Steroid-Induced Psychosis after EUS-Guided Celiac Plexus Blockade

Area of Science:

• Gastroenterology
• Psychiatry
• Pain Management

Background:

• Endoscopic ultrasound-guided celiac plexus blockade (EUS-CPB) is an effective treatment for chronic pancreatitis pain.
• Corticosteroids, such as triamcinolone, are often used in EUS-CPB to enhance its efficacy.
• Steroid-induced psychiatric complications are a known risk, but rarely reported in the context of EUS-CPB.

Observation:

• A 46-year-old female with no prior psychiatric history developed acute psychosis, including racing thoughts, delusional thinking, and insomnia.
• These symptoms emerged after receiving multiple EUS-guided celiac plexus blockade procedures for chronic pancreatitis pain.
• The psychosis was directly attributed to the triamcinolone used during the EUS-CPB procedures.

Findings:

• This is the first reported case of steroid-induced psychosis secondary to EUS-guided celiac plexus blockade.
• The patient experienced significant psychiatric distress directly linked to triamcinolone administration.
• The findings underscore the potential neurotoxicity of corticosteroids in this interventional setting.

Implications:

• Clinicians performing EUS-CPB should be vigilant for potential psychiatric side effects of triamcinolone.
• Early recognition and management of steroid-induced psychosis are crucial for patient well-being.
• Alternative pain management strategies or modified steroid protocols may be considered in susceptible patients.