Skip to main content
SpringerLink
Log in

And Tell Yourself, “This is not Me, it’s the Drug”

Coping with the Psychological Impact of Corticosteroid Treatments in Hematology — Further Results from a Pilot Study

  • Original Research Article
  • Published:
The Patient: Patient-Centered Outcomes Research Aims and scope Submit manuscript

Abstract

Background: Corticosteroids are documented as associated with psychological adverse effects, including insomnia, irritability, aggression, neuropsychological deficits, mood disorders (including severe depression), delirium, and psychosis. Given the severity of these potential adverse effects and that corticosteroid use is central to the treatment of most hematological malignancies, it would be expected that a thorough research literature would exist on the effects of corticosteroid use in hematology. However, scant research is available. This leaves many questions unanswered and a vacuum for clinical practice. Thus, there is a strong need for empirical data, not only on the psychological adverse effects experienced by patients, but also on the coping strategies patients use to manage them.

Objective: To present findings on the coping strategies used by ten hematology patients in Australia undergoing treatment involving corticosteroids as a first step in understanding the emotional and psychological effects experienced by this group of patients.

Methods: The pilot study was conducted from January 2007 until March 2008.

The study participants were ten hematology outpatients (eight with multiple myeloma, two with acute immune thrombocytopenia purpura) from two major Australian public hospitals (Princess Alexandra Hospital, Brisbane, Queensland, and Fremantle Hospital, Fremantle, Western Australia) who were taking dexamethasone and/or prednisolone and referred to the study by their treating hematologists on the basis that they were experiencing difficulties with their corticosteroid therapy.

Data were collected through an iterative, phenomenological, qualitative research methodology using open-ended interviews. Interview transcriptions were entered into the QSR NUD*IST (Non-numeric, Unstructured Data * Index and Searching Technology) computer program and analyzed thematically.

Results: Coping strategies found to be helpful by patients included believing that corticosteroids are necessary for disease control, knowing that the negative emotional states being experienced are due to the corticosteroids, stoicism and self-reliance based on a cognitive-rational approach, keeping busy, remaining fit and active, and, for some, using antidepressants to help with mood swings. For sleep disturbances, patients found it helpful to try to accept the sleeplessness, engage in distraction, and have light sleeps. Support from family and friends who understand the range of corticosteroid adverse effects, including patients’ need to withdraw during treatment, was seen as important. Counseling was not considered helpful. Tapering corticosteroid doses and cessation of corticosteroids were also discussed as aids to coping.

Conclusion: These findings provide a start to understanding how individuals cope with corticosteroid therapy for hematological conditions. There is a need for further extensive research in this area.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

References

  1. Hong SI, Cho DH, Kang HC, et al. Acute onset of steroid psychosis with very low dose of prednisolone in Sheehan’s syndrome. Endocr J 2006; 53(2): 255–8

    Article  PubMed  Google Scholar 

  2. Naber D, Sand P, Heigl B. Psychopathological and neuropsychological effects of 8-days’ corticosteroid treatment: a prospective study. Psychoneuroendocrinology 1996; 21(1): 25–31

    Article  PubMed  CAS  Google Scholar 

  3. Patten SB, Neutel CI. Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf 2000 Feb; 22(2): 111–22

    Article  PubMed  CAS  Google Scholar 

  4. Beshay B, Pumariega AJ. Sertraline treatment of mood disorder associated with prednisone: a case report. J Child Adolesc Psychopharmacol 1998; 8(3): 187–93

    Article  PubMed  CAS  Google Scholar 

  5. Alisky JM. Dexamethasone could improve myocardial infarction outcomes and provide new therapeutic options for non-interventional patients. Med Hypotheses 2006; 67(1): 53–6

    Article  PubMed  CAS  Google Scholar 

  6. Koh YI, Choi IS, Shin IS, et al. Steroid-induced delirium in a patient with asthma: report of one case. Korean J Intern Med 2002; 17(2): 150–2

    PubMed  Google Scholar 

  7. Braunig P, Bleistein J, Rao ML. Suicidality and corticosteroid-induced psychosis. Biol Psychiatry 1989 June; 26(2): 209–10

    Article  PubMed  CAS  Google Scholar 

  8. Wolkowitz O. Suicidality and corticosteroid psychosis. Biol Psychiatry 1990 Feb 15; 27(4): 459

    Article  PubMed  CAS  Google Scholar 

  9. McGrath P, Pun P, James S, et al. Psychological and psychiatric sequelae of steroid use in hematology treatments: a review of the literature. Australasian J Cancer 2007; 6(2): 87–95

    Google Scholar 

  10. de Fraine A, Diekman J, Gaynor G. Clinical guidelines for the use of antineoplastic agents: a publication of the Society of Hospital Pharmacists of Australia. 2nd ed. Crow’s Nest (NSW): The Society of Hospital Pharmacists of Australia, 1986

    Google Scholar 

  11. Gernsheimer T, Stratton J, Ballem PJ, et al. Mechanisms of response to treatment in autoimmune thrombocytopenic purpura. N Engl J Med 1989; 320(15): 974

    Article  PubMed  CAS  Google Scholar 

  12. Meyer O, Stahl D, Beckhove P, et al. Pulsed high-dose dexamethasone in chronic autoimmune haemolytic anaemia of warm type. Br J Haematol 1997; 98(4): 860–2

