Inhaled Steroid–Induced Mania in an Adolescent Girl

Psychiatric Adverse Effects of Pediatric Corticosteroid Use

“…These symptoms resolved within 48 hours of discontinuing the inhaler, and she did not require psychiatric hospitalization. 58 The paucity of reports detailing psychiatric adverse effects of inhaled corticosteroids should not be mistaken for proof that such effects do not occur. Although 1 article exploreddand found no difference betweendsteroid and reference groups with respect to behavioral effect, most articles regarding inhaled corticosteroids fail to mention behavioral and psychiatric issues and focus instead on other common corticosteroid adverse effects.…”

“…Other reports agreed, documenting symptom onset either immediately or days into treatment. 41,48,58,77 However, if they were documented at all, psychiatric adverse events were sometimes delayed, emerging only after weeks of treatment 41,42,50 or even after cessation. 38,39,47 In those case studies documenting psychiatric reactions that began 1 to 11 days after corticosteroid administration was stopped, most reactions were characterized as psychosis; one case emphasized combativeness and emotional lability, and another described acute-onset obsessive-compulsive symptoms.…”

“…[79][80][81][82] The simplest approach to treatment for both groups is corticosteroid cessation, which may be adequate to resolve the symptoms. 5,11,13,58 We recommend dosage reduction or cessation, if possible, when acute psychiatric events occur. If cessation is not possible or is ineffective, the responses to antipsychotic medications and/or benzodiazepines described in the cases below may help inform therapeutic choices.…”

Behavioural side effects of inhaled corticosteroids among children and adolescents with asthma

“…Oral administration of steroids is spread systemically in the body and is known to be associated with several behavioural changes, including mood changes, hyperactivity, and inattention [ 7 ]. However, it is less documented to which extent such behavioural changes also applies to ICS [ 8 ], although case-reports have been published [ 7 , 9 , 10 ]. Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by symptoms of inattention and/or hyperactivity and is also associated with a 45–53% increased risk of asthma [ 11 ], possibly due to a mix of environmental and genetic risk factors [ 12 ].…”