L Seurs1, A Mierzejewska, S J Claes. 1. Universitair Psychiatrisch Centrum KU Leuven, Kortenerg, Belgium. lore.seurs@uc.kortenberg.be
Abstract
BACKGROUND: Our study focuses on a 30-year-old man who was hospitalised against his will because of his agitated psychotic state. His symptoms were indicative of a paranoid psychotic disorder resulting from the use of corticosteroids. We considered it important to report this case because corticosteroids have been widely prescribed since about 1950 to treat a broad spectrum of somatic illnesses and because there have been many reports of both mild and acute psychiatric side-effects. AIM: To obtain answers to the following questions: what is the incidence of steroid-induced psychotic symptoms? Do patients with a psychiatric history run a greater risk of developing a steroid-induced psychosis? What are the most important risk factors and how can we prevent the development of steroid-induced psychotic symptoms? METHOD: After discussing the case, we studied the literature systematically using Medline. RESULTS: Up till now, very little reliable evidence has been available relating to steroidinduced psychosis. Therefore there has been a lack of information about the incidence of psychotic symptoms caused by steroids, about the risks involved when the patient has a psychiatric history and about the preventive measures that can be taken. CONCLUSIONS: The most important risk factor seems to be the dose. Thus, if a patient requires treatment with steroid, it seems advisable to prescribe the lowest possible dose.
BACKGROUND: Our study focuses on a 30-year-old man who was hospitalised against his will because of his agitated psychotic state. His symptoms were indicative of a paranoid psychotic disorder resulting from the use of corticosteroids. We considered it important to report this case because corticosteroids have been widely prescribed since about 1950 to treat a broad spectrum of somatic illnesses and because there have been many reports of both mild and acute psychiatric side-effects. AIM: To obtain answers to the following questions: what is the incidence of steroid-induced psychotic symptoms? Do patients with a psychiatric history run a greater risk of developing a steroid-induced psychosis? What are the most important risk factors and how can we prevent the development of steroid-induced psychotic symptoms? METHOD: After discussing the case, we studied the literature systematically using Medline. RESULTS: Up till now, very little reliable evidence has been available relating to steroidinducedpsychosis. Therefore there has been a lack of information about the incidence of psychotic symptoms caused by steroids, about the risks involved when the patient has a psychiatric history and about the preventive measures that can be taken. CONCLUSIONS: The most important risk factor seems to be the dose. Thus, if a patient requires treatment with steroid, it seems advisable to prescribe the lowest possible dose.