Steroid (Corticosteroid) Psychosis

A psychosis is a state of mind where a person has lost touch with reality. This means he/she hears voices or sees things that are not there. He/she may have abnormal thinking. A steroid psychosis is a state of mind which is a side effect or reaction to taking steroids. Corticosteroids are a form of steroids which the body requires. They are commonly-used anti-inflammatory (against soreness and redness) medications. They are used for allergies and other medical conditions.

Steroid psychoses usually are sudden in their onset (beginning). But mental changes can happen at any time during therapy. Most problems occur within the first 6 to 10 hours following the administration of ACTH. This is a hormone which tells your body to produce more corticosteroid. Or problems may happen within the first 4 to 6 days following the oral administration of corticosteroids. This is the medication your caregiver has prescribed for you. The incidence of steroid induced psychosis in men and women is about equal. Patients' symptoms tend to change radically during the time of this illness. So it is hard to classify.

CAUSES

The higher the dose of steroid used, the more likely there is to be a psychotic reaction. There is not a relationship between the response to the first course of steroid treatment and response to a second course of drug. This means even if you did well once with a steroid, you may not do well the second time. This is also not related to previous psychological problems.

SYMPTOMS

Symptoms include:

  • Depression, apathy or lack of caring about anything.

  • Bipolar disorder which varies from mania to depression.

  • Mood changes.

  • Sudden onset of confusion.

  • Mania (hyperactivity).

  • Agitated abnormal thinking states.

  • Feeling that people are not to be trusted.

  • Emotional ups and downs.

DIAGNOSIS

Your caregiver often knows what is wrong when the patient reacts strangely following the use of corticosteroids. It is a diagnosis made by observation and examination.

TREATMENT

With no treatment, these conditions usually get better in 2 weeks to 6 months. The majority of people are better in 6 weeks. Your caregiver has a good range of medications which can be prescribed to treat this disorder. Phenothiazines are one type of medication. They can shorten the condition noticeably and reduce the time to wellness to one or two weeks. 90% of sufferers have recovered within 6 weeks. Three percent of patients with steroid psychosis commit suicide. The remaining few percent will have an ongoing psychotic or depressive disorder or develop recurrent psychiatric symptoms.

Patients, even those with affective disorder produced by steroids, tend to do poorly when treated at the same time with tricyclic antidepressants while still on steroids. These patients may also get worse even after tapering off steroids when tricyclics are used. For this reason it is recommended that tricyclic and other antidepressant medications not be given until after the patient's steroid psychosis has been properly treated.

SUMMARY

  • Steroid induced mental changes are common (steroid psychoses).

  • The overall incidence of steroid psychosis (when steroids are used to control systemic medical disorders) varies and is usually less than 6%.

  • There is a best time of from 24 to 96 hours to start treatment and stop the full-blown course of steroid psychosis.

  • Early treatment with medications and stopping steroids when possible usually produces a rapid and good response.