Acute psychosis induced by short-term treatment with methylprednisolone – a case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S626-S626 ◽  
Author(s):  
I.A. Andrei ◽  
A.M. Cristache ◽  
M.E. Parfene-Banu ◽  
A.A. Frunză ◽  
M.C. Boer ◽  
...  
Keyword(s):  
Glucocorticoid Receptors ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Early Recognition ◽  
Corticosteroid Treatment ◽  
Hippocampal Volume ◽  
Term Treatment ◽  
Psychotic Symptoms ◽  
Short Term Treatment ◽  
Disc Protrusion

Steroid treatment has been widely used for immunologic and inflammatory disorders. Psychiatric symptoms are not uncommon complications of the corticosteroid treatment. Correlations between the hypothalamic-pituitary-adrenal (HPA) axis and various psychoses have been already established in the specialty literature (modified HPA activity by drugs or not, glucocorticoid receptors downregulation, reduced hippocampal volume). The prevalence of corticosteroid-induced psychotic disorders varies around 5–6%. Most corticosteroid-induced symptoms start during the first few weeks after treatment initiation, but their onset can also be in the first 3–4 days. We would like to report the case of a 30-year-old woman who was taken to the psychiatry emergency room for psychomotor agitation, auditory and visual hallucinations, and bizarre delusions, disorganized thinking and modified behavior. The patient had no personal or family history of psychiatric illness. One month earlier, she was admitted in a neurosurgery ward and underwent lumbar surgery for L4–L5 disc protrusion; at discharge, eight days later, she began treatment with methylprednisolone 80 mg/day for three days. One week later, psychotic symptoms emerged that resulted in her hospitalization in our ward for apparent steroid-induced psychosis. Treatment with risperidone (up to 6 mg/day) and diazepam (10 mg/day, rapidly discontinued) was initiated. The endocrinology examination revealed modified plasmatic cortisol. The psychosis resolved several weeks later and the patient was discharged. Psychiatric complications induced by steroids underline the role of physicians that have to educate the patients and their families about these side effects and their early recognition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychosis and dementia: risk factor, prodrome, or cause?

2017 ◽  
Vol 30 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Corinne E. Fischer ◽  
Luis Agüera-Ortiz
Keyword(s):  
Psychotic Disorders ◽  
Clinical Course ◽  
Late Onset ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Functional Psychosis ◽  
Dementia Risk ◽  
Treatment Considerations ◽  
The Impact

ABSTRACTBackground:Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course. Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied. Comparatively, there has been little focus on psychotic symptoms in PrD.Methods:The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations.Results:Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear. Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia. Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies. The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia.Conclusions:Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively. Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD.

scholarly journals Steroid induced psychiatric adverse effects: an overview of risk factors, clinical features and management

2020 ◽  
Vol 8 (6) ◽  
pp. 2365
Author(s):  
Anant Parasher ◽  
Jeplin Bez
Keyword(s):  
Adverse Effects ◽  
Steroid Therapy ◽  
Wound Repair ◽  
Glucocorticoid Receptors ◽  
Psychiatric Symptoms ◽  
Immunosuppressive Drugs ◽  
Psychotic Symptoms ◽  
Metabolic Disturbances ◽  
Duration Of Treatment

Corticosteroids have been in use since the past five decades as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Adverse effects include growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. The psychiatric effects of steroids are due to the wide expression of Glucocorticoid Receptors in the brain, and their long-term modulation can lead to functional and anatomical alterations along with hippocampal dysfunction. In most cases, the psychiatric symptoms disappear on cessation of steroid therapy; others may require some form of therapeutic management. A search was conducted for clinically relevant articles from 1971 to 2016 by including the terms corticosteroids, mania, depression, psychosis and cognitive defects. About one-fifth of patients receiving high doses of corticosteroids develop psychiatric symptoms. These symptoms are observed to be dose-dependent and generally occur during the first few weeks of therapy. Lithium has a preventive as well as therapeutic role, while antipsychotics are reserved for high risk cases with predominant psychotic symptoms. Psychiatric effects of long term steroid therapy have become increasingly common nowadays due to long duration of treatment of many chronic respiratory and orthopedic illnesses. Reduction in the dose or complete discontinuation of steroid therapy has been proven beneficial in many patients. Among the therapeutic options, lithium has a definitive role, both in the prevention as well as treatment of psychiatric symptoms. Better co-ordination between the physician and psychiatrist can go a long way to improve the quality of life in these patients. 

