Journal of Clinical Case Reports

Sustained Corticosteroid-Induced Mania and Psychosis Despite Cessation: A Case Study and Brief Literature Review

Abstract

Mary Gable and Dwayne Depry DO

Objective: Corticosteroids generally result in short-lasting neuropsychiatric symptoms following cessation, but
the following case highlights an unusually long-lasting course of symptoms in a patient following near immediate
cessation of medication, despite medication management and electroconvulsive therapy. The case presentation
will be followed by a discussion of the presentation, treatment, mechanism, and management of steroid induced
neuropsychiatric symptoms.
Methods: The patient was followed from symptom onset to resolution.
Results: The patient’s symptom course was unusually long and required a long course of multi-modal therapy.
Conclusions: Corticosteroids are commonly used medications both in a wide variety of medical settings,
and despite this, their neuropsychiatric effects are poorly understood. The affective and behavioral symptoms, in
particular mania and psychosis, can be unpredictable and challenging to treat as in our patient, who developed a
long lasting psychotic episode on high dose steroids, despite having tolerated them multiple times in the past and
whose very marked symptoms persisted, despite discontinuation and treatment for almost 6 months.