What is the duration of steroid psychosis?

Duration of Steroid Psychosis

Steroid psychosis typically resolves within 7-10 days after discontinuation of steroids, though symptoms can last up to 3 weeks in some cases. 1, 2

Clinical Presentation and Incidence

Steroid-induced psychosis is a serious adverse effect of corticosteroid therapy characterized by:

• Delusions
• Hallucinations
• Emotional lability
• Pressured speech
• Racing thoughts
• Anger and agitation
• Paranoia
• Insomnia

The incidence of severe psychiatric symptoms is approximately 5.7% in patients receiving high-dose steroids (equivalent to >80 mg/day of prednisone or 12 mg/day dexamethasone), while any psychiatric symptoms occur in about 18.6% of these patients 3.

Timeline and Course

The development and resolution of steroid psychosis follows a predictable pattern:

1. Onset: Psychiatric disturbances usually occur early in the course of steroid therapy 4

   • Can develop rapidly even with low doses
   • Can occur with various administration routes (oral, epidural, intra-articular)

2. Duration:

   • Symptoms typically resolve within 7-10 days after steroid discontinuation 1
   • In some cases, resolution may take up to 3 weeks 2
   • Most patients recover within several weeks of symptom onset 4

3. Risk factors:

   • Female sex
   • Systemic lupus erythematosus
   • High corticosteroid doses
   • History of psychiatric disorders 4, 5

Management Approach

1. Recognition and Discontinuation:

   • Early recognition is critical
   • Discontinue steroids when clinically appropriate 3

2. Pharmacological Management:

   • Atypical antipsychotics are first-line treatment:
     • Risperidone has been successfully used in adolescents 6
     • Olanzapine and risperidone cause fewer extrapyramidal symptoms than typical antipsychotics 3
   • Typical antipsychotics like haloperidol can be effective but have more side effects
   • Tricyclic antidepressants appear less effective 4

3. Environmental Management:

   • Reduce environmental stimulation
   • Provide supportive care during the acute phase

Prevention and Monitoring

For patients requiring ongoing steroid therapy:

• Use minimum effective doses for interventional procedures 5
• Consider prophylactic antipsychotic medication in high-risk patients
• Provide patient and family education about potential psychiatric side effects 5
• Consider close follow-up and multidisciplinary coordination for high-risk patients

Special Considerations

• Corticosteroid-induced adrenal suppression is duration-dependent, and patients receiving longer courses (>14 days) may benefit from tapering rather than abrupt discontinuation 2
• Inflammation may recur after discontinuing corticosteroid therapy, especially when stopped abruptly, requiring careful monitoring 2
• In patients who deteriorate after stopping corticosteroids, reinitiating therapy may be beneficial 2

Conclusion

While steroid psychosis is a concerning side effect of corticosteroid therapy, it is typically self-limited, resolving within 7-10 days after steroid discontinuation. Management includes early recognition, steroid withdrawal when appropriate, and treatment with atypical antipsychotics if symptoms are severe.