Steroid-induced Psychosis in a Patient without a Previous Psychiatric History

Abstract

This is a 45-year-old Hispanic male with retinitis pigmentosa, no previous psychiatric history, and no known substance use disorder who was treated with 80 mg of oral prednisone, tapered off over 6 weeks before undergoing eye surgery. One week after completing the treatment, he went missing, and when he was found, he described visual and auditory hallucinations, as well as paranoid thoughts. He demonstrated a calm affect, flat mood, decreased expressiveness, poor eye contact, and fluent speech. The thought process was linear and goal-directed. Thought content was negative for hallucinations and paranoia, but delusional, with limited judgment and insight into his current situation. Negative suicidal or homicidal ideations. He was admitted to the hospital for further work up for encephalopathy. Images and laboratory results were irrelevant. The patient's encephalopathy completely resolved the following day, and no antipsychotic medications were administered. The psychiatric assessment was compatible with steroid-induced psychosis based on the acute onset, the brief psychotic episode with complete resolution of symptoms (5 days), precipitated by stressors (combined effects of an incapacitating disease). With this case presentation, we want to raise awareness among primary care physicians of the occurrence of steroid-induced psychosis and highlight the importance of patient education including their caregivers, as the cornerstone for an early recognition and prompt management of neuropsychiatric adverse events of glucocorticosteroids.