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Steroid Psychosis — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologySteroid PsychosisSCE Medical Oncology

A 55-year-old man with cancer develops confusion and hallucinations 10 days after starting high-dose dexamethasone. What is the likely cause?

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Correct answer: E — Steroid-induced psychosis — occurs within 1-2 weeks of starting/escalating high-dose steroids (>40 mg prednisolone equivalent); dose-dependent; resolves with dose reduction; haloperidol/olanzapine for acute symptoms

Steroid psychiatric effects: ~5-20% at >40mg prednisolone equivalent. Insomnia most common; mania, psychosis, depression also. Management: reduce dose (most important) + haloperidol/olanzapine.

Reference: BNF; Warrington et al QJM 2006