THERAPEUTIC MANAGEMENT AND PHARMACOLOGICAL INTERVENTIONS IN THE TREATMENT OF CORTICOSTEROID-INDUCED PSYCHOSIS

Abstract

This study is a narrative literature review that aimed to synthesize and analyze the therapeutic management and pharmacological interventions in corticosteroid-induced psychosis. The increasing use of synthetic corticosteroids for the management of various conditions, such as chronic pain and autoimmune diseases, is associated with serious neuropsychiatric manifestations, the incidence of which is dose-dependent. The pathophysiology involves the modulation of the dopaminergic, cholinergic, and serotonergic systems, with hypoalbuminemia, previous psychiatric history, and female sex being risk factors. The clinical picture, which typically appears in the first 7 to 11 days, includes insomnia, paranoia, agitation, and delusions. Primary management consists of reducing or discontinuing the corticosteroid, when clinically possible. Pharmacological intervention includes the use of antipsychotics (risperidone, haloperidol, olanzapine, or quetiapine) and benzodiazepines (clonazepam) to control agitation. Prophylactic strategies, such as dosage adjustment and the use of lithium in some cases, have demonstrated preventive potential. The study reinforces the need for early symptom recognition, intensive monitoring, and a multidisciplinary approach, given the scarcity of standardized clinical guidelines.