Psychiatric symptoms’ treatment to patients addicted to alcohol, cocaine and crack

2011 ◽  
Vol 26 (S2) ◽  
pp. 112-112
Author(s):  
A.M. Silva ◽  
M.L. Pequeno ◽  
M.D. Feltrin ◽  
J.A. Gonçalves ◽  
F.J. Ropero Pelaez ◽  
...  
Keyword(s):  
Illicit Drugs ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Public Mental Health ◽  
Psychotic Symptoms ◽  
Limiting Factor ◽  
Atypical Neuroleptics ◽  
Consciousness Level ◽  
Public Mental Health Service ◽  
Level Reduction

IntroductionExtrapyramidal side-effects (EPS) related to the use of neuroleptics are an limiting factor to patients’ compliance during the treatment with this group of drugs.ObjectiveThe aim of this study was to identify which drugs are mostly prescribed for cocaine, crack and alcohol addicts’ psychotic symptoms.MethodsThis study selected 31 patients with mean age of 33.61 ± 1.90 enrolled with psychotic disorders related to use of illicit drugs in an public mental health service.ResultsPatients under this study were addict to alcohol (61,29%), cocaine or crack, associated (38,71%).The percentage of patients addicted to alcohol treated with typical neuroleptic-(typical-neurol) was 42,11%, with atypical neuroleptic-(atypical-neurol) was 26,32%, with association of typical and atypical neuroleptics-(typical/atypical-neurol) (21,60%), and with benzodiazepines associated with serotonin-reuptake-inhibitors (BZD-SSRI) (10,00)%. The cocaine or crack associated or not with alcohol patients were treated with typical-neurol (41,67%), atypical-neurol (41,67%), typical/atypical-neurolol (8,33%) and BZD-SSRI (8,33%).The EPS related to the use of neuroleptics in patients addicted to alcohol were given biperiden (52,65%), promethazine or anticolvulsant (Prometh/Anticonv) (42,11%) and no-treatment (5,26%). For those patients, addicted to cocaine, crack and alcohol altogether were given biperiden (58,34%), Prometh/Anticonv (25,00%) and no-treatment (16,67%).ConclusionsIn the case of using neuroleptics, the EPS should be reversed with biperiden in an dose combined with the neuroleptic prescribed to each individual, in an effort to minimized hallucination. Also, if sedation was indicated using Prometh/Anticonv to patients that are taking neuroleptics, then the health care professional team in charge must be aware of consciousness level-reduction.

Perceived Stress and Life Events in Patients Affected by Schizophrenia and Schizoaffective and Bipolar Disorder: Is There a Role for Self-Reported Basic Symptoms?

2021 ◽  
pp. 1-8
Author(s):  
Giovanna Parmigiani ◽  
Gabriele Mandarelli ◽  
Lorenzo Tarsitani ◽  
Valentina Roselli ◽  
Ilaria Gaviano ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Life Events ◽  
Perceived Stress ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Study Groups ◽  
Psychotic Symptoms ◽  
Subjective Perception ◽  
University Hospitals ◽  
Basic Symptoms

<b><i>Introduction:</i></b> The stress-diathesis model of psychotic disorders describes, in vulnerable individuals, the role of psychosocial stress in the onset and exacerbation of psychotic symptoms. Another interesting approach to the study of vulnerability in the development of psychosis is represented by the basic symptoms concept. <b><i>Objective:</i></b> The present study aims at proposing an integration between these two models and investigating possible associations between psychotic symptoms, basic symptoms, perceived stress, and life events in a sample of patients affected by schizophrenia (SZ), schizoaffective (SA), and bipolar disorder with and without psychotic symptoms. <b><i>Methods:</i></b> 112 patients were recruited in two university hospitals. Severity of psychiatric symptoms (Positive and Negative Syndrome Scale, PANSS), basic symptoms (Frankfurt Complaint Questionnaire, FCQ), perceived stress (Stress-related Vulnerability Scale, SVS), and life events (Paykel’s interview for recent life events) were assessed. <b><i>Results:</i></b> Patients affected by bipolar disorder (both with and without psychotic symptoms) showed a higher number of independent life events (<i>p</i> &#x3c; 0.01) and tended to report more frequently at least 1 life event in the previous 6 months (<i>p</i> &#x3c; 0.01) than patients affected by SZ or SA disorder. No differences emerged between the study groups in perceived stress nor in measures of basic symptoms. In the whole sample, a logistic regression analysis showed that the SVS total score (<i>p</i> &#x3c; 0.05) and PANSS total score (<i>p</i> &#x3c; 0.001) were associated with the presence of psychotic symptoms. <b><i>Conclusions:</i></b> In the study sample, life events and basic symptoms did not play a major role in influencing psychotic symptoms, compared to the subjective perception of stress and the severity of psychopathology. Taken together, these results can be informative for rehabilitation therapies aimed at enhancing resilience and coping strategies in this vulnerable group of patients.

