Abstract
We report the case of an old man treated with methylprednisolone for chronic lymphoid leukemia. After two months of treatment, he declared an acute steroid psychosis and beat his wife to death. Steroids were stopped and the psychotic symptoms subsided, but his condition declined very quickly. The clinical course was complicated by a major depressive disorder with suicidal ideas, due to the steroid stoppage, the leukemia progressed, and by a sudden onset of a fatal pulmonary embolism. This clinical case highlights the importance of early detection of steroid psychosis and proposes, should treatment not be stopped, a strategy of dose reduction combined with a mood stabilizer or antipsychotic treatment. In addition have been revised the risks of the adverse psychiatric effects of steroids.
Highlights
Argentine physiologist Bernardo Houssay identified cortisone and described its main actions on the body at the beginning of the 20th century
Cortisone is secreted by the adrenal cortex, under the control of the hypothalamus, which is itself regulated by the limbic system and the anterior pituitary gland
It could be advanced that the pneumonia, due to the immunodepressed state, which is itself due to the chronic lymphoid leukemia, added to the hyponatremia, contributed to weakening cerebral homeostasis, and facilitated the occurrence of iatrogenic effects, such as cortico-induced psychosis
Summary
Argentine physiologist Bernardo Houssay identified cortisone and described its main actions on the body at the beginning of the 20th century. Corticosteroid therapy is today a treatment which has many broad uses, from autoimmune and system diseases to severe inflammatory and allergic reactions, as well as in palliative care and support [2, 4]. The counterweight of these broad therapeutic indications is witnessed in numerous undesirable side effects, including amongst others metabolic, endocrine, digestive, immunological, ophthalmological, dermatological, and neuropsychiatric disorders. Case Reports in Medicine disorder could be risk factors for the development of a corticosteroid-induced psychiatric episode [12]. We report on the case of a patient who presented an acute corticosteroid-induced psychotic reaction, resulting in the committing of a heteroaggressive deed which led to the death of his spouse
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