Doug: Steroid Induced Psychosis

I took Doug to see the doctor today. He has been diagnosed with Steroid Induced Psychosis.

Here is some information about this disorder. Hopefully he will be fine in a couple of weeks if he is able to taper down from this medication. Doug started at 60 mg of prednisone. He is now at 20mg of predisone. He will taper to 15 mg tomorrow and then will take that for 5 days; before tapering to 10 mg for 5 days.

A study about steroid induced psychosis suggest that patients receiving daily doses of greater than 40mg of Prednisone or its equivalent were at greatest risk for developing a steroid psychosis.

The most prominent symptoms appear during the course of the illness consisted of the following:
Emotional lability: no laughter, crying or smiling
Anxiety: uneasiness, fear or worry
Distractibility: lack of interest/lack of attention
Pressured speech: non-stop talking/hard to interrupt
Sensory flooding: difficulty with the process of ideation (forming an idea of using a known movement to achieve a planned purpose), motor planning (planning the action needed to achieve the idea), and execution (carrying out the planned movement)
Insomnia: difficulty falling asleep/ difficulty staying asleep
Depression: abnormal depressed mood
Perplexity: being perplexed / puzzled
Agitation: restlessness, unpleasant state of arousal, increased tension & irritability.
Hallucinations: audio/visual disturbances (dreaming while awake)
Memory impairment: intermittent difficulty to store, retain and recall information
Mutism: inability to speak the thoughts/ unable to express thought process
Delusions: belief based on false information
Apathy: state of indifference, lack of interest or concern
Hypomania: persistant / pervasive irritable mood, thoughts, behaviors
Physical Symptoms: insomnia, loss of appetite, blank stare

Steroid induced mental changes are common. The overall incidence of steroid psychosis when steroids are used to control systemic medical disorders varies between 3 and 6%. The average person gets better with the decreasing of the corticosteroid treatment. (93% had a complete recovery, but 4% had continued symptoms or recurrence of symptoms and 3% committed suicide.)

In reviewing these articles, several conclusions can be made.
First, the neuropsychiatric complications of steroid treatment are quite common.
Second, the specific types of neuropsychiatric impairments comprise a range of symptoms from anxiety, irritability and impaired cognition to depression, mania, psychosis, and suicidality.
Third, although the available literature fails to reveal a uniform approach to the treatment of these specific side-effects, it is clear that these symptoms are common enough and potentially very severe so as to warrant aggressive and early intervention by psychiatric consultants.
Lastly, given the overall lack of published scientific literature on this topic, it behooves patients, family, and care-providers to work to improve the promulgation of this knowledge with the goals of stimulating further research on this subject as well as improving the quality of care for patients with this condition.