Steroid-induced Obsessive-compulsive Disorder Associated With Oral Budesonide: Case Report and Literature Review

While psychiatric adverse effects to corticosteroids have been widely reported in the literature, only 6 reports of new-onset, steroid-induced obsessive-compulsive disorder (OCD) have been published. This article discusses what, to our knowledge, is the first reported case of oral budesonide-associated steroid-induced OCD. The patient was a 73-year-old female with a psychiatric history of bipolar disorder who developed pedophilic obsessive-compulsive symptoms as part of a constellation of psychiatric symptoms 14 days after starting oral budesonide 9 mg/d for the maintenance treatment of lymphocytic colitis. Following treatment recommendations for general psychiatric adverse effects to steroids, the patient was restarted on her original medications, tapered off budesonide over 14 days, and started on brexpiprazole 2 mg/d. The patient's symptoms fully resolved within 14 days of starting treatment. While this case demonstrates many risk factors for the general psychiatric adverse effects of steroids, there are notable differences between the characteristics shared by the reviewed cases of steroid-induced OCD and this case. This finding suggests that risk factors for steroid-induced OCD may vary from the general risk factors for psychiatric adverse effects and should be further researched. Despite some differences, both this case and previous cases in the literature demonstrated a resolution of OCD symptoms following discontinuation of the corticosteroid, adding evidence to current recommendations of discontinuing the corticosteroid, when possible, to treat steroid-induced psychiatric symptoms. Finally, despite a warning on the drug label concerning compulsive behaviors, augmentation with brexpiprazole was associated with a resolution of symptoms in this case. Brexpiprazole should be further researched for possible uses in both steroid-induced OCD and primary OCD.