Recurrent cases of corticosteroid-induced mood disorder: clinical characteristics and treatment.
BACKGROUND
Corticosteroids often induce steroid psychosis, a collection of heterogeneous syndromes with different pathophysiologic mechanisms. To date, no study has focused specifically on recurrent corticosteroid-induced mood disorders and considered their long-term outcome and treatment strategies.


METHODS
Nine patients whose initial clinical presentation met DSM-IV criteria for a substance-induced mood disorder were identified by a review of medical records. Their clinical characteristics and treatments were examined.


RESULTS
All 9 corticosteroid-treated patients had a clinical course of bipolar disorder. Seven patients initially developed a manic or hypomanic state with subacute onset ranging from 1 to 3 months. Six patients had manic episodes accompanied by psychotic features. The proportion of manic episodes relative to total mood episodes of the 9 patients was 65.6%, suggesting manic predominance. Seven patients showed mood episodes that had no direct relationship to corticosteroid therapy and were preceded by various psychosocial stressors. Four of 5 patients who received steroid pulse therapy rapidly became manic or hypomanic. Antidepressants as well as mood stabilizers were useful for treatment of the present 9 patients.


CONCLUSIONS
Recurrent cases of corticosteroid-induced mood disorder have interesting clinical features, such as subacute onset, manic predominance, frequent accompanying psychotic features, and similar recurrent episodes in association with psychosocial stressors and corticosteroid use. Management, including psychopharmacologic intervention, should be indicated by a consideration of the underlying illnesses and psychosocial stressors.
Wada
K
K
Department of Neuropsychiatry, Okayama University Medical School, Japan.
Yamada
N
N
Suzuki
H
H
Lee
Y
Y
Kuroda
S
S
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D003866:Depressive Disorder / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D019964:Mood Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011570:Psychiatry; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012017:Referral and Consultation
D000305:Adrenal Cortex Hormones; D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008094:Lithium; D008775:Methylprednisolone