Table 1

Case reports of severe adverse psychological side effects including psychosis

Reference	Age	Sex	Ethnicity	Diagnosis	CS type + dose	Clinical presentation
N/K, not known.
Hall, 1979⁵⁰	17	F	N/K	Asthma	ACTH oral 40 units/day Prednisolone oral 40–60 mg/day	Fluctuating presentation including insomnia, distractability, emotional lability, grandiosity, pressured speech, agitation, hypomania

Ducore, 1983³⁴	15	M	White	ALL	Prednisolone oral 90 mg/day + intermittent IV hydrocortisone as part of chemotherapy protocol	Initially anxiety and fear of dying proceeding to frank psychosis with delusions of grandiosity, persecutory delusions, disinhibited behaviour, fluctuating levels of alertness, intermittent disorientation

Ducore, 1983³⁴	13	F	Black	ALL	Prednisolone oral 40 mg/m²/day	Disinhibition, regressive behaviour, apathy, incontinence, “frankly psychotic” behaviour

Lewis, 1983¹⁴	5.5	F	N/K	Asthma	Budesonide inhaled 100 μg twice daily	Hyperactive, aggressive, severe insomnia

Meyboom, 1988¹⁵	9	M	N/K	Asthma	Budesonide inhaled 100 μg twice daily added to nasal beclomethasone	Hyperactive behaviour, impaired psychomotor activity and strongly increased appetite

Connett, 1991¹⁶	2.5	M	N/K	Asthma	Budesonide (inhaled via spacer and mask) 400 μg twice daily	Severe temper tantrums, “miserable and uncooperative”

Connett, 1991¹⁶	3	M	N/K	Asthma	Budesonide as above	Insomnia, screaming, aggression

Connett, 1991¹⁶	2	M	N/K	Asthma	Budesonide as above	Hyperactive, undisciplined, insomnia

Connett, 1991¹⁶	2.5	M	N/K	Asthma	Budesonide as above, but thrice daily	Secondary enuresis, aggression and violence towards sister, insomnia

Watanabe, 1994²⁴	17	F	N/K	ALL	Dexamethasone 15 mg/day for 3/52, then dose tapered for 2/52 as part of chemotherapy protocol	Symptoms emerged during tapering: psychomotor agitation, marked insomnia, euphoria, disinhibition, pressured speech, labile affect, flight of ideas

Watanabe, 1994²⁴	13	F	N/K	ALL	Dexamethasone 15 mg/day for 3/52, then dose tapered for 1/52 as part of chemotherapy protocol	Symptoms emerged during tapering: hypochondriasis and fear of dying, panic symptoms, sadness, separation anxiety

Turktas, 1997¹⁷	14	M	N/K	Asthma	Beclomethasone inhaled 1500 μg/day	Insomnia, visual and auditory hallucinations, pressured speech, labile affect, decreased attention and memory

Dawson, 1998¹⁸	8	F	Black	Asthma	Prednisolone oral 20 mg twice daily for 5 days	Hyperactivity, aggression, insomnia progressing to emotional lability, visual hallucinations, pressured speech, episodic crying spells

Beshay, 1998⁵¹	12	M	White	Ulcerative colitis	Long term oral prednisolone Rx up to 60 mg/day	Recurrent episodes of irritability, insomnia, agitation, physical aggression, auditory hallucinations, depressive symptoms, social withdrawal

Kramer, 1999²⁵	14	F	Black African American	ALL	Dexamethasone oral 24 mg/day for 21/7, then 10/7 taper	Symptoms during tapering: fluctuating presentation with disorientation, auditory and visual hallucinations, grandiose delusions, suicidality

Ingram, 2003⁴⁸	2	M	White	ALL, BMT, GVHD	Methylpred 2 mg/kg/day in 3 divided doses	Irritable, visual hallucinations, crying, head banging