Steroid-induced pschosis

A search of this forum for the word "psychosis" yields only four posts, and all are incidental to other topics. Steroid-induced psychosis is a topic that deserves its own subject line.

Steroid-induced psychosis is a real potential side effect that can occur when taking glucocorticoids, especially at higher doses, as with dexamethasone pulses. One scenario is when steroid euphoria evolves into manic psychosis, The patient just thinks they are feeling really good, when in fact they are delusional.

If psychosis develops, tapering is still required. Abruptly stopping taking steroids only makes things worse. Full recovery from steroid-induced psychosis can be lengthy.

It is a good idea when taking steroids, especially at higher doses, to have someone in addition to yourself be aware of this (remote) possibility and ready to step in if necessary.

Not a huge risk, but it happens.

Remember, if rare things didn't happen, you wouldn't have ITP in the first place, so take all possible side effects seriously, and don't assume they only happen to someone else!

It's important to also remember that there is a distinction between feeling psychotic and actually being psychotic. I had a lot of weird thoughts and mood swings, but I don't think I qualified for true psychosis. I found that I did have control over it when I put myself in time out and cleared my head.

Apparently, if one gets steroid-induced psychosis after starting a short-course of steroids (like my husband, who was prescribed them for a non-ITP condition), it is not necessary to taper. The doctor had him quit immediately--but then he had only been on a big dose for a few days. He was scary. He did not think he was feeling good; he was miserable. He couldn't function normally at all. He wanted to die and didn't care if everyone else died too--though he wasn't a danger to anyone else or himself. We notified the doctor, who told him to stop all steroids. It started getting better the next day.

I have been thinking more & more lately that all Drs. should have a course of steroids as part of their training!! And if they think that's OK then have their spleen out - after all they don't need it!
mj