Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T12:34:00.113Z Has data issue: false hasContentIssue false

Corticosteroid induced mania with psychotic symptoms

Published online by Cambridge University Press:  13 August 2021

F. Gomes Tavares*
Affiliation:
Departamento De Psiquiatria E Saúde Mental - Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
M. Viseu De Carvalho
Affiliation:
Departamento De Psiquiatria E Saúde Mental - Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
M. Pinto
Affiliation:
Departamento De Psiquiatria E Saúde Mental - Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
C. Solana
Affiliation:
Departamento De Psiquiatria E Saúde Mental - Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
S. Batista
Affiliation:
Departamento De Psiquiatria E Saúde Mental - Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
*
*Corresponding author.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction

Corticosteroids may induce psychiatric symptoms (agitation, fear, hypomania, insomnia, irritability, labile mood, pressured speech and restlessness) with incidence rates ranging from 1,8% to 57%. We present a case of corticosteroid-induced mania and psychosis.

Objectives

Non-systematic review on corticosteroid therapy induced psychiatric symptoms. Analysis and comparison of a patient’s case with the existing literature.

Methods

Case report and a non-systematic review through databases as Pubmed, UpToDate, Medscape, between 2000 and 2020.

Results

We present a female 70 year-old patient without psychiatric background, diagnosed with Rhizomelic Pseudopolyarthritis, who started treatment with prednisone 20 mg. During the third month of treatment the patient started progressively worse behavior changes (such as destruction of the neighbor’s property), developed persecutory delusions, decreased sleep and increased energy. The patient was committed to our psychiatric ward and started on diazepam 10 mg and olanzapine 15 mg per day. Despite introduction of antipsychotics, which has evidence for mood stabilization, the patient maintained the symptoms, so it was necessary to gradually reduce corticosteroids until symptomatic control.

Conclusions

Psychosis (24%), hypomania and mania (35%), are the most common psychiatric reactions to corticosteroid therapy. Several studies show that even a low dosage may induce psychiatric disturbances, most frequently during the first two weeks of treatment. However, as reported in this case, symptoms may occur at any time. Thus, a multidisciplinary team, as well as training of professionals from different specialties, such as psychiatry, rheumatology and endocrinology, are needed, since these syndromes may be confused with pure psychiatric conditions and consequently delay treatment and compromise prognosis.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
Submit a response

Comments

No Comments have been published for this article.