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<p>Corticosteroids are among the most widely prescribed medications in modern medicine, valued for their potent anti-inflammatory and immunosuppressive properties. Despite their therapeutic benefits, corticosteroids are frequently associated with adverse neuropsychiatric manifestations that range from mild mood disturbances to severe psychosis. These side effects, although often under recognized, can significantly impair quality of life and complicate clinical management. The incidence of steroid-induced psychiatric symptoms varies widely, from 5 to 20%, depending on dosage, duration of therapy, and patