37 days x 100mg of PRED daily: 28 days of max dose, 9 days of dose reduction; Prot. II: 30 days x 16 mg of DEXA: 21 days of the max dose, 9 days of reduction). During PRED dose reduction (on 29th-37th days) the patient was observed with psychomotor retardation, impaired verbal contact, oss of interest in surroundings and people, depression, isolation, anxiety and crying. During the first day of DEXA reduction (the 22th day) the boy attempted suicide, resisted to an attempt to intervene, he was excited, he expressed suicidal thoughts aloud. Patient B (15.2 year-old boy) with ALL (ALL-IC 2002; Prot. I: 37 days x 115mg of PRED daily: 28 days of max dose, 9 days of dose reduction; Prot. II: 31 days x 20 mg of DEXA: 22 days of full dose, 9 days of reduction). 10 days after the start of PRED therapy, after reaching the maximum dose, the boy has become very ittle active, secluded and in ow mood. Symptoms remained at the same evel from 10th to 37th day. And during the first day of DEXA dose reduction anxiety and fear were observed in the patient, and behavioral indications pointed to intense hallucinatory experience.Conclusions. 1. Children and adolescents receiving high-dose steroids (PRED and/or DEXA) in the course of cancer treatment are at risk of developing mental disorders. 2. Episodes of mental disorders in adolescent boys with ALL occurred at the time of the reduction of steroids and had similar elements in the psychopathological image, but differed in the field of applied medication and course of the subsequent functioning of patients. 3. Diagnosis and treatment of psychiatric episodes in children with cancer requires the development of standards of procedure in conditions of Polish centers of pediatric oncology and hematology, also after the completion of treatment.
Authors and Affiliations
Marzena Samardakiewicz, Jakub Litak, Aneta Szudy, Agata Makarewicz
Keywords
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