Journal of the Korean Academy of Child and Adolescent Psychiatry

Korean Academy of Child and Adolescent Psychiatry (대한소아청소년정신의학회)
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Steroid-induced Psychosis in Adolescent Patient with Crohn's Disease

  • Kim, Jin Woo (Medical Course, Jeju National University School of Medicine) ;
  • Kang, Ki Soo (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Kang, Na Ri (Department of Psychiatry, Jeju National University School of Medicine)
  • Received : 2020.05.22
  • Accepted : 2020.06.08
  • Published : 2020.07.01
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Abstract

Crohn's disease is a chronic inflammatory disease that involves the upper and lower gastrointestinal tracts, including the oral cavity. For the conventional treatment of inflammatory bowel diseases, steroids are usually used as induction therapy, and azathioprine is used as maintenance therapy. Steroids are associated with various side effects. Under rare circumstances, they can even cause psychotic symptoms, and reports on steroid-induced psychosis in the pediatric population are few. Here, we report the first case of steroid-induced psychosis in a 16-year-old female with Crohn's disease administered with steroids as induction therapy in South Korea. She showed psychotic symptoms, including auditory hallucination, loosening of association, and idea of reference, after 2 weeks of administering prednisolone 60 mg/day. One week after steroid discontinuation, the patient gradually recovered and was treated with quetiapine. Therefore, pediatricians should be aware of serious psychiatric adverse effects when administering corticosteroids for various indications.

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References

  1. Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr 2015;169:1053-1060. https://doi.org/10.1001/jamapediatrics.2015.1982
  2. Kitamura M. [Growth retardation in children with frequent relapsing nephrotic syndrome on steroid--improvement of height velocity after administration of immunosuppressive agent]. Nihon Jinzo Gakkai Shi 1992;34:117-124.
  3. Lewis DA, Smith RE. Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature. J Affect Disord 1983;5:319-332. https://doi.org/10.1016/0165-0327(83)90022-8
  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5(R)). Arlington, VA: American Psychiatric Pub; 2013.
  5. Janes M, Kuster S, Goldson TM, Forjuoh SN. Steroid-induced psychosis. Proc (Bayl Univ Med Cent) 2019;32:614-615. https://doi.org/10.1080/08998280.2019.1629223
  6. Wiesen A, Wiesen J, Limaye S, Kaushik N. Mesalazine-induced aplastic anemia. Am J Gastroenterol 2009;104:1063. https://doi.org/10.1038/ajg.2008.164
  7. Su C, Lichtenstein GR. Treatment of inflammatory bowel disease with azathioprine and 6-mercaptopurine. Gastroenterol Clin North Am 2004;33:209-234. https://doi.org/10.1016/j.gtc.2004.02.004
  8. French J, Khan A, White H. Steroid induced psychosis in an asthmatic child: case report & 10 year literature review. Can Child Adolesc Psychiatr Rev 2003;12:117-118.
  9. Hodgins GE, Saltz SB, Gibbs EP, Gonzalez R, Regan J, Nemeroff C. Steroid-induced psychosis in the pediatric population: a new case and review of the literature. J Child Adolesc Psychopharmacol 2018;28:354-359. https://doi.org/10.1089/cap.2018.0017
  10. Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc 2006;81:1361-1367. https://doi.org/10.4065/81.10.1361
  11. Kenna HA, Poon AW, de los Angeles CP, Koran LM. Psychiatric complications of treatment with corticosteroids: review with case report. Psychiatry Clin Neurosci 2011;65:549-560. https://doi.org/10.1111/j.1440-1819.2011.02260.x
  12. Mullen RS, Romans-Clarkson SE. Behavioural sensitisation and steroid-induced psychosis. Br J Psychiatry 1993;162:549-551. https://doi.org/10.1192/bjp.162.4.549
  13. Bag O, Erdogan I, Onder ZS, Altinoz S, Ozturk A. Steroid-induced psychosis in a child: treatment with risperidone. Gen Hosp Psychiatry 2012;34:103.e5-e6. https://doi.org/10.1016/j.genhosppsych.2011.09.003

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