Risperidone Treatment in a Steroid-Induced Psychosis Case

Steroidler, gerek akut gerekse de kronik, çok çeşitli tıbbi durumların tedavisinde uzun yıllardır etkin olarak kullanılmaktadırlar. Bu ilaçların kullanımı ile ruhsal bozukluklar arasındaki ilişki, bazı iyi bilinen yan etkilere rağmen, yeterince kurulmamış ve belgelenmemiştir. Yakın zamanda optik nevrit tanısı almış, steroid ile tetiklendiği düşünülen psikotik semptomlara sahip olan 46 yaşındaki bir erkek olguyu tanımlıyoruz. Ruhsal belirtiler steroidin ilk dozu sonrasında ortaya çıkmış ve steroid ile tetiklenen psikoz tanısı konulmuştur. Steroid tedavisi kesildikten sonra ruhsal belirtilerde düzelme olmamış, ancak 4 haftalık risperidon tedavisinden sonra hasta tümüyle iyileşmiştir. Bu olgu, optik nevritli hastalarda steroid ile tetiklenen ruhsal belirtiler görülmesine dair sayıca az, ancak giderek artmakta olan kanıtlara bir ektir. Bu görüngünün yaygınlığının güncel literatürde bildirilenden daha fazla olabileceğini düşünüyoruz.

Steroid ile tetiklenen bir psikoz olgusunda risperidon tedavisi

Steroids have been used effectively for many years to treat a wide variety of both acute and chronic medical conditions. Despite some well-known side effects, the association of psychiatric disorders with the use of these drugs has not been well established and documented. We describe a case of a 46-year-old man with a recent diagnosis of optic neuritis, who has psychotic symptoms which appear to be induced by steroids. Psychiatric symptoms emerged after the first dose of steroid and diagnosis of steroid-induced psychosis was made. After discontinuation of steroid therapy, psychiatric symptoms did not improve. But after four weeks of risperidone treatment, he recovered completely. This case adds to small but progressive body of evidence supporting the incidence of steroid-induced psychiatric symptoms in patients with optic neuritis. We suggest that the prevalence of this phenomenon might be considerably higher than what has been reported in the current literature.

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1. Lee KM, Lin YZ, Huang FY. Steroid-induced acute psychosis in a child with asthma: report of one case. Acta Paediatr Taiwan 2001; 42 :169-171.
2. Lewis DA, Smith RE. Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature. J Affect Disord 1983; 5:319-332.
3. Patten SB, Neutel I. Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis, and management. Drug Saf 2000; 22:111-122.
4. The Boston Collaborative Drug Surveillance Program. Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther 1972; 13:694-698.
5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fourth ed. Washington DC: American Psychiatric Association, 1994.
6. DeKloet E, Beldhuis H. Adrenocortical hormone action. Handbook Neurochem 1985; 8:47-91.
7. Beshay H, Pumariega AJ. Sertraline treatment of mood disorder associated with prednisone: a case report. J Child Adolesc Psychopharmacol 1998; 8:187-193.
8. Carpenter WT Jr. Serotonin-dopamine antagonists and treatment of negative symptoms. J Clin Psychopharmacol 1995; 15 (Suppl.1):30-35.
9. Bloch M, Gur E, Shalev A. Chlorpromazine prophylaxis of steroid induced psychosis. Gen Hosp Psychiatry 1994; 16:42-44.
10. Wada K, Yamada N, Sato T, Suzuki H, Miki M, Lee Y, Akiyama K, Kuroda S. Corticosteroid-induced psychotic and mood disorders: diagnosis defined by DSM-IV and clinical pictures. Psychosomatics 2001; 42:461-466.
11. Robinson DE, Harrison-Hansley E, Spencer RF. Steroid psychosis after an intra-articular injection [letter]. Ann Rheum Dis 2000; 59:927.
12. Hall RC, Popkin MK, Kirkpatric B. Tricyclic exacerbation of steroid psychosis. J Nerv Ment Dis 1978; 166:738-742.
13. Goggans FC, Weisberg LJ, Koran LM. Lithium prophylaxis of prednisone psychosis: a case report. J Clin Psychiatry 1983; 44:111-112.
14. Abbas A, Styra R. Valproate prophylaxis against steroid induced psychosis [letter]. Can J Psychiatry 1994; 39:188-189.
15. Brown ES, Chandler PA. Mood and cognitive changes during systemic corticosteroid therapy. Prim Care Companion J Clin Psychiatry 2001; 3:17-21.
16. DeSilva CC, Nurse MC, Vokey K. Steroid-induced psychosis treated with risperidone [letter]. Can J Psychiatry 2002; 61:562- 563.
17. Kramer TM, Cottingham EM. Risperidone in the treatment of steroid induced psychosis. J Child Adolesc Psychopharmacol 1999; 9:315-316.
18. Coşkun A, Savaş HA, Tamar DT, Arkonaç O. Steroid kullanımına ikincil gelişmiş bir psikoz olgusu. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 1995; 8:4-6.
19. Hakerler İ, Çımrın AH. Göğüs kliniğinde gözlenen ardışık iki steroid psikoz olgusu. Solunum Hastalıkları 2002; 13:311-313.
20. Genç G, Bek S, Hamamcıoğlu K, Yetkin S, Önal MR, Demirkaya Ş, Odabaşı Z. Optik nörit şeklinde ortaya çıkan klinik izole sendromlu bir hastada steroid tedavisi sonrası psikotik atak. J Neurol Sci Turk 2008; 25:148-153.
21. Hergüner S, Bilge I, Yılmaz-Yavuz A, Tüzün DÜ. Steroidinduced psychosis in an adolescent: treatment and prophylaxis with risperidone. Turk J Pediatr 2006; 48:244-247.
22. Hall RCW. Psychiatric adverse drug reactions: steroid psychosis. Clin Advances Treatm Psychiatr Disord 1991; April/May:8-10.