Can a 14-year-old develop acute psychosis from oral corticosteroids (oral steroids)?

Acute Psychosis from Oral Steroids in Adolescents

Yes, a 14-year-old can develop acute psychosis from oral steroids, even at relatively low doses. 1

Risk of Steroid-Induced Psychosis in Adolescents

• Psychiatric derangements are well-documented adverse effects of oral corticosteroids, ranging from euphoria and mood swings to severe depression and frank psychotic manifestations 1
• The FDA drug label specifically warns that corticosteroids can aggravate existing emotional instability or psychotic tendencies 1
• While the risk of psychiatric side effects increases with higher doses (typically >40mg/day), psychosis can occur even with lower doses 2
• Adolescents may be particularly vulnerable to neuropsychiatric effects of steroids due to ongoing brain development 3

Clinical Presentation of Steroid-Induced Psychosis

• Symptoms can develop rapidly, sometimes within hours to days of starting steroid therapy 4
• Clinical manifestations may include:
  • Hallucinations (visual or auditory) 5
  • Delusions or paranoia 5
  • Disorganized thinking 6
  • Agitation or abnormal behaviors 4
  • Decreased or disorganized speech 4
  • Sleep disturbances 4

Risk Factors for Developing Steroid-Induced Psychosis

• Higher doses of steroids increase risk, but psychosis can occur at any dose 2
• Pre-existing psychiatric conditions or family history of mental illness 1
• Previous episodes of steroid-induced psychiatric symptoms 5
• Concurrent use of other medications that affect the central nervous system 1

Management of Steroid-Induced Psychosis

• Immediate reduction or discontinuation of the steroid when clinically possible 6
• Psychiatric consultation for assessment and management 6
• Antipsychotic medications (such as haloperidol) may be needed for acute management 6
• Close monitoring in a safe environment until symptoms resolve 6
• If steroids must be continued for medical necessity:
  • Use the lowest effective dose 3
  • Consider dose reduction with addition of steroid-sparing agents 3
  • Add mood stabilizers or antipsychotics prophylactically 5

Prevention Strategies

• Use the lowest effective dose of corticosteroids for the shortest duration possible 1
• Consider alternative treatments when appropriate 3
• Educate patients and families about potential psychiatric side effects and the importance of reporting any behavioral changes promptly 1
• More frequent monitoring for adolescents on steroid therapy 3

Special Considerations for Adolescents

• Corticosteroids can affect growth and development in pediatric patients, requiring careful monitoring 3
• Psychological impact may be more pronounced in adolescents due to developmental factors 3
• Family education and support are crucial components of management 1

Steroid-induced psychosis is a serious but typically reversible condition that requires prompt recognition and management. Clinicians should maintain a high index of suspicion when adolescents on oral steroids exhibit any behavioral changes.