IntroductionCorticosteroids have either somatic and psychiatric side effects. Somatic adverse effects are well described while neuropsychiatric have received less attention. Psychiatric symptoms such as depression, psychosis and especially mania are common side effects of corticotherapy.Aims and objectivesDescribe a case of a 53 year old female patient, with no psychiatric history, who developed psychiatric symptoms during the treatment of an acute exacerbation of multiple sclerosis with large parenteral doses of corticosteroids. Three days after the onset of corticotherapy she developed increased energy, elevated mood, increased motor activity, racing thoughts, and diminished need for sleep. She subsequently developed grandiose and persecutory ideation and then feared her grandson was going to die. This lead to her admission to psychiatric unit of our hospital to address this behavioral problems. Her husband noticed that she had become “hyper” in the past when she received pulse corticosteroid therapy, but the most recent episode was by far the worst.MethodsRevision of the scientific literature through Pubmed, Embase and Psychinfo using search terms including corticosteroids, mania, depression, psychosis and mood.ResultsPrednisone was suspended and Risperidone 2 mg was begun for presumed steroid-induced mood disorder, and the patient became calmer and much less guarded over the next 2-3 days. After a week she recovered complete euthymic mood and reverted to normal functioning.ConclusionsThese data suggest that Risperidone is well tolerated and appears to be useful for mood disturbances associated with corticosteroid therapy. Controlled trials seem warranted to confirm these observations.
There have been several reports correlating low levels of estrogen with psychotic symptoms, leading to studies evaluating the possible effect of this hormone as an antipsychotic. In this case, we report psychotic symptoms with high levels of estradiol, which is contrary to that theory.
IntroductionThe clinical syndromes related to fronto-temporal lobar degeneration are the second most common cause of pre-senile primary dementia. There are three distinct clinical variants: behavioral-variant fronto-temporal dementia (BvFTD), semantic dementia and progressive non-fluent aphasia. BvFTD is characterized by a significant change in the patients personality and social behavior, and impaired executive function.ObjectivesReview the current literature on both the pharmacologic and nonphar- macologic management of fronto-temporal dementia.AimsBrief literature review.MethodsCase report and literature review.ResultsWe describe case of a 65-years-old male with hyperactivity, desinhibition, aggressive, stereotyped and persevering behaviors with continuous walking and changes in eating habits (hyperphagia). He also presented distractibility, poor speech with loss of spontaneity, an indifferent attitude, mental rigidity, inflexibility, and lack of insight for his condition. This condition developed within one year, with a change in his personality and the appearance of an inadequate social conduct, with an insidious onset and gradual progression. He has family history of dementia. Computerized Tomography scan shows lobar fronto-temporal atrophy. During hospitalization no drugs has had effect, apart from paroxetine (partial response).ConclusionConcerning therapy, several drugs were used without proved effect in controlling the symptoms, highlighting the difficulty in the psychopharmacological approach of this disorder. The selective serotonin reuptake inhibitors have shown some effect on behavior.
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