[Homicide and acute cortico-induced psychosis: A case report].
BACKGROUND
Since their commercialization in 1950, the first psychiatric side effects of steroids have been reported. Today, steroids have become an important therapeutic tool in many diseases, but pharmacological mechanisms responsible for their side effects are still little known. The neuropsychiatric side effects concern 15% of patients while severe reactions occur in 5% of cases, mostly as acute psychotic episodes such as delusion. Serious forensic risks in this context are poorly documented and underestimated.


METHODS
We report the case of a 77 year-old man, treated by methylprednisolone for chronic lymphoid leukemia. After two months of treatment, although stabilized for the neoplastic disease, he stabbed his wife to death with a knife. In the emergency unit, an acute delirious state, a disorganization syndrome, and confusion items such as amnesia, disorientation and symptomatology fluctuation were observed. Mr. M also presented with hyponatremia and infectious pneumonia. Steroids were stopped and his condition rapidly declined, he died one month later during the hospitalization.


CONCLUSIONS
This clinical case underlines the importance of the early detection of steroid psychosis and its management. Treatment should not be stopped brutally and a dose reducing strategy should be applied in combination with a mood stabilizer or antipsychotic treatment. Disease management strategies are insufficiently documented to be recommended. The extremely acute onset of the symptoms, a partial insight into delusions, a history of iatrogenic neuropsychiatry, the existence of somatic precipitating disorders and confusion factors should always alert the practitioner. The patient, and eventually his family circle, must be aware of the risks of adverse psychiatric effects of steroids for both ethical and forensic reasons, and must report them as early as possible to the clinician if they occur.
Département de psychiatrie et de psychologie médicale, CHU d'Angers, 49933 Angers cedex 09, France. guillaumeairagnes@yahoo.fr
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Airagnes
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Rouge-Maillart
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Garre
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Gohier
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D017809:Fatal Outcome; D006708:Homicide / Q000523:psychology*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000523:psychology; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D011605:Psychoses, Substance-Induced / Q000175:diagnosis* / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000401:mortality
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone