Articles:Steroid-induced psychosis

Psychosis following administration of exogenous steroidal medication is a well-known but uncommon phenomenon. It is a dose-dependent disorder more often occurring after systemic steroid treatment, although there are reports of psychotic episodes following local steroid injections. In most instances the psychosis resolves without treatment, and is often of low severity and a short duration. The diagnosis of steroid-induced psychosis hinges on exclusion, with a number of criteria needing to be met:

• Psychosis (hallucination or delusion) must follow steroid administration
• The episode is not better explained by a preexisting psychotic disorder
• The episode does not occur concurrently with patient delirium
• The episode must cause significant clinical distress or impairment

It is therefore crucial to investigate and exclude potential differentials such as non-steroidal (potentially) psychosis-inducing medication, illicit drug use, intoxication by other licit means, electrolyte imbalance, any contributory infections, recent hypo- or hyper-glycaemia, intracranial pathology, or known psychiatric illness.