No abstract

Corticosteroids are commonly used medications both in a wide variety of medical settings, and despite this, their neuropsychiatric effects are poorly understood. The affective and behavioral symptoms, in particular mania and psychosis, can be unpredictable and challenging to treat as in our patient, who developed a long-lasting psychotic episode on high-dose steroids despite discontinuation and treatment of nearly six months. This was despite having tolerated steroids multiple times in the past.

The authors present the case of an inpatient hospitalized at the Veterans Affairs psychiatric unit diagnosed with Wernicke–Korsakoff syndrome to promote awareness of this prevalent yet often underdiagnosed and undertreated condition. Although Veterans present with a unique predisposition for alcohol abuse, it remains problematic in the general population as well. Analysis from 2000 to 2003 reveals alcohol use in the past month in Veterans at 56.6% and 50.8% in comparable non-Veterans. According to the National Survey on Drug Use and Health, it is estimated that of those who are 18 and older, 86.4% have used alcohol, 26.9% have engaged in binge drinking in the past month, 7% engaged in heavy alcohol use in the past month, and 6.2% (15.1 million) carried the diagnosis of alcohol use disorder., The lifetime prevalence of alcohol abuse in the general population is estimated to be between 4.5% and 13.2%. Primary care providers should maintain a high degree of vigilance in evaluating patients for timely diagnosis and prompt treatment of those suspected to have thiamine deficiency. Indeed, Wernicke’s encephalopathy carries a significant level of morbidity and mortality associated with the syndrome, even in cases when it does not present with all of the classic signs. This article aims to raise the primary and ambulatory care provider’s ability to recognize the condition, emphasize a low threshold to treat, and highlight current treatment recommendations.

Introduction: This is a case of a patient on therapeutic dextroamphetamine for adult ADHD who developed severe psychotic symptoms requiring hospitalization and anti-psychotic medication. While there are case reports of patients who abuse stimulants or do not take them as directed, there is little in the literature describing those who take moderate doses as prescribed, particularly over a short duration, and develop florid psychosis. Case Presentation: A 26 year old male who suffered from adult attention-deficit hyperactivity disorder (ADHD) was brought to the attention of the psychiatric consult-liaison service as he suddenly developed psychotic symptoms after taking a prescribed stimulant three times per day for a short duration. He ultimately required a four-day hospitalization in inpatient psychiatry with medication management lasting nearly two weeks before complete symptom resolution was achieved. Conclusion: Patients taking stimulants as prescribed for the treatment of ADHD may be at risk of developing psychosis. It is essential that patients be monitored closely on initiation of treatment and during induction for behavioral changes. Fortunately, there are a variety of pharmacologic and behavioral treatment modalities that do not include stimulants, but that are proven effective and can be used as alternatives in such cases.