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Corticosteroid-related psychosis 💊
May be seen in patients receiving high-dose corticosteroids. Often in the context of underlying inflammatory or neoplastic disease.
⚙️ Aetiology
- Corticosteroid-related psychosis can develop within days of starting high-dose oral or IV corticosteroids.
- Some patients may present later, up to 12 weeks or more after commencing therapy.
🩺 Clinical Features
- Agitation and restlessness.
- Hypomania or mania.
- Depression or suicidal ideation.
- Paranoia or frank psychosis.
- May overlap with features of delirium.
⚖️ Differentials
- Sepsis or systemic infection.
- Underlying medical illness (e.g. CNS malignancy, autoimmune encephalitis).
- Primary psychiatric disorders (e.g. bipolar disorder, schizophrenia).
- Hyperactive delirium from metabolic disturbance or drugs.
🔬 Investigations
- Basic bloods: FBC, U&E, CRP, LFTs.
- Infection screen: blood cultures, urine dip/culture, CXR.
- Consider brain imaging (CT/MRI) to exclude intracranial pathology.
- Exclude metabolic or drug-related causes of delirium.
🛠️ Management
- Supportive care and close observation.
- Reduce or withdraw corticosteroid if possible (balance against underlying disease needs).
- Short-term use of antipsychotics (e.g. haloperidol, risperidone, olanzapine) or benzodiazepines may be required for agitation.
- Liaison psychiatry input for severe or persistent symptoms.
📚 References
- BNF – Corticosteroids
- Hall RC et al. (1979). “Psychiatric manifestations of corticosteroid use.” Psychosomatics.
- Lewis DA, Smith RE (1983). “Steroid-induced psychiatric syndromes.” J Affect Disord.
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