Department: Ask an Expert Show
Richard L. Pullen, Jr., is a Professor of Nursing at Texas Tech University Health Sciences Center School of Nursing in Lubbock, Tex., and a Nursing made Incredibly Easy! Editorial Board Member. The author has disclosed no financial relationships related to this article. Q: What causes mood
changes in patients receiving corticosteroid therapy? A: Corticosteroids are medications that imitate the action of cortisol—a glucocorticoid hormone regulating carbohydrate, protein, and lipid metabolism; fluid and electrolyte balance; BP; and immune, endocrine, nervous system, skeletal muscle, and kidney function. Cortisol also suppresses inflammation, promotes a balance in wake-sleep patterns, and
helps the body adapt to physical, psychological, and environmental stressors. Individuals who have conditions such as allergic reactions, asthma, autoimmune disease, skin conditions, and cancer or who've received an organ transplant may require exogenous, synthetically prepared corticosteroids, such as prednisone, prednisolone, and dexamethasone, to reduce immune response and inflammation. Resulting from neurotransmitter imbalances in the brain, the neuro-psychiatric adverse reactions of corticosteroid therapy may cause patients distress. Corticosteroids reduce serotonin, which regulates mood, sleep, and pain perception. Excessive amounts of corticosteroids can lead to mood fluctuations and depression. Norepinephrine regulates emotions, alertness, sleeping, and dreaming. An excessive amount of norepinephrine can lead to overstimulation of the sympathetic nervous system, causing an increase in heart rate and BP, trembling, and anxiety. Gamma-aminobutyric acid (GABA) is a neurotransmitter that reduces central nervous system activity and excitability. Corticosteroids reduce GABA, leading to anxiety, changes in mood, depression, seizure disorders, and a decreased capacity to cope with chronic pain. Corticosteroids may also impact the hippocampus in the brain, which regulates memory and emotional processing. Common corticosteroid-induced neuro-psychiatric disturbances from neurotransmitter imbalances include problems with cognition, hyperactivity, irritability, anxiety, insomnia, and depression. Individuals may experience an increase in heart rate and BP and have a headache. Psychosis may occur in some individuals. Patients may also experience mental status changes because they're attempting to cope with the disease process and adverse reactions of corticosteroid medication. For example, pain and immobility may lead to anxiety and depression, whereas fluid retention causing weight gain and a roundness of the face may cause disturbances in body image. Priority nursing interventions include:
Neuro-psychiatric disturbances and physical symptoms improve with a reduction in the dose and frequency of corticosteroid therapy. Symptoms should disappear over time when the medication is discontinued. REFERENCESJoëls M. Corticosteroids and the brain. J Endocrinol. 2018;238(3):R121–R130. Kapugi M, Cunningham K. Corticosteroids. Orthop Nurs. 2019;38(5):336–339. Thibaut F. Corticosteroid-induced psychiatric disorders: genetic studies are needed. Eur Arch Psychiatry Clin Neurosci. 2019;269(6):623–625. Which neurotransmitter would the nurse associate with a patient's clinical manifestation?Serotonin is an important neurotransmitter in the central nervous system involved in the regulation of mood, sleep, and emotions. The lack of this neurotransmitter may cause the patient's clinical manifestations.
Which cranial nerve CN would the nurse associate with a patient's sense of hearing during a neurologic examination?Cranial nerve VIII brings sound and information about one's position and movement in space into the brain. The auditory and vestibular systems subserve several functions basic to clinical medicine and to psychiatry.
Which clinical manifestation would the nurse identify when admitting a patient suspected of having lesions in Brocas area?Which clinical manifestation would the RN identify when admitting a pt suspected of having lesions in Broca's area? Broca's area, located at the frontal lobe of the cerebrum, refulates verbal expression. Lesions in Broca's area affect speech production.
Which neurotransmitter released by the preganglionic and postganglionic fibers would the nurse associate with a patient's parasympathetic response?The preganglionic and postganglionic fibers release acetylcholine during a parasympathetic response.
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