Hypomanic Episode Associated with Steroid Eye Drops ın an Adolescent.

Abstract

[Author Affiliation]Ozgur Cakici. 1 Department of Ophthalmology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey.Sabri Herguner. 2 Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Konya, Turkey.Address correspondence to: Ozgur Cakici, Department of Ophthalmology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Besiktas Ortakoy, Istanbul 21288, Turkey, E-mail: drozgurcakici@hotmail.comTo The Editor:Corticosteroids are commonly used and highly effective in the treatment of various systemic diseases, including allergic and inflammatory conditions. Unfortunately, psychiatric adverse effects are common. Nearly 5% of patients taking corticosteroids develop severe symptoms including mania, depression, and psychosis (Lewis and Smith 1983). Symptoms may develop at any time of treatment, most often within days, and are typically reversible with discontinuation of medication. If the psychiatric symptoms are severe or the dose cannot be reduced, adjunctive use of psychopharmacologic treatment may be warranted (Drozdowicz and Bostwick 2014).We report the case of an adolescent who developed hypomania during treatment with topical steroid eye drops, which resolved after cessation of the steroid and adding quetiapine treatment.Case ReportA, a 15-year-old male, had ocular surgery (secondary intraocular lens implantation) and started using a topical steroid (fluorometholone 0.1%) eye drops for three times a day postoperatively. He referred to our outpatient clinic 10 days after the operation and reported a 7 day history of insomnia, extreme irritability, and restlessness. He had a decreased need for sleep (3-4 hours of sleep per night) compared with his usual sleep habits (7-8 hours of sleep per night). His parents reported that he had developed aggressiveness and hostility toward them. His motor and verbal activity increased markedly. During the clinical interview, he displayed psychomotor agitation and was restless, verbally aggressive, and irritable. In his psychiatric assessment he was cooperative; oriented; and aware of the time, place, and the people around him. He did not show grandiosity or report delusions or hallucinations. He did not report drug or alcohol use and had no known drug allergy. He had a past history of attention-deficit/hyperactivity disorder and had received methylphenidate treatment when he was 10 years old for 2 years. His mother had a history of depression.He and his parents reported that his psychiatric complaints began immediately 2 days after the ocular surgery and commencement of topical fluorometholone eye drops. After consultation with his physician, the fluorometholone was discontinued and quetiapine (100 mg/day) was administered for his insomnia and agitation. All his psychiatric symptoms resolved rapidly 1 week after, and quetiapine was ceased in the 3rd month.According to the clinical picture and history of the presented case, we gave a diagnosis of steroid-induced hypomania. There was a clear temporal association between the use of the topical steroid and onset of hypomanic symptoms. Kumagai and Ichimiya (2014) described a 76-year-old man who developed a manic episode induced by steroid (fluorometholone) eye drops and treated with sodium valproate. …