Risk factor in steroid induced psychosis

Q: 44 years old female with a known history of Systemic Lupus Erythematosus (SLE) is admitted with psychosis. Subsequent workup led to the diagnosis of glucocorticoid-induced psychosis. Which of the following may exacerbate the glucocorticoid-induced psychosis in this patient? (select one)

A) Hypoalbuminemia

B) Hypercholesterolemia

Answer: A

There are a lot of misconceptions on glucocorticoid-induced psychosis. It has been commonly believed that glucocorticoid-induced psychosis can occur at any dose and even with a short course. In fact, it 'almost exclusively' occurs with prednisone above 20 mg/day for a prolonged period. Second, it has been incorrectly mentioned that it is usually irreversible. In reality, the response to antipsychotic drugs is usually robust.

Patients with SLE who are on chronic steroids and have hypoalbuminemia are particularly prone to it.

#psychiatry

#pharmacology

#rheumatology

References:

1. Da Silva JA, Jacobs JW, Kirwan JR, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis 2006; 65:285. 

2. Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther 1972; 13:694. 

3. Dubovsky AN, Arvikar S, Stern TA, Axelrod L. The neuropsychiatric complications of glucocorticoid use: steroid psychosis revisited. Psychosomatics 2012; 53:103. 

4. Chau SY, Mok CC. Factors predictive of corticosteroid psychosis in patients with systemic lupus erythematosus. Neurology 2003; 61:104.