Schizoaffective and schizotypal disorders/acute and transient psychotic disorders

2020 ◽  
pp. 609-618
Author(s):  
William S. Stone ◽  
Stephen V. Faraone ◽  
Ming T. Tsuang
Keyword(s):  
Personality Disorder ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Schizotypal Personality Disorder ◽  
Differential Diagnoses ◽  
Psychotic Symptoms ◽  
Management Options ◽  
Schizotypal Personality ◽  
Treatment Management ◽  
Dsm 5

This chapter focuses on three disorders that demonstrate similarities to schizophrenia, including schizoaffective disorder, schizotypal personality disorder and acute and transient psychotic disorders (also known as brief psychotic disorders). These conditions typically include positive psychiatric symptoms such as psychotic or attenuated psychotic symptoms in at least some stages of the disorder, though they vary considerably in the extent to which they persist. Similarly, these disorders differ in other dimensions such as their clinical outcomes, relationships to each other, and heterogeneity of their presentations, among others. This chapter reviews the current clinical classifications of these three disorders by emphasizing their (DSM-5) diagnoses, differential diagnoses, clinical features, courses, epidemiology, and treatment/management options.

scholarly journals Nongenomic Glucocorticoid Effects on Activity-Dependent Potentiation of Catecholamine Release in Chromaffin Cells

Endocrinology ◽  
2008 ◽  
Vol 149 (10) ◽  
pp. 4921-4927 ◽  
Author(s):  
Yong-Soo Park ◽  
Yoon Ha Choi ◽  
Choon-Ho Park ◽  
Kyong-Tai Kim
Keyword(s):  
Chromaffin Cells ◽  
Glucocorticoid Receptors ◽  
Inhibitory Effect ◽  
Term Treatment ◽  
Catecholamine Release ◽  
Dependent Manner ◽  
Short Term ◽  
Short Term Treatment ◽  
Kinase Substrate ◽  
Activity Dependent

Adrenal medulla chromaffin cells are neuroendocrine and modified sympathetic ganglion cells. Catecholamines released from chromaffin cells mediate the fight-or-flight response or alert reaction against dangerous conditions. Here we report that short-term treatment with glucocorticoids, released from adrenal cortex cells in response to chronic stress, inhibits activity-dependent potentiation (ADP) of catecholamine release. First, short-term treatment with dexamethasone (DEX), a synthetic glucocorticoid, reduces ADP in a concentration-dependent manner (IC50 324.2 ± 54.5 nm). The inhibitory effect of DEX is not reversed by RU-486 treatment, suggesting that the rapid inhibitory effect of DEX on ADP of catecholamine release is independent of glucocorticoid receptors. Second, DEX treatment reduces the frequency of fusion between vesicles and plasma membrane without affecting calcium influx. DEX disrupts activity-induced vesicle translocation and F-actin disassembly, thereby leading to inhibition of the vesicle fusion frequency. Third, we provide evidence that DEX reduces F-actin disassembly via inhibiting phosphorylation and translocation of myristoylated alanine-rich C kinase substrate and its upstream kinase protein kinase Cε. Altogether, we suggest that glucocorticoids inhibit ADP of catecholamine release by decreasing myristoylated alanine-rich C kinase substrate phosphorylation, which inhibits F-actin disassembly and vesicle translocation.

Psychiatric Aspects of Temporal Arteritis: A Case Report and Review of the Literature

1997 ◽  
Vol 10 (4) ◽  
pp. 142-145 ◽  
Author(s):  
Hazel Johnson ◽  
Walter Bouman ◽  
Gillian Pinner
Keyword(s):  
Temporal Arteritis ◽  
Psychiatric Symptoms ◽  
Corticosteroid Treatment ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Clear Cut ◽  
Full Remission ◽  
Affective Symptoms ◽  
Atypical Manifestations ◽  
Psychotic Features

Temporal arteritis may present with atypical manifestations that can hamper its diagnosis. We report a case presenting with predominantly psychiatric symptoms including psychotic features and affective symptoms both on a background of cognitive impairment. Such clear-cut psychotic symptoms have not been described previously in the literature. Corticosteroid treatment was followed by full remission of psychotic and affective symptoms; treatment with antipsychotic medication was unnecessary. Temporal arteritis should be considered in the differential diagnosis of psychosis and affective disorder in the elderly. The erythrocyte sedimentation rate is a valuable parameter in the assessment of old-age psychiatry patients presenting both with functional and neurologic disorders.

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