P-178 - Corticosteroids and behaviour changes - a case report

Abstract

Corticosteroids have been widely prescribed in routine clinical practice and physicians have long known their many side effects. These include metabolic syndrome, osteoporosis, glaucoma, cataracts, peptic ulcers and psychiatric symptoms. Psychiatric side effects from corticosteroids include mania, depression and mood disturbances. Description of a 75 year old female patient's case study, without previous psychiatric history, diagnosed with bronchopneumonia and requiring treatment with prednisone 40 mg daily. Since the first week of treatment she reported behaviour changes such as episodes of elevated and irritable mood, pressured speech, insomnia, jealousy and megalomania delusions. These symptoms worsened, leading to admission in a psychiatric hospital. Revision of the scientific literature through Pubmed , using search terms including corticosteroids, mania, depression, psychosis and mood. The research was complemented with information from Uptodate. Prednisone was suspended and the patient began treatment with Olanzapine, starting with a dosage of 5 mg daily at night, reaching a maximum of 10 mg. The patient recovered complete euthymic mood and reverted to normal functioning. These results support the theory that this psychopathologic state was induced by the corticotherapy administered previously. Corticosteroids are usually associated with psychiatric disorders and cognitive symptoms. Mania symptoms are the most important manifestations of corticosteroids-induced psychiatric toxicity. It usually occurs within the first two weeks of therapy and it seems to be dose-related. Clinicians should be aware of these facts and carefully monitor patients for psychiatric and cognitive side effects of corticosteroid use.