Thursday April 23, 2009


Q: Treatment of steroid psychosis is?

A) Mellaril (Thioridazine)
B) Thorazine (Chlorpromazine)
C) Haloperidol
D) All of the above


Answer is E

Steroid psychosis is very common in ICUs and unfortunately often go undiagnosed. It occurs in about 5% of patients receiving steroids for other medical reasons. Physician usually has a window of 1-3 days to abort the full-blown picture of steroid psychosis. Discontinuation of steroids, supportive treatment and psychotropic medications are needed.

Treatment include Mellaril 50 to 200mg q.d.; Thorazine 50 to 200mg p.o., q.d. or Haloperidol 2 to 10mg p.o., q.d.

Symptoms of steroid psychosis sits on a wide range of spectrum including profound distractibility, pressured speech, anxiety, emotional lability, severe insomnia, sensory flooding, depression, perplexity, hallucinations, agitation, intermittent memory impairment, mutism, delusions, disturbances of body image, apathy and hypomania.



Reference:

1. Corticosteroid-Induced Psychotic and Mood Disorders - Psychosomatics 42:461-466, December 2001

2. Psychiatric Adverse Drug Reactions: Steroid Psychosis - lecture of Richard C.W. Hall, M.D.