Steroid Induced Psychosis: Current Understanding and Novel Approaches to Management

Corticosteroids are widely used for their potent anti-inflammatory and immunosuppressive properties, but they can cause significant neuropsychiatric side effects, including steroidinduced psychosis (SIP). SIP manifests as hallucinations, delusions, mood disturbances, or cognitive impairment, with higher risk at doses exceeding 40 mg/day of prednisone. The condition typically appears within days to weeks of corticosteroid initiation but may also arise during dose tapering or cessation. Pathophysiological mechanisms include hypothalamic-pituitaryadrenal (HPA) axis dysregulation, elevated dopamine activity, neurotransmitter imbalances, and genetic vulnerabilities. Diagnosis is clinical, supported by symptom rating scales and causality assessment tools. Management primarily involves dose reduction and, if needed, antipsychotics. Novel interventions such as anti- glucocorticoid agents, mood stabilizers, and neurostimulation are under exploration. Early psychiatric involvement plays a pivotal role in improving outcomes. This review highlights current knowledge and emerging strategies for managing SIP.