Steroid-Induced Mental Disorders in Oncology Patients: A 10-Year Retrospective Case Series Review

Patients with cancer are commonly prescribed corticosteroids for a variety of indications. Corticosteroids have long been known to affect mental state. Neuropsychiatric effects range from insomnia, cognitive impairment, and mood symptoms to psychosis and mania. In this study, we aimed to investigate the demographics, steroid exposure, referring indications, symptom profiles, and subsequent treatments of steroid-induced mental disorders in oncology patients.

We conducted a retrospective chart review of patients diagnosed with a steroid-induced mental disorder, as assessed by the psycho-oncology team in Cork University Hospital from 2626 referrals to the service between January 2010 to December 2019.

In total, 297 patients had a diagnosis of steroid-induced mental disorder (11% of referrals). 60.6% were female and mean age ± standard deviation (SD) was 57.5 ± 12.9 years. Breast cancer was the most frequent malignancy among females. Haematological cancer was the most frequent among males and the second most frequent among females. The most commonly prescribed steroid was dexamethasone, followed by prednisolone. The median (interquartile range [IQR]) cumulative weekly prednisolone equivalent dose was 186 mg (125-350 mg), with a median (IQR) duration of steroid exposure before symptom onset of 14 (6-47) days. The most frequently recorded symptoms following psychiatric assessment included insomnia, anxiety, and irritability. Psychotropics were commenced in n = 174 (74%) patients, with antipsychotics prescribed to 62.1%. A watchful wait approach was adopted for 25.5% of the patients. 90.2% (n = 185/205) of the patients experienced either complete or partial resolution of the symptoms at their first clinical review.

Steroid-induced mental disorders can cause significant comorbidity in patients receiving cancer treatment. The most common symptoms recorded during assessment included insomnia, anxiety, and irritability.