Corticosteroid-Induced Insomnia — SCE Palliative Medicine MCQ
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Correct answer: E — Corticosteroid‑induced insomnia and mood disturbance — a common dose‑dependent side effect
The correct answer is E. At a high dose (16 mg daily), dexamethasone frequently causes neuropsychiatric side effects such as insomnia, irritability and racing thoughts; these are dose‑dependent and well‑described in UK NHS prescribing information. The acute onset temporally linked to steroid dosing strongly supports this cause. Caffeine toxicity is not indicated by the history; primary insomnia is unlikely given the clear iatrogenic trigger; brain metastases might cause symptoms but typically present with focal or neurological signs and develop less acutely; sleep apnoea lacks characteristic features. Management would include timing doses earlier, considering dose reduction if clinically permissible, and supportive symptomatic measures.
Reference: NHS: Side effects of dexamethasone tablets and liquid (2023); Steroid‑Induced Mental Disorders in Oncology Patients: A 10‑Year Retrospective Case Series Review (2025), https://www.nhs.uk/medicines/dexamethasone-tablets-and-liquid/side-effects-of-dexamethasone-tablets-and-liquid/