BACKGROUND Synthetic glucocorticoids are widely used among patients suffering from a wide range of diseases. Glucocorticoids are very efficacious, but can be accompanied by neuropsychiatric adverse effects. This systematic review and meta-analysis assesses and quantifies the proportion of different neuropsychiatric adverse effects in patients using synthetic glucocorticoids. METHODS Six electronic databases were searched to identify potentially relevant studies. Randomized controlled trials, cohort and cross-sectional studies assessing psychiatric side effects of glucocorticoids measured with validated questionnaires were eligible. Risk of bias was assessed with RoB 2, ROBINS-I, and AXIS appraisal tool. For proportions of neuropsychiatric outcomes, we pooled proportions, and when possible, differences in questionnaire scores between glucocorticoid users and non-users were expressed as standardized mean differences (SMD). Data were pooled in a random-effects logistic regression model. RESULTS We included 49 studies with heterogeneity in study populations, type, dose, and duration of glucocorticoids. For glucocorticoid users, meta-analysis showed a proportion of 22% for depression (95%CI 14%-33%), 11% for mania (95%CI 2%-46%), 8% for anxiety (95%CI 2%-25%), 16% for delirium (95%CI 6%-36%), and 52% for behavioural changes (95%CI 42%-61%). Questionnaire scores for depression (SMD of 0.80 (95%CI 0.35-1.26)), and mania (0.78 (95%CI 0.14-1.42)) were higher than in controls, indicating more depressive and manic symptoms following glucocorticoid use. CONCLUSIONS The heterogeneity of glucocorticoid use is reflected in the available studies. Despite this heterogeneity, the proportion of neuropsychiatric adverse effects in glucocorticoid users is high. The most substantial associations with glucocorticoid use were found for depression and mania. Upon starting glucocorticoid treatment, awareness of possible psychiatric side effects is essential. More structured studies on incidence and potential pathways of neuropsychiatric side effects of prescribed glucocorticoids are clearly needed.

中文翻译：

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合成糖皮质激素的神经精神不良反应：系统评价和荟萃分析。

背景技术合成糖皮质激素广泛用于患有多种疾病的患者。糖皮质激素非常有效，但可能伴随神经精神不良反应。这项系统评价和荟萃分析评估并量化了使用合成糖皮质激素的患者中不同神经精神不良反应的比例。方法 检索六个电子数据库以确定潜在的相关研究。使用经过验证的问卷来评估糖皮质激素的精神副作用的随机对照试验、队列和横断面研究是合格的。使用 RoB 2、ROBINS-I 和 AXIS 评估工具评估偏倚风险。对于神经精神结果的比例，我们汇总了比例，并且在可能的情况下，糖皮质激素使用者和非使用者之间的问卷分数差异表示为标准化平均差（SMD）。数据汇集在随机效应逻辑回归模型中。结果 我们纳入了 49 项研究，这些研究在研究人群、糖皮质激素类型、剂量和持续时间方面存在异质性。对于糖皮质激素使用者，荟萃分析显示抑郁症的比例为 22%（95%CI 14%-33%），躁狂症的比例为 11%（95%CI 2%-46%），焦虑症的比例为 8%（95%CI 2） %-25%），谵妄为 16%（95%CI 6%-36%），行为改变为 52%（95%CI 42%-61%）。抑郁症（SMD 为 0.80（95%CI 0.35-1.26））和躁狂症（0.78（95%CI 0.14-1.42））的问卷评分高于对照组，表明使用糖皮质激素后出现更多抑郁和躁狂症状。结论 现有研究反映了糖皮质激素使用的异质性。尽管存在这种异质性，糖皮质激素使用者中神经精神不良反应的比例仍然很高。抑郁症和躁狂症与糖皮质激素的使用存在最显着的关联。开始糖皮质激素治疗后，了解可能的精神副作用至关重要。显然需要对处方糖皮质激素的神经精神副作用的发生率和潜在途径进行更结构化的研究。