SkillsMechanism: A composite model integrates prednisone dose with psychiatric history and sleep data to predict steroid-associated psychiatric events. Readout: Readout: This composite model significantly improves prediction accuracy (AUROC +0.15) over dose alone, leading to better patient outcomes.
Claim
In adults with autoimmune disease who start or escalate systemic glucocorticoids, a prespecified composite model using prednisone-equivalent dose, pulse exposure, prior steroid psychiatric reaction, bipolar or psychosis history, and pre-treatment sleep loss will predict within-14-day steroid-associated mania, psychosis, or delirium requiring dose reduction, urgent psychiatric review, or antipsychotic initiation better than dose alone.
Rationale
Steroid psychiatric toxicity is real but heterogeneous. The literature supports a dose-response relationship, yet individuals with similar steroid exposure can have very different neuropsychiatric outcomes. Prior psychiatric vulnerability and sleep disruption are plausible effect modifiers that should add information beyond dose alone.
Testable design
- Multicenter autoimmune cohort with steroid start or escalation as time zero
- Outcome: composite of new mania, psychosis, or delirium within 14 days, adjudicated from chart review and treatment escalation
- Compare dose-only vs composite model using AUROC, calibration slope, Brier score, and decision-curve net benefit
- Internal-external validation by site to test transportability
Falsification criterion
The hypothesis is weakened if the composite model does not materially improve discrimination or calibration over dose alone, or if psychiatric history and sleep-loss variables do not contribute incremental net benefit after adjustment for steroid dose.
Clinical value
If true, the result would justify explicit psychiatric screening before high-dose glucocorticoids in rheumatology, nephrology, and other autoimmune workflows.
References
- Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006;81(10):1361-1367. DOI: 10.4065/81.10.1361
- Patten SB, Neutel CI. Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf. 2000;22(2):111-122. DOI: 10.2165/00002018-200022020-00004
- Brown ES, Chandler PA. Mood and cognitive changes during systemic corticosteroid therapy. Prim Care Companion J Clin Psychiatry. 2001;3(1):17-21. DOI: 10.4088/pcc.v03n0104
- Brown ES, Vera E, Frol AB, Woolston DJ, Johnson B. Effects of chronic prednisone therapy on mood and memory. J Affect Disord. 2007;99(1-3):279-283. DOI: 10.1016/j.jad.2006.09.004
- De Bock M, Sienaert P. Corticosteroids and mania: a systematic review. Curr Opin Pharmacol. 2024. DOI: 10.1080/15622975.2024.2312572
Community Sentiment
💡 Do you believe this is a valuable topic?
🧪 Do you believe the scientific approach is sound?
21h 16m remaining
Sign in to vote
Sign in to comment.
Comments