Acute Onset of Steroid Psychosis with Very Low Dose of Prednisolone in Sheehan's Syndrome

Abstract

Abstract. Corticosteroid treatment is frequently associated with psychiatric disturbances. These adverse effects are unusual with low dose of corticosteroid. We describe a patient who rapidly developed a steroid-induced psychosis with very low dose of prednisolone. A 48-year-old woman of Sheehan's syndrome was admitted to hospital with insomnia, euphoric moods and visual hallucinations. She had taken prednisolone (10 mg in the morning and 5 mg at night) for 6 days before admission. These symptoms appeared after first dose of prednisolone. A diagnosis of acute psychosis was made. After improvement of acute psychosis with discontinuation, re-administration of prednisolone at a dose of 2.5 mg per day gave rise to agitation and insomnia. She recovered completely by gradual dosage increase of short-acting corticosteroid after the discontinuation of prednisolone.

The Emotional Consequences of Corticosteroid Use in Hematology: Preliminary Findings

“…However, even for this group there were problems associated with the unpleasant emotional state, mood swings, and temperamental behaviors. As noted elsewhere (Hong et al, 2006;Patten & Neutel, 2000), euphoria, mood disorders, and even mania can be associated with steroid use.…”

“…In the current study, the participant who reported experiencing psychosis from steroids remained in this state for many months while on treatment and required ongoing psychiatric care. Although documented as uncommon, psychosis is noted as a complication of steroids in a number of diagnostic conditions other than hematological malignancies such as myocardial infarction, asthma, and Sheehan's syndrome (Alisky, 2006;Hong et al, 2006;Koh et al, 2002). Depression has been reported elsewhere as a serious side effect of steroid administration in a case study of a 15-year-old girl with acute lymphoblastic leukemia, a common hematological malignancy (Sutor et al, 1996).…”

“…The potential for steroid treatments to cause severe emotional and even psychiatric disturbances, ranging from mood disturbances to (florid) psychosis, are well documented (Hong, Cho, Kang, Chung, & Chung, 2006;Ruiz, Dabi, Matusevich, & Finkelsztein, 2002). From the literature, we know that common side effects of steroid treatments can include symptoms of insomnia, euphoric moods, mood disorders (with depressive, manic, and mixed features), mania, visual hallucinations (Hong et al, 2006;Nabar, Sand, & Heigl, 1996;Patten & Neutel, 2000), severe depression, irritability, violence (Beshay & Pumariega, 1998), neurophysical deficits, and psychotic states (Naber et al, 1996). However, there is a dearth of literature documenting the emotional and psychiatric side effects of steroid use for hematology patients (McGrath, Pun, James, & Holewa, 2007) and a related lack of comprehensive recommendations for the management, education, and support of patients undergoing steroid treatment and their families.…”

“I was never like that”: Australian findings on the psychological and psychiatric sequelae of corticosteroids in haematology treatments

“…Typical sequelae from the use of corticosteroids can include symptoms such as insomnia, euphoric moods, mood disorders (with depressive, manic and mixed features), mania and visual hallucinations [12,14,25,27], severe depression [13], irritability, violence [1], neuropsychological deficits and psychotic states [15,25,32].…”

Acute onset psychosis following steroid replacement in Sheehan syndrome

“…Withdrawal of prednisolone was associated with improvement but reintroduction of small dose of 2.5 mg again resulted in agitation. After stopping prednisolone and starting a low dose of hydrocortisone (10mg) followed by gradually building up the dose did not result in recurrence of psychotic symptoms (7). In our first patient we stopped prednisolone for five days and introduced 5 mg of hydrocortisone daily.…”