Steroid-induced psychosis - Revision history

Rossdonaldson1: /* Clinical Features */

2025-01-29T22:55:30Z

Clinical Features

← Older revision		Revision as of 22:55, 29 January 2025
Line 9:		Line 9:
	**Case reports of psychosis within one day after exposure		**Case reports of psychosis within one day after exposure
	*Wide range of possible psychiatric symptoms		*Wide range of possible psychiatric symptoms
	**Delusions or hallucinations		**[[Delusions]] or [[hallucinations]]
	**Euphoria		**Euphoria
	**Mania, depression, anxiety		**[[Mania]], [[depression]], [[anxiety]]
	**Severe cases may present with suicidal ideation, violence, aggression		**Severe cases may present with [[suicidal ideation]], violence, aggression

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Clinical Features */

2025-01-29T22:55:04Z

Clinical Features

← Older revision		Revision as of 22:55, 29 January 2025
Line 7:		Line 7:
	*Time of onset variable		*Time of onset variable
	**Median onset after 11.5-12.5 days<ref>Lewis DA, Smith RE. Steroid-Induced Psychiatric Syndromes. J Affect Disord. 1983;5(4):319-332.</ref><ref>Nishimura K, Harigai M, Omori M, Sato E, Hara M. Blood-Brain Barrier Damage as a Risk Factor for Corticosteroid-Induced Psychiatric Disorders in Systemic Lupus Erythematosus. Psychoneuroendocrinology. 2008;33(3):395-403.</ref>		**Median onset after 11.5-12.5 days<ref>Lewis DA, Smith RE. Steroid-Induced Psychiatric Syndromes. J Affect Disord. 1983;5(4):319-332.</ref><ref>Nishimura K, Harigai M, Omori M, Sato E, Hara M. Blood-Brain Barrier Damage as a Risk Factor for Corticosteroid-Induced Psychiatric Disorders in Systemic Lupus Erythematosus. Psychoneuroendocrinology. 2008;33(3):395-403.</ref>
	**Case reports of psychosis within one day after exposure ~~to steroids~~		**Case reports of psychosis within one day after exposure
	*Wide range of possible psychiatric symptoms		*Wide range of possible psychiatric symptoms
	**Delusions or hallucinations		**Delusions or hallucinations

Rossdonaldson1: /* Background */

2025-01-29T22:54:37Z

Background

← Older revision		Revision as of 22:54, 29 January 2025
Line 1:		Line 1:
	==Background==		==Background==
	*~5% of patients on 40 mg ~~or higher per day~~ of [[prednisone]] have psychiatric symptoms<ref>Acute adverse reactions to [[prednisone]] in relation to dosage. Clin Pharmacol Ther. 1972;13:694-698.</ref>		*~5% of patients on ≥40 mg daily of [[prednisone]] have psychiatric symptoms<ref>Acute adverse reactions to [[prednisone]] in relation to dosage. Clin Pharmacol Ther. 1972;13:694-698.</ref>
	**Incidence rises to ~~18.4~~% for patients receiving more ~~than 80~~ mg per day		**Incidence rises to just under 20% for patients receiving more ≥80 mg per day
	*Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids<ref>J Pharm Technol. 2021 Apr; 37(2): 120–126. Published online 2020 Dec 2.</ref>		*Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids<ref>J Pharm Technol. 2021 Apr; 37(2): 120–126. Published online 2020 Dec 2.</ref>

Rossdonaldson1 at 22:53, 29 January 2025

2025-01-29T22:53:21Z

← Older revision		Revision as of 22:53, 29 January 2025
Line 1:		Line 1:
	==Background==		==Background==
	*~~In 718 hospitalized patients, 4.6~~% of patients on 40 mg or higher per day of [[prednisone]] ~~had~~ psychiatric symptoms<ref>Acute adverse reactions to [[prednisone]] in relation to dosage. Clin Pharmacol Ther. 1972;13:694-698.</ref>		*~5% of patients on 40 mg or higher per day of [[prednisone]] have psychiatric symptoms<ref>Acute adverse reactions to [[prednisone]] in relation to dosage. Clin Pharmacol Ther. 1972;13:694-698.</ref>
	**Incidence rises to 18.4% for patients receiving more than 80 mg per day		**Incidence rises to 18.4% for patients receiving more than 80 mg per day
	*Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids<ref>J Pharm Technol. 2021 Apr; 37(2): 120–126. Published online 2020 Dec 2.</ref>		*Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids<ref>J Pharm Technol. 2021 Apr; 37(2): 120–126. Published online 2020 Dec 2.</ref>

Rossdonaldson1: Rossdonaldson1 moved page Steroid induced psychosis to Steroid-induced psychosis

2025-01-29T22:52:34Z

Rossdonaldson1 moved page Steroid induced psychosis to Steroid-induced psychosis

← Older revision	Revision as of 22:52, 29 January 2025
(No difference)

Rossdonaldson1: /* References */

2025-01-29T19:01:35Z

References

← Older revision		Revision as of 19:01, 29 January 2025
Line 48:		Line 48:
	==References==		==References==
	<references/>		<references/>

			[[Category:Neurology]]

