Steroid-Induced Psychosis
DISCLAIMER
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Introduction:
Steroid-induced psychosis is a less commonly discussed, yet still important, subject in the field of psychiatry. With the high utilization of corticosteroids in various medical treatments, PMHNPs need to be well-versed in identifying and managing this condition.
The Mechanism:
Corticosteroids, such as prednisone or dexamethasone, are primarily used for their anti-inflammatory and immunosuppressive properties. They act on glucocorticoid receptors in the brain, impacting neurotransmitter levels, and can inadvertently lead to neuropsychiatric effects.
Presentation:
Patients with steroid-induced psychosis may exhibit symptoms similar to those of schizophrenia or bipolar disorder, such as hallucinations, delusions, and disorganized thinking. They might also display mood disturbances like depression or mania. Unlike most other forms of psychosis, steroid-induced psychosis can develop rapidly, sometimes within days or weeks of starting steroid therapy. It can also be quite intense, with reports of patients becoming violently paranoid.
Risk Factors:
High doses of corticosteroids
Pre-existing psychiatric conditions
Prolonged duration of steroid use
Diagnosis:
Diagnosis can be challenging because the symptoms mimic other psychiatric disorders. The key is to obtain a thorough medical history, focusing on recent steroid use, and ruling out other potential causes through laboratory tests and imaging studies.
Management:
Immediate Attention: The first line of treatment typically involves discontinuing the steroid medication, if medically feasible.
Medication Adjustment: Lowering the steroid dosage can sometimes ameliorate symptoms, to be done in coordination with primary care provider.
Pharmacotherapy: Antipsychotic medications may be used for symptom relief. The choice of antipsychotic should be made cautiously, considering any underlying conditions the patient might have.
Consultation: In severe or unresponsive cases, consultation with a neurologist or psychiatrist may be warranted.
Prognosis:
The good news is that steroid-induced psychosis is treatable. Most patients see a full recovery of psychiatric symptoms once the offending steroid is discontinued or reduced, although this might take time.
Conclusion and Implications for PMHNPs
Steroid-induced psychosis is a serious medical condition that may result in severe psychiatric symptoms & due to risks of self harm or other dangerous behaviors, it may warrant inpatient intervention. Psychiatric Nurse Practitioners must be mindful of and screen for recent corticosteroid use when treating patients with when patients are initiated on corticosteroid treatment, monitoring for early signs of neuropsychiatric complications.