title: Corticosteroid induced psychosis in the pain management setting.
abstract: BACKGROUND
  Synthetic corticosteroids are commonly utilized in interventional pain management procedures. These substances have potential side-effects including psychological adverse events.
  
  
  OBJECTIVE
  We describe a case of substance-induced psychotic disorder resulting from corticosteroids administration.
  
  
  METHODS
  Case Report.
  
  
  METHODS
  We describe a 67-year-old male that, six months prior to being consulted at our center, received a cervical epidural, 4 level medial branch blocks, 4 trigger point injections and a tendon injection in the shoulder all including corticosteroids all in one treatment session.
  
  
  RESULTS
  Approximately 7 days following the multiple injections, the patient developed psychotic episodes including racing thoughts, anger, agitation, pressured hyperverbal speech and paranoia. The symptoms spontaneously resolved in approximately 7-10 days.
  
  
  CONCLUSIONS
  Although well known as a potential complication, corticosteroid induced psychosis secondary to interventional pain procedures have never been reported. We further discuss this potential side effect of utilizing corticosteroids and emphasize the need for guidelines regarding steroid utilization.
authors.affiliation: Millennium Pain Center, Bloomington, IL 61701, USA. benyamin@millenniumpaincenter.com
authors.forename: Ramsin M
authors.initials: RM
authors.lastname: Benyamin
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vallejo
authors.forename: Jeffery
authors.initials: J
authors.lastname: Kramer
authors.forename: Roueen
authors.initials: R
authors.lastname: Rafeyan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000374:Aggression / Q000187:drug effects / Q000502:physiology; D000786:Anger / Q000187:drug effects / Q000502:physiology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000187:drug effects; D017579:Domestic Violence; D004334:Drug Administration Schedule; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects / Q000592:standards; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009209:Myofascial Pain Syndromes / Q000188:drug therapy; D019547:Neck Pain / Q000188:drug therapy*; D009407:Nerve Block / Q000009:adverse effects / Q000592:standards; D010260:Paranoid Personality Disorder / Q000139:chemically induced / Q000503:physiopathology; D011605:Psychoses, Substance-Induced / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D014221:Triamcinolone / Q000008:administration & dosage
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D008775:Methylprednisolone