A Case of Steroid Induced Mania
Abstract
Maryam M Alnasser, Yasser M Alanzi and Amena H Alhemyari
Background: Steroids have been widely used and prescribed for a variety of systemic diseases. Although they prove to be highly effective, they have many physical and psychiatric adverse effects. The systemic side effects of these medications are well known and well studied, in contrast to the psychiatric adverse effects which its phenomenology needs to be the focus of more clinical studies. However, the incidence of diagnosable psychiatric disorders due to steroid therapy is reported to be 3-6%. Affective reactions such as depression, mania, and hypomania are the most common adverse effects, along with psychosis, anxiety and delirium.
Aim: We describe a case of corticosteroid induced mania, its unusual clinical picture, its course and management.
Case description: A 14-year-old female intermediate school student, with a recent diagnosis of Chron’s disease was brought to A&E department due to acute behavioral disturbance in form of confusion, visual hallucinations, psychomotor agitation, irritability, hyperactivity, talkativeness, lack of sleep, and physical aggression. Those symptoms have started few days following corticosteroid therapy which was Prednisolone 40mg PO OD. And she was diagnosed with steroid induced mania.
Discussion: This case illustrates the need for more understanding of the phenomenology and diversity of corticosteroids induced psychiatric syndromes.
Conclusion: The incidence of Steroid induced psychiatric symptoms ranging from 8-15% of adult patients, but there is no report of incidence in children and adolescence. Although the mechanism by which corticosteroids affect behavior is likely multi factorial, there is a well-documented relationship between the dosage of prednisone and the risk of developing acute psychosis. Pediatricians should be aware of this rare complication when administering corticosteroids for various medical illnesses.