Acute Psychosis Following Corticosteroid Administration

Area of Science:

• Endocrinology
• Neuropsychiatry
• Pharmacology

Background:

• Glucocorticoids are widely used for endocrine and non-endocrine conditions.
• These medications can cause significant adverse effects across multiple organ systems.
• Corticosteroids are frequently used in managing severe COVID-19 infections.

Observation:

• A 55-year-old woman with diabetes and hypertension developed acute psychosis after a seven-day course of intravenous dexamethasone for COVID-19 pneumonia.
• The patient had no prior psychiatric history and was asymptomatic during her initial hospitalization.
• Psychiatric symptoms emerged three days post-discharge, following dexamethasone treatment.

Findings:

• Glucocorticoid administration is linked to a spectrum of neuropsychiatric effects, including psychosis, delirium, depression, and mania.
• Acute psychosis is a potential adverse effect of dexamethasone therapy.
• The case highlights a direct correlation between corticosteroid use and the onset of severe psychiatric symptoms.

Implications:

• Clinicians must maintain high awareness of potential acute neuropsychiatric side effects associated with corticosteroid use.
• Prompt evaluation for delirium and other psychiatric disturbances is crucial in patients receiving glucocorticoids.
• Further research is needed to elucidate the pathophysiology and identify predisposing factors for these side effects.
• Investigating the efficacy of atypical antipsychotics for managing steroid-induced neuropsychiatric events is warranted.