Expect psychiatric side effects from corticosteroid use in the elderly.

Psychiatric side effects including mania, depression, psychosis, and delirium, are extremely common in patients treated with corticosteroids. The elderly and those with previous psychiatric diagnoses are not at increased risk for these side effects, but females and those with prior corticosteroid-induced psychiatric side effects are. Depression and mania are the most frequent behavioral side effects, followed by psychosis and delirium. In the geriatric population, there is a long list of medical etiologies of psychosis, delirium, mania, and depression. These must be distinguished from corticosteroid side effects. Treatment involves stopping the corticosteroids, if possible, and targeting the specific psychiatric symptoms that develop.