High on steroids: manische episode na gebruik van corticosteroïden

Abstract

High on steroids: manic episode after using corticosteroids This article describes a case of a severe manic episode with a patient using corticosteroids which were one of the precipitating factors. Since the first use of corticosteroids in medicine, psychiatric side effects as well as a myriad of somatic side effects have been known to occur. The neuropsychiatric side effects are situated within both the affective as well as the psychotic spectrum. While mostly mild and transient, these side effects can be severe, as glucocorticoids increase the risk of suicide to a significant degree. The risk of developing side effects is dose-dependent and a psychiatric history can be considered a risk factor. The HPA-axis and a potential inbalance between different glucocortoid receptors play a role in causing these side effects. While convincing evidence exists for the increased risk of psychiatric symptoms caused by systemic use of corticosteroids, far less scientific literature exists regarding the specific treatment. In addition, the case in this article demonstrates how psychiatric symptoms can severely interfere with the course and treatment of a pneumonia. Such cases remain a challenge in a hospital setting where departments (psychiatry or general medicine) are never completely tailored to the needs of these patients who thereby tend to fall between two stools.