Steroid drugs can cause a significant amount of side effects, as they mimic the action of hormones in the body and therefore have a systemic effect. One side effect of steroids is steroid-induced psychosis.
What is Psychosis?
Psychosis is a distortion of the perception of reality. It manifests itself as a disturbance of behavior and cognitive disorders (forgetfulness, distractibility, and thinking problems). This disorder can be a symptom of mental illness, for example, schizophrenia, or an individual psychotic disorder. This factor affects the nature of the course of the disease, options for treatment and outlook. Before you start treatment, you need to determine the particular health disorder. There are various types of psychosis, such as for example:
- Bipolar disorder (manic depression): This is an alternation of periods of depression and elevated mood (mania or hypomania).
- Reactive psychosis: This condition occurs after severe psycho-emotional stress. Vegetative factors and certain types of stressed behavior provoke the disorder.
- Alcoholic hallucinosis (alcohol-induced psychotic disorder): It is manifested by delusions, deterioration of sleep, and predominantly auditory hallucinations. This condition differs from Delirium Tremens.
Steroid psychosis, a symptom Cushing’s syndrome, independently appears. The phenomenon is caused by the pathologically high level of hormones in the body caused by steroids during the treatment of a physical illness.
Causes of Steroid-Induced Psychosis
Cushing’s syndrome psychosis is also called pituitary-suprarenal disease psychosis. This is one of the manifestations of symptoms characteristic of this disease resulting from the hyperfunction of basophilic cells of the anterior lobe of the pituitary gland. The functions of the adrenal, pancreas and sex glands are also disturbed. The most frequent variant of Cushing’s syndrome faced by healthcare professionals is the exogenous form amid glucocorticoid therapy. Therefore, the main cause of this disorder is the ingestion of corticosteroids, especially in high dosages. Psychosis can also occur because of anabolic steroids, but in this case, it has a different nature. They associate steroid psychosis with increased aggression and the development of psychological dependence on drugs.
Symptoms and Cases of Steroid-Induced Psychosis
Steroid psychosis symptoms usually include melancholic syndrome, and less often a manic one which develops against the background of inherent lassitude, asthenia, and somnolence. The psychosis can last for various periods – from several weeks to several months, ending usually with recovery. It has recurrences and complications with the early development of atherosclerosis of the cerebral vessels, which entails the appearance of inherently irreversible symptoms in the form of persistent dementia and, sometimes, death from hemorrhage in the brain.
In a study by Sandeep Grover, Swapnajeet Sahoo et al. (Chandigarh, India, 2014), they described the following corticosteroid mania case. A male person in his early 80s, Mr. X, had no mental disorders in the past although his brother had a psychotic illness. He suffered from high blood pressure for twenty years and was taking five milligrams of amlodipine a day. Suddenly he noticed redness on his face and felt itching all over his body. He decided that the symptoms were caused by exposing his body to sun 2-3 hours daily in late winter. For three days, he had been undergoing treatment with antihistamines in the tablet form: twenty-five milligrams of chlorpheniramine maleate a day, but the symptoms didn’t disappear. Following a pharmacist’s advice, the man took dexamethasone for 4-5 days, which helped him obtain significant relief. However, after 5 days, he started to speak too much, became overactive, cheerful, started to talk to strangers, felt increased appetite and had reduced sleep. Despite sleeping for only about two-three hours, he remained energetic and fresh. Later, he also developed symptoms of over planning, overspending, and grandiosity.
Diagnosis of Steroid-Induced Psychosis
Physical (not only psychical) symptoms are very important for the diagnosis. These include severe hyperemia of the face, especially cheeks. Facial, abdominal, and chest obesities are observed. In these areas, there are strips of red-purple scarring, which are called striae distensae. Sex glands are hypoplastic, menstruation stops, beard and mustache grow in women. The arterial blood pressure rises sharply, reaching 200 mm Hg. Characteristic features are also metabolic disorders, manifested by hyperglycemia, glycosuria, and cholesterolemia.
Treatment of Steroid-Induced Psychosis
The goal of treatment of steroid-induced psychosis is the normalization of the level of adrenal cortex hormones in the blood. According to medical studies, tapering of corticosteroid dose and administration of psychiatric meds for symptom relief were 2 key options. Doctors can prescribe long-term taking of the drugs that reduce the production of hormones in the adrenal cortex. These may be, for example, ketoconazole and aminoglutethimide (Elipten, Cytadren, Orimeten).
Symptomatic treatment of Cushing’s syndrome is carried out with diuretics, sugar-reducing, and antihypertensive drugs. Patients suffering from psychosis take sedatives and tranquilizers. They have to be under psychiatric observation.
Recovery after Steroid-Induced Psychosis
Scientist Lewis (cit. ex: François Sirois 2003) found that reducing the corticosteroid dosage (tapering) only resulted in steroid psychosis recovery in 92 percent of 36 patients, neuroleptics only provided recovery in 84 percent of cases, and all patients treated with both options recovered. Psychiatric meds used for symptom reduction included neuroleptics & tricyclic antidepressants (TCAs). Neuroleptics dosage had to be ascertained case by case. TCAs used in persons with depressive reactions aggravated the disorder that was reversed with phenothiazine drugs. According to Wada K, Yamada N, Sato T (Okayama University Medical School, 2001), the treatment should be psychopharmacological, that is, include psychotherapy and drug therapy.
On Kato and Hitoshi Misawa (International Medical Center of Japan, 2005) reported a case of treating the condition with valproic acid and risperidone (Risperdal, Prospera, Perilife trade names, among others) in a female with systemic lupus erythematosus (SLE).