Table 1

 Case reports of severe adverse psychological side effects including psychosis

ReferenceAgeSexEthnicityDiagnosisCS type + doseClinical presentation
N/K, not known.
Hall, 19795017FN/KAsthmaACTH oral 40 units/day Prednisolone oral 40–60 mg/dayFluctuating presentation including insomnia, distractability, emotional lability, grandiosity, pressured speech, agitation, hypomania
Ducore, 19833415MWhiteALLPrednisolone oral 90 mg/day + intermittent IV hydrocortisone as part of chemotherapy protocolInitially anxiety and fear of dying proceeding to frank psychosis with delusions of grandiosity, persecutory delusions, disinhibited behaviour, fluctuating levels of alertness, intermittent disorientation
Ducore, 19833413FBlackALLPrednisolone oral 40 mg/m2/dayDisinhibition, regressive behaviour, apathy, incontinence, “frankly psychotic” behaviour
Lewis, 1983145.5FN/KAsthmaBudesonide inhaled 100 μg twice dailyHyperactive, aggressive, severe insomnia
Meyboom, 1988159MN/KAsthmaBudesonide inhaled 100 μg twice daily added to nasal beclomethasoneHyperactive behaviour, impaired psychomotor activity and strongly increased appetite
Connett, 1991162.5MN/KAsthmaBudesonide (inhaled via spacer and mask) 400 μg twice dailySevere temper tantrums, “miserable and uncooperative”
Connett, 1991163MN/KAsthmaBudesonide as aboveInsomnia, screaming, aggression
Connett, 1991162MN/KAsthmaBudesonide as aboveHyperactive, undisciplined, insomnia
Connett, 1991162.5MN/KAsthmaBudesonide as above, but thrice dailySecondary enuresis, aggression and violence towards sister, insomnia
Watanabe, 19942417FN/KALLDexamethasone 15 mg/day for 3/52, then dose tapered for 2/52 as part of chemotherapy protocolSymptoms emerged during tapering: psychomotor agitation, marked insomnia, euphoria, disinhibition, pressured speech, labile affect, flight of ideas
Watanabe, 19942413FN/KALLDexamethasone 15 mg/day for 3/52, then dose tapered for 1/52 as part of chemotherapy protocolSymptoms emerged during tapering: hypochondriasis and fear of dying, panic symptoms, sadness, separation anxiety
Turktas, 19971714MN/KAsthmaBeclomethasone inhaled 1500 μg/dayInsomnia, visual and auditory hallucinations, pressured speech, labile affect, decreased attention and memory
Dawson, 1998188FBlackAsthmaPrednisolone oral 20 mg twice daily for 5 daysHyperactivity, aggression, insomnia progressing to emotional lability, visual hallucinations, pressured speech, episodic crying spells
Beshay, 19985112MWhiteUlcerative colitisLong term oral prednisolone Rx up to 60 mg/dayRecurrent episodes of irritability, insomnia, agitation, physical aggression, auditory hallucinations, depressive symptoms, social withdrawal
Kramer, 19992514FBlack African AmericanALLDexamethasone oral 24 mg/day for 21/7, then 10/7 taperSymptoms during tapering: fluctuating presentation with disorientation, auditory and visual hallucinations, grandiose delusions, suicidality
Ingram, 2003482MWhiteALL, BMT, GVHDMethylpred 2 mg/kg/day in 3 divided dosesIrritable, visual hallucinations, crying, head banging