Response to Meduri and Shih letter

摘要

To the Editor: We thank Dr. Meduri and Dr. Shih for their interest in our work and wish to provide clarifications on the points raised.Regarding the first point, based on findings referenced in our article (1), we chose depressive symptoms to identify outcomes because these codes recorded by the general practitioners reflect true family practice, in which physicians are more likely to record symptoms than a definite diagnosis. Exclusion of these codes would have led to an underestimation of the incidence rates and a classification bias, as general practitioners may be more likely to record symptoms than diagnoses for a neuropsychiatric illness attributable to glucocorticoid exposure with the view that the symptoms would improve once glucocorticoids were stopped or reduced. Psychiatric referral was similar between the group of patients who were exposed to glucocorticoids and patients who were not. However, as specified in the article, the term "psychiatric referral" refers to consultation with a psychiatrist without any details of the experienced symptoms. These referrals may relate to the neuropsychiatric disorders we studied or to other psychiatric illnesses and symptoms such as anxiety or eating disorders. These referrals concerned only 108 people, compared with the 10,221 patients for whom details of the symptoms or illnesses were available.