Rossdonaldson1 at 22:38, 20 March 2024

2024-03-20T22:38:36Z

← Older revision		Revision as of 22:38, 20 March 2024
Line 1:		Line 1:
	==Background==		==Background==
	*In 718 hospitalized patients, 4.6% of patients on 40 mg or higher per day of prednisone had psychiatric symptoms<ref>Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther. 1972;13:694-698.</ref>		*In 718 hospitalized patients, 4.6% of patients on 40 mg or higher per day of [[prednisone]] had psychiatric symptoms<ref>Acute adverse reactions to [[prednisone]] in relation to dosage. Clin Pharmacol Ther. 1972;13:694-698.</ref>
	**Incidence rises to 18.4% for patients receiving more than 80 mg per day		**Incidence rises to 18.4% for patients receiving more than 80 mg per day
	*Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids<ref>J Pharm Technol. 2021 Apr; 37(2): 120–126. Published online 2020 Dec 2.</ref>		*Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids<ref>J Pharm Technol. 2021 Apr; 37(2): 120–126. Published online 2020 Dec 2.</ref>
Line 28:		Line 28:

	==Management==		==Management==
	*Cease offending agent or taper depending on clinical need for corticosteroids vs psychiatric complications		*Cease offending agent or taper depending on clinical need for [[corticosteroids]] vs psychiatric complications
	**Onset of relief of symptoms vary widely, with some improving within 24 hours or as long as 8 weeks at the longest		**Onset of relief of symptoms vary widely, with some improving within 24 hours or as long as 8 weeks at the longest
	**Discontinuing immediately, as opposed to tapering, contributed to quicker resolution of symptoms		**Discontinuing immediately, as opposed to tapering, contributed to quicker resolution of symptoms
	*Antipsychotics mediate dopamine D2 receptor, correlating with possible mechanism of steroid induced psychosis		*Antipsychotics mediate dopamine D2 receptor, correlating with possible mechanism of steroid induced psychosis
	**2nd generation antipsychotics, low-moderate dosage - [[risperdone]], [[olanzapine]], [[quetiapine]]<ref>Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394:939-951.</ref>		**2nd generation [[antipsychotics]], low-moderate dosage - [[risperdone]], [[olanzapine]], [[quetiapine]]<ref>Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394:939-951.</ref>
	**Severe may require IM/IV doses		**Severe may require IM/IV doses
	*Consult psychiatry for duration of medication treatment		*Consult psychiatry for duration of medication treatment
Line 38:		Line 38:
	==Disposition==		==Disposition==
	*Admission for severe cases		*Admission for severe cases
	*Possible discharge for mild cases, consider short supply atypical antipsychotics and close follow up		*Possible discharge for mild cases, consider short supply atypical [[antipsychotics]] and close follow up

	==See Also==		==See Also==

Kxl328: /* Management */

2024-03-13T13:26:18Z

Management

← Older revision		Revision as of 13:26, 13 March 2024
Line 31:		Line 31:
	**Onset of relief of symptoms vary widely, with some improving within 24 hours or as long as 8 weeks at the longest		**Onset of relief of symptoms vary widely, with some improving within 24 hours or as long as 8 weeks at the longest
	**Discontinuing immediately, as opposed to tapering, contributed to quicker resolution of symptoms		**Discontinuing immediately, as opposed to tapering, contributed to quicker resolution of symptoms
			*Antipsychotics mediate dopamine D2 receptor, correlating with possible mechanism of steroid induced psychosis
			**2nd generation antipsychotics, low-moderate dosage - [[risperdone]], [[olanzapine]], [[quetiapine]]<ref>Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394:939-951.</ref>
			**Severe may require IM/IV doses
			*Consult psychiatry for duration of medication treatment

	==Disposition==		==Disposition==

Kxl328: /* Clinical Features */

2024-03-13T13:12:22Z

Clinical Features

← Older revision		Revision as of 13:12, 13 March 2024
Line 5:		Line 5:

	==Clinical Features==		==Clinical Features==
			*Time of onset variable
			**Median onset after 11.5-12.5 days<ref>Lewis DA, Smith RE. Steroid-Induced Psychiatric Syndromes. J Affect Disord. 1983;5(4):319-332.</ref><ref>Nishimura K, Harigai M, Omori M, Sato E, Hara M. Blood-Brain Barrier Damage as a Risk Factor for Corticosteroid-Induced Psychiatric Disorders in Systemic Lupus Erythematosus. Psychoneuroendocrinology. 2008;33(3):395-403.</ref>
			**Case reports of psychosis within one day after exposure to steroids
	*Wide range of possible psychiatric symptoms		*Wide range of possible psychiatric symptoms
	**Delusions or hallucinations		**Delusions or hallucinations

Kxl328: /* Workup */

2024-03-13T13:09:42Z

Workup

← Older revision		Revision as of 13:09, 13 March 2024
Line 17:		Line 17:
	===Workup===		===Workup===
	*Diagnosis of exclusion		*Diagnosis of exclusion
			*DSM 5 diagnostic criteria
			**Must include hallucinations or delusions after steroid exposure<ref>American Psychiatric Association. Schizophrenia Spectrum and Other Psychotic Disorders: Substance/Medication-Induced Psychotic Disorder. DSM-5-TR. Published 2022.</ref>
			**Other causes cannot explain symptoms

	===Diagnosis===		===Diagnosis===