Table 2

 Trials and case series

Referencen/age in years DesignDiseaseDrug/daily doseStandardised tests usedMain findingsLimitations
See Appendix for list of test abbreviations.
De La Riva, 1957934/4–14 Open Case seriesVariousACTH/ cortisoneNone Relatives’ reports and psychiatric assessments61% of sample had psychiatric SE: 59% “depressive”, 41% “euphoric” Depressed group had usually shown euphoric symptoms firstNo standardised tests used Little detail given about nature of psychiatric SE
Harris, 19863016/4–16 Prospective Child as own control Repeated measuresALL (14) Lymphoma (2)Prednisolone (pred) 40–60 mg/day oral for 4/52 every 4/12CSI CDI SHSQNight-waking increased on pred (NS). Irritability, tearfulness, argumentativeness, mild depressive symptoms and tiredness increased when on predCDI is for use in children over 8 y of age, excluding 6 of their sample. Not blinded
Suess, 198622120/9–18 Prospective Comparison Single blindAsthmaNon-asthmatic controls v theophylline only v theoph + pred (alt days 16 mg/day)BVRT WMSIncreased delayed memory recall in steroid groups at 6–8 h. No significant difference between groups at 22–24 h or 46–48 h post-doseNo steroid alone group so ? differences due to steroid- theophylline interaction
Bender, 19883127/8–16 Prospective Comparison HD v LDAsthmaPrednisolone (oral) 3.3 mg/day (low dose, LD) v 62 mg/day (high dose, HD)CDI, CMAS, CPT, DRT, SRT, ultrasonic motion detector for hyperactivity, static steadiness tester for fine motor controlHD: decreased memory, increased anxiety + depressive symptoms. No differences in impulsiveness, hyperactivity, motor unsteadinessNo information gathered from parents/carers. Children not asked re other psychiatric Sx
Bender, 19913232/8–16 Prospective Comparison HD v LDAsthmaPrednisolone (oral) 7 mg/day (LD) v 62 mg/day (HD)PPVT, CGAS, FGAS, CDI, CMAS, CPT, SRT, ultrasonic motion detector for hyperactivity, static steadiness tester for fine motor controlConfirmed above results No predisposing factors identifiedChildren not asked re other psychiatric Sx. ? Atypical sample in terms of social class
Nall 19922919/7–15 Prospective Child as own controlAsthmaPrednisolone (oral) 1–2 mg/kg/day on or offWRAT-R BRP-2No difference in cognitive tests or behaviour scale scoreResearchers not blind
Drigan, 19923338/2.5–8.8 Prospective Comparison Repeated measuresALLChemo + pred (oral) 40 mg/m2/day (Ch+LD) v chem + pred 120 mg/m2/day (Ch+HD) v chemo aloneConners Parent-Teacher Hyperkinesis Index (amended) administered to parents onlyAdverse changes in attention/hyperactivity, emotionality, sleep disturbance, depressed mood, listlessness + peer relations in Ch+LD and Ch+HD v Ch alone No differences in behaviours between Ch+HD v Ch+LDSmall matched sample size may have limited ability to detect difference between LD and HD groups
Bender, 199821102/6–17 Prospective Double-blind controlled multi-centreAsthmaBeclomethasone (inh) 2×50 μg qds+placebo tab v theophylline+placebo inhalerCBCL, WISC-R, W-J, SCWT, WCST, TT, BRVRT, SDLT, RAVLTNo significant differences in cognitive tests or behaviour between groupsSample did not include children under 6 who may be most vulnerable to APSE from inhaled steroids
Klein-Gitelman, 199811213/1–18 Case seriesAcute rheumatic diseaseIntermittent pulsed IV methylprednisolone 30 mg/kgNone10% of sample had adverse psychological SE, including psychosis. Majority appeared post pulse and ceased within 48 hCase series rather than controlled study
Soliday, 19992810/ages not known Prospective Child as own controlSteroid sensitive idiopathic nephritic syndrome“High dose” prednisolone therapy (oral)CBCLAnxious, depressive and aggressive behavioural changes at doses of >1 mg/kg/48 hSmall sample Not blinded