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Home » Steroid-Induced Psychosis in the ­Pediatric Population

Steroid-Induced Psychosis in the ­Pediatric Population

June 11, 2019
Ahhan Nazeer, MD.
From The Carlat Child Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Ahhan Nazeer, MD. Dr. Nazeer has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Review of: Hodgins GE et al, J Child Adolesc Psychopharmacol 2018;28(5):354–359

Childhood psychosis is a rare disorder, and accurate diagnosis is crucial. Recently, clinicians at the University of Miami Miller School of Medicine reported a case of steroid-induced psychosis in a pediatric patient.

In the case report, a 12-year-old Haitian girl was diagnosed with discoid lupus erythematosus after she presented with fever, fatigue, and anemia. She was started on prednisolone and hydroxychloroquine, and a few days later presented with mutism, drooling, and altered mental status. She was admitted to the PICU, and her symptoms were assumed to be related to her lupus; therefore, she was treated with IV prednisolone. After 8 days of admission, the patient remained disoriented, mute, and paranoid. After a negative organic workup, the psychiatry consultation team recommended tapering the steroid and started her on clonazepam 0.25 mg BID and risperidone 0.5 mg BID (later switched to haloperidol). After 12 days, the patient was much improved—she was more verbal and had no hallucinations. Once the steroid was entirely discontinued, she became completely organized and was discharged on haloperidol 5 mg/day and lorazepam 1 mg twice daily.

The authors did a literature review and found 15 other case reports of steroid-induced psychosis in children and adolescents. Asthma was the most common indication for the initiation of steroids. The higher the dose of steroids (>40–80 mg/day), the more chances of psychiatric manifestations. Discontinuation of steroids is the gold standard and typically completely diminishes the symptoms within a few days to 1 month. For instances where steroid taper is not possible, a trial of benzodiazepines and antipsychotics was helpful.

CCPR’s Take
This case highlights the need to search for specific causes of psychotic symptoms that can usually be resolved, avoiding unnecessary long-term treatments.
Child Psychiatry
KEYWORDS adolescents child_psychiatry children free_articles pediatric psychosis research-update steroids teens
Ahhan Nazeer, MD.

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www.thecarlatreport.com
Issue Date: June 11, 2019
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Table Of Contents
Note From the Editor-in-Chief
Medications for Depression
Practical Approaches to Vetting Clinical Research
FDA Approves Adhansia XR
First Non-Drug Treatment Approved by FDA for Treating Children With ADHD
Prescribing Patterns for Children With Anxiety Disorders
Melatonin for Insomnia in Patients With Autism
Steroid-Induced Psychosis in the ­Pediatric Population
Risk of Psychosis With Stimulants in ADHD Patients
Transcranial Magnetic Stimulation (TMS) for Depression in Children and Adolescents
CME Post-Test - Depression in Children and Adolescents, CCPR, Summer 2019
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