Steroid-Induced Psychosis: Advances in Understanding, Diagnosis, and Management

Abstract

Steroid-induced psychosis is an under recognized but clinically significant complication of systemic corticosteroid therapy, characterized by a spectrum of psychiatric manifestations ranging from mood disturbances to acute psychotic episodes. Its pathophysiology involves multifactorial mechanisms, including dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered neurotransmitter signaling (dopamine, serotonin, and glutamate), neuroinflammation, and genetic or epigenetic susceptibility. High-dose and prolonged corticosteroid therapy, advanced age, pre-existing psychiatric conditions, and pharmacokinetic variability are important risk factors, while neuroimaging studies have revealed structural and functional alterations correlating with symptom severity. Diagnosis remains primarily clinical, supported by standardized rating scales, biomarker assessment, and neuroimaging when necessary. Management requires a multifaceted approach encompassing pharmacological interventions (antipsychotics, mood stabilizers, benzodiazepines), non-pharmacological strategies, and careful steroid dose modulation. Emerging personalized medicine strategies, including genetic and epigenetic profiling, offer promise for tailored interventions. Preventive measures such as risk stratification, routine psychiatric screening, patient and caregiver education, and judicious corticosteroid use are critical to minimize morbidity. Future directions involve biomarker discovery, integration of artificial intelligence for risk prediction, and development of standardized clinical guidelines. Early recognition, individualized management, and coordinated multidisciplinary care are essential to optimize patient outcomes and reduce healthcare burden associated with steroid-induced psychosis.