Ver el código de «Steroid-induced psychosis»

==Background==
*~5% of patients on ≥40 mg daily of [[prednisone]] have psychiatric symptoms<ref>Acute adverse reactions to [[prednisone]] in relation to dosage. Clin Pharmacol Ther. 1972;13:694-698.</ref>
**Incidence rises to just under 20% for patients receiving more ≥80 mg per day
*Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids<ref>J Pharm Technol. 2021 Apr; 37(2): 120–126. Published online 2020 Dec 2.</ref>

==Clinical Features==
*Time of onset variable
**Median onset after 11.5-12.5 days<ref>Lewis DA, Smith RE. Steroid-Induced Psychiatric Syndromes. J Affect Disord. 1983;5(4):319-332.</ref><ref>Nishimura K, Harigai M, Omori M, Sato E, Hara M. Blood-Brain Barrier Damage as a Risk Factor for Corticosteroid-Induced Psychiatric Disorders in Systemic Lupus Erythematosus. Psychoneuroendocrinology. 2008;33(3):395-403.</ref>
**Case reports of psychosis within one day after exposure
*Wide range of possible psychiatric symptoms
**[[Delusions]] or [[hallucinations]]
**Euphoria
**[[Mania]], [[depression]], [[anxiety]]
**Severe cases may present with [[suicidal ideation]], violence, aggression

==Differential Diagnosis==
{{AMS DDX}}

==Evaluation==
===Workup===
*Diagnosis of exclusion
*DSM 5 diagnostic criteria
**Must include hallucinations or delusions after steroid exposure<ref>American Psychiatric Association. Schizophrenia Spectrum and Other Psychotic Disorders: Substance/Medication-Induced Psychotic Disorder. DSM-5-TR. Published 2022.</ref>
**Other causes cannot explain symptoms

===Diagnosis===
*Consider [[AMS]] workup

==Management==
*Cease offending agent or taper depending on clinical need for [[corticosteroids]] vs psychiatric complications
**Onset of relief of symptoms vary widely, with some improving within 24 hours or as long as 8 weeks at the longest
**Discontinuing immediately, as opposed to tapering, contributed to quicker resolution of symptoms
*Antipsychotics mediate dopamine D2 receptor, correlating with possible mechanism of steroid induced psychosis
**2nd generation [[antipsychotics]], low-moderate dosage - [[risperdone]], [[olanzapine]], [[quetiapine]]<ref>Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394:939-951.</ref>
**Severe may require IM/IV doses
*Consult psychiatry for duration of medication treatment

==Disposition==
*Admission for severe cases
*Possible discharge for mild cases, consider short supply atypical [[antipsychotics]] and close follow up

==See Also==


==External Links==


==References==
<references/>

[[Category:Neurology]]