Psychotic Symptoms Caused by Corticosteroid Treatment

Introduction Prednisolone, a corticosteroid, has well-documented neuropsychiatric side effects, including steroid-induced psychosis. Excessive doses of prednisolone disrupt dopaminergic, glutamatergic, serotonergic and GABAergic mechanisms. Glucocorticoids stimulate the release of dopamine in the mesolimbic system, which causes delusions, hallucinations, and disorientation [1]. In this case, a 37-year-old man who had undergone a kidney transplant in 2002 was prescribed long-term immunosuppressive treatment with 5 mg of Prednisolone. The medical history indicates that a high dose regimen was prescribed due to transplant-related complications, possibly leading to the clinical symptomatology of acute psychosis [2]. Case Presentation At the beginning of the year, acute psychosis with delusional interpretations and inappropriate behaviour (F23.10) was diagnosed. The patient has been taking the prescribed dose of 5 mg Prednisolone consistently for the past 20 years, however at the end of 2022, the dose was increased due to transplant-related complications. The patient reported feeling particularly stressed during this time, he didn’t believe that this change was needed, therefore he began taking the medicine inconsistently. However, after altering the high dose regimen, the patient felt unwell and took a double dose for ,,additional protection”. Psychotic symptoms appeared withing a week after this drastic change in the dosage. Discussion Approximately 20% of patients taking more than 40 mg of Prednisolone daily or high doses of corticosteroids may develop psychiatric disorders such as manic episodes, psychosis or major depressive episodes which even require pharmacological treatment [4]. Gradual dose reduction and the addition of treatment with antipsychotic medication has resulted in the absence of psychiatric symptomatology [5]. In this case, the patient has been taking the higher prescribed dose irregularly because he didn’t believe that it was necessary. As a result, sudden change and doubled dose caused psychosis. Conclusions Given the potential adverse effects of corticosteroids, clinicians should prescribe them judiciously, remain vigilant for emerging psychiatric symptoms, and adjust treatment accordingly. This case underscores the necessity of closely monitoring corticosteroid dosage and its neuropsychiatric effects.