glucocorticoid and psychosis

Q: Which of the glucocorticoids is least likely to induce psychosis? - select one

A) Methylprednisolone

B) Dexamethasone

C) Betamethasone

D) Hydrocortisone

Answer: B

Corticosteroids are well known to cause insomnia, irritability, impaired concentration, mood changes, and, in severe cases, florid steroid psychosis. Stopping the drug is the best option, but if glucocorticoids are absolutely needed, there is some weak evidence that dexamethasone is least likely to induce psychosis. However, it is not a foolproof statement! 

Adjuvant use of antipsychotic agents may help. Lithium is particularly effective in steroid psychosis. 

#psychiatry

#pharmacology

References:

1. Huynh G, Reinert JP. Pharmacological Management of Steroid-Induced Psychosis: A Review of Patient Cases. J Pharm Technol. 2021 Apr;37(2):120-126. doi: 10.1177/8755122520978534. Epub 2020 Dec 2. PMID: 34752563; PMCID: PMC7953074.

2.  Janes M, Kuster S, Goldson TM, Forjuoh SN. Steroid-induced psychosis. Proc (Bayl Univ Med Cent). 2019 Jul 22;32(4):614-615. doi: 10.1080/08998280.2019.1629223. PMID: 31656440; PMCID: PMC6793974.

3. Julio A Chalela, Michael J Aminoff, Janet L Wilterdink - Acute toxic-metabolic encephalopathy in adults - last updated: May 22, 2024. Link: https://www.uptodate.com/contents/acute-toxic-metabolic-encephalopathy-in-adults (last accessed : November 3, 2025) 

4. Falk WE, Mahnke MW, Poskanzer DC. Lithium prophylaxis of corticotropin-induced psychosis. JAMA. 1979 Mar 9;241(10):1011-2. PMID: 216818.