A 45-year-old with SLE on high-dose prednisolone develops euphoria, pressured speech, grandiose delusions, and decreased need for sleep 3 weeks into treatment. Which is the most likely diagnosis?
- A SLE-related neuropsychiatric lupus
- B Steroid-induced secondary mania ✓
- C Bipolar I disorder, first episode
- D Substance-induced psychotic disorder (corticosteroid)
Explanation
Steroid-induced secondary mania is the most likely cause of euphoria, grandiosity, and decreased sleep appearing within weeks of high-dose corticosteroid therapy. Psychiatric side effects of corticosteroids are dose-dependent and occur in about 5% of patients at >40 mg/day prednisone equivalent; they include mania, psychosis, depression, and mixed states. Distinguishing this from primary bipolar disorder requires temporal correlation with steroid initiation. Neuropsychiatric lupus can cause similar features but occurs without the temporal relationship to steroid initiation and is mediated by autoantibodies. Management involves dose reduction if medically feasible, and antipsychotics or mood stabilisers.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.