This material was presented in the 25th European Congress of Psychiatry which was organised by the European Psychiatry Association in Florence, Italy from 1-4th April 2017. I had access to the material as I attended the full Congress. Please note that this material remains the intellectual property of the European Psychiatry Association and its authors and any citation should include a full reference to it. For more information on the EPA and how to become a member, please visit: http://www.europsy.net/

1. Copyright © 2014 Martín-Gutiérrez, Raquel. rakemargutie@gmail.com
Glucocorticoids (along with mineral corticosteroids and androgens) are steroid hormones secreted by the adrenal cortex (ie,
corticosteroids) that are involved in a variety of systemic processes (eg, carbohydrate metabolism, inflammation). Glucocorticoids
are widely prescribed for a variety of diseases and are known to cause neuropsychiatric as well as somatic side effects.
R. Martín Gutierrez1, P. Suarez Pinilla1, R. Medina Blanco1, R. Landera Rodriguez1, M. Juncal Ruiz1, M. Gómez Revuelta1,
I. Madrazo del Río Hortega1, O. Porta Olivares1, J. González Gómez1, R. Hernando Fernández2
1Hospital Universitario Marques De Valdecilla, Psychiatry, Santander, Spain 2Hospital Universitario Marques De Valdecilla,
General Practicioner, Santander, Spain
STEROID-INDUCED PSYCHIATRIC SYNDROMES:
a case report and a review of the literature
INTRODUCTION:
OBJETIVE:
To review the incidence, clinical characteristics, course and treatment of neuropsychiatric effects of glucocorticoids.
AIM:
We have described the case of a 86 year-old woman. She had no
family or personal history of psychiatric problems. She presented
wrist arthritis requiring high doses of an oral corticoid treatment
(prednisona 20 mg/d). After a week, she started with symptoms
characterised by persecutory and surveillance delusions.
Organicity was descarted. The patient got a progressive recovery
after starting antipsychotic medication (haloperidol 10 drops/day)
and progressive reduction of the steroid drugs.
METHODS:
We have perfomed a literatura review of the
neuropsychiatric complications of glucocorticoids
using the PubMed database.
RESULTS:
Neuropsychiatric effects of glucocorticoids involve affective, behavioral, and cognitive manifestations. The affective effect is the
most frequent (it is found in approximately 75% of patients) and may be predominantly depressive, where apathy and mutism are
the most frequent, in other cases they are presented with manic symptoms.
These side effects are less described in the literature than somatic ones. The incidence is variable, between 2 and 60 % of patients
who receive steroids. Although the effects of glucocorticoids are unpredictable, the most important risk factor seems to be the
given dose together with a prolonged use of the steroid. The onset of symptoms occurs during early stages so that about 90% of
cases occur within the first 6 weeks of initiation of treatment. The duration of the symptomatology is very variable. They can be
produced by any type of inhaled steroid preparation by non-systemic routes, and also by systemics. Among the most frequent risk
factors of the patient are: female gender, advanced age, blood-brain barrier damage and hypoalbuminemia.
Typically, dosage reduction results in clinical recovery. And this is the first opcion in the treatment. As for the therapeutic options,
the most described in the literature is the use of antipsychotics both atypical and typical at low doses, other alternatives are lithium,
or antidepressants. At the prophylaxis level, it is difficult to make recommendations given the lack of large randomized controlled
trials. Furthermore it is a problem that clinicians face on their regular basis. There is currently no ability to predict those patients
who will develop neuropsychiatric complications.
CONCLUSIONS:
The neuropsychiatric effects of glucocorticoids are unpredictable and non-specific. More controlled trials are needed in order to
perform evidence-based clinical guidelines for the treatment with glucocorticoids and for the prevention of neuropsychiatric
manifestations. It is very important to explain to the patient the side effects derived from the use of glucocorticoids both at the
somatic and neuropsychiatric levels before starting the drug and it is necessary to warn the alert symptoms to both, patients and their
families.
1. Mary Gable, et al. Substained corticosteroid-induced mania and psychosis despite cessation: A case study and brief literatura review.
The international Journal of psychiatry in medicine 2015. 398-404.
2.Kenna et al. Psychiatric complications of treatment with corticosteroids: Review with case report. Psychiatric and clinical
neurosciences. Heather A. 2011: 549-560.