Steroid-induced Psychosis in Adolescent Patient with Crohn’s Disease

Abstract

Crohn’s disease is a chronic inflammatory disease that involves the upper and lower gastrointestinal tracts, including the oral cavity. For the conventional treatment of inflammatory bowel diseases, steroids are usually used as induction therapy, and azathioprine is used as maintenance therapy. Steroids are associated with various side effects. Under rare circumstances, they can even cause psychotic symptoms, and reports on steroid-induced psychosis in the pediatric population are few. Here, we report the first case of steroid-induced psychosis in a 16-year-old female with Crohn’s disease administered with steroids as induction therapy in South Korea. She showed psychotic symptoms, including auditory hallucination, loosening of association, and idea of reference, after 2 weeks of administering prednisolone 60 mg/day. One week after steroid discontinuation, the patient gradually recovered and was treated with quetiapine. Therefore, pediatricians should be aware of serious psychiatric adverse effects when administering corticosteroids for various indications.

Steroid-Induced acute psychosis in an 8-year-old child with inflammatory bowel disease

“…[7] Furthermore, Kim et al reported a 16-year-old female patient diagnosed with CD, which showed psychotic changes after 2 weeks of administering prednisolone 60 mg/day, which recovered gradually after 1 week of discontinuation steroid and starting antipsychotic therapy. [8] The consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric CD states that "In children and adolescents who did not have finished their growth, exclusive enteral nutrition is the induction therapy of the first choice due to its excellent safety profile, preferable over corticosteroids, which are equipotential to induce remission." [9] On the same consensus guideline, when prednisolone fails, then budesonide is the 2 nd line.…”

Association between Childhood Onset Inflammatory Bowel Disease and Psychiatric Comorbidities in Adulthood

“…While a population-based cohort study conducted in Taiwan (2020) demonstrated a significant association between schizophrenia and subsequent IBD development (1.14% vs. 0.25% in non-IBD population), other studies failed to demonstrate any association between somatic and mental illnesses [112,113]. In pediatric populations, rare and isolated cases of medication-induced psychosis are described in the literature [114,115] Recent evidence suggests there is a possible association between IBD and eating disorders, although the exact mechanisms involved in its ethio-pathogenesis are not fully understood. This association may lead to worse prognosis [108,116,117].…”

Steroid Induced Psychosis in a Case of Erythema Multiforme Major.

“…Quetiapine at 300mg/day for 3 months after onset of psychiatric manifestation . Ward et al 16 demonstrates successful management of psychosis with tab. Aripiprazole followed by Inj.…”