    Article  PubMed  CAS  Google Scholar 

  13. Hanks G, Trueman T, Twycross R. Corticosteroids in terminal cancer: a prospective analysis of current practice. Postgrad Med J 1983; 59(697): 702–6

    Article  PubMed  CAS  Google Scholar 

  14. Rowe JM, Buck G, Burnett AK, et al. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial — MRC UKALL XII/ECOG E2993. Blood 2005; 106(12): 3760

    Article  PubMed  CAS  Google Scholar 

  15. Facon T, Mary JY, Pegourie B, et al. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy. Blood 2006; 107(4): 1292

    Article  PubMed  CAS  Google Scholar 

  16. Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med 1994; 96(2): 115–23

    Article  PubMed  CAS  Google Scholar 

  17. Sirois F. Steroid psychosis: a review. Gen Hosp Psychiatry 2003; 25(1): 27–33

    Article  PubMed  Google Scholar 

  18. Krathwohl DR. Methods of educational and social science research: an integrated approach. New York: Longman, 1993

    Google Scholar 

  19. Spiegelberg H. Doing phenomenology: essays on and in phenomenology. The Hague: Springer, 1975

    Book  Google Scholar 

  20. Polit DF, Hungler BP. Nursing research: principles and methods. 5th ed. Philadelphia (PA): JB Lippincott, 1995

    Google Scholar 

  21. Sorrell J, Redmond G. Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies. J Adv Nurs 1995; 21: 1117–22

    Article  PubMed  CAS  Google Scholar 

  22. Streubert J, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. New York: JB Lippincott, 1995

    Google Scholar 

  23. Crombie IK, Davies HTO. Research in health care: design, conduct, and interpretation of health services research. New York: John Wiley & Sons, 1996

    Google Scholar 

  24. Greenhalgh T, Taylor R. How to read a paper: papers that go beyond numbers (qualitative research). BMJ 1997; 315: 740–3

    Article  PubMed  CAS  Google Scholar 

  25. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV, 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  26. Van Manen M. Researching lived experience: human science for an action sensitive pedagogy. London (ON): State University of New York Press, 1990

    Google Scholar 

  27. QSR International [online]. Available from URL: http://www.qsrinternational.com/products_previous-products_n6.aspx [Accessed 2008 Dec 3]

  28. McGrath P, Patton MA, James S. “I was never like that”: Australian findings on the psychological and psychiatric sequelae of corticosteroids in haematology treatments. Support Care Cancer. Epub 2008 May 14

  29. The Cancer Council Australia and Australian Cancer Network. Australian Cancer Network Diagnosis and Management of Lymphoma Guidelines Working Party guidelines for the diagnosis and management of lymphoma: psychosocial effects of treatment of lymphoma. 2005: 350-1 [online]. Available from URL: http://www.cancer.org.au/Healthprofessionals/clinicalguidelines/Lymphoma.htm/ [Accessed 2008 Apr 29]

  30. McGrath P. The burden of the ‘RA RA’ positive: survivors’ and hospice patients’ reflections on maintaining a positive attitude to serious illness. Support Care Cancer 2004; 12(1): 25–33

    Article  PubMed  Google Scholar 

  31. Brown ES, Frol A, Bobadilla L, et al. Effect of lamo-trigine on mood and cognition in patients receiving chronic exogenous corticosteroids. Psychosomatics 2003; 44(3): 204

    Article  PubMed  CAS  Google Scholar 

  32. Kostic VS, Levic Z. Psychiatric disorders associated with corticosteroid therapy. Neurologija 1989; 38(2): 161–6

    PubMed  CAS  Google Scholar 

  33. Reinhart WH. Corticosteroid therapy. Schweiz Rundsch Med Prax 2005 Feb 16; 94(7): 239–43

    CAS  Google Scholar 

  34. Matsukawa Y, Sawada S, Hayama T, et al. Suicide in patients with systemic lupus erythematosus: a clinical analysis of seven suicidal patients. Lupus 1994; 3(1): 31

    Article  PubMed  CAS  Google Scholar 

Download references

The authors would like to thank Mrs Elaine Phillips for her excellent work with transcribing, and Dr Peter Mollee and Dr Paul Pun for providing access to the study participants. No sources of funding were used to assist in the preparation or conduct of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

  1. International Program of Psycho-Social Health Research (IPP-SHR), Central Queensland University Kenmore, Brisbane, Queensland, Australia

    Pam McGrath (NH&MRC Senior Research Fellow and Director) & Mary Anne Patton

  2. School of Medicine and Pharmacy, University of Western Australia, Fremantle, Western Australia, Australia

    Michael Leahy

  3. Department of Haematology, Fremantle Hospital, Fremantle, Western Australia, Australia

    Michael Leahy

Authors
  1. Pam McGrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary Anne Patton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Leahy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pam McGrath.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McGrath, P., Patton, M.A. & Leahy, M. And Tell Yourself, “This is not Me, it’s the Drug”. Patient-Patient-Centered-Outcome-Res 2, 19–31 (2009). https://doi.org/10.2165/01312067-200902010-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/01312067-200902010-00003

Keywords

Search

Navigation