Q: Steroids are widely used in ICUs. How early it can cause psychosis?

Answer: 3 to 4 days

Steroid-induced psychosis may emerge within 3 to 4 days (to a median of 11 days) after a patient starts corticosteroid therapy. Unfortunately, even after steroids are discontinued, symptoms may persists up to 4 weeks. Meanwhile, different anti-psychotics may be used including haloperidol, olanzapine, risperidone, quetiapine, lithium, carbamazepine and others. Resistant cases may require electroconvulsive therapy. 

References:

1. Sirois F. Steroid psychosis: a review. Gen Hosp Psychiatry 2003;25:27-33.

2. Patten SB, Neutel CI. Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Drug Saf 2000;22:111-22.

3.  Wada K, Yamada N, Suzuki K, et al. Recurrent cases of corticosteroid-induced mood disorder: a clinical characteristics and treatment. J Clin Psychiatry 2000;61:261-7.

4.  Brown ES, Chamberlain W, Dhanani N, et al. An open-label trial of olanzapine for corticosteroid-induced mood symptoms. J Affect Disord 2004;83:277-81.

5.  Wada K, Yamada N, Yamauchi Y, Kuroda S. Carbamazepine treatment of corticosteroid-induced mood disorder. J Affect Disord 2001;65:315-7.

6.  Siddiqui Z, Ramaswamy S, Petty F. Quetiapine therapy for corticosteroid-induced mania. Can J Psychiatry 2005;50:77-8.

7. DeSilva CC, Nurse MC, Vokey K. Steroid-induced psychosis treated with risperidone. Can J Psychiatry 2002;47:388-9.