Case Report
Copyright ©The Author(s) 2023.
World J Neurol. May 31, 2023; 9(3): 28-36
Published online May 31, 2023. doi: 10.5316/wjn.v9.i3.28
Table 1 Summarized clinical profile of steroid-induced psychosis compared with the clinical profile of the 2 cases of steroid-induced psychosis associated with excision of pituitary adenoma
Parameters
Latest literature review of steroid-induced psychosis (Huynh et al[4], 2021)
Mizutani et al[3], 2015
Aranas & Tangalin, 2023
AgeMean age of 42.54 yr old35 yr old47 yr old
SexCases were mostly male; Female sex – proven risk factorMaleMale
Indication for steroidsSuppression of inflammatory processes and the immune systemPerioperative steroid replacementPerioperative steroid replacement
Steroids (prednisone equivalent in average (mg/d)Prednisone, Prednisolone, Methylprednisolone, Dexamethasone, Hydrocortisone, Triamcinolone, Betamethasone; (15-1250 mg of prednisone/d)Hydrocortisone 10-300 mg/d; (2.5-75 mg of prednisone/d)Dexamethasone 2–16 mg/d; (26.7-106.7 mg of prednisone or its equivalent per day)
Duration of steroid therapyShortest: < 2 d; Longest: 2 yr; Mostly within 3 d up to 6 mo8 d11 d
Onset of psychosis from 1st dose of steroidsEarliest: < 24 h; Latest: After 2 yr of chronic use; Mostly within 2 da to up to 2 wk4 d1 d
SymptomatologyMost common: Delusions & hallucinations; Others: Insomnia, agitation, irritability, combativeness, confusion, cognitive impairment, mania, depression, and suicidal ideationElated and irritable mood, grandiose and persecutory delusions, anxiety, and agitationAnxious mood, persecutory delusions, thought broadcasting, auditory hallucination, agitation
History of Psychiatric illnessMajority without psychiatric illness; Anxiety disorder; Depressive disorderNoneSevere depressive episode without psychotic symptoms
Steroid management following diagnosis of psychosisDiscontinued – quicker resolution; TaperedTapered (7 d)Tapered (11 d)
Pharmacologic interventionTypical antipsychotics: Haloperidol, Levomepromazine, perphenazine, & zuclopenthixol; Atypical antipsychotics: Risperidone, Olanzapine & Quetiapine; Mood stabilizers: Lithium & Valproic acid; Benzodiazepines: Clonazepam, diazepam, lorazepam, & FlunitrazepamAtypical antipsychotic: RisperidoneAtypical antipsychotic: Risperidone
Recovery/ImprovementEarliest: 1 mo; Longest: 8 wk4 d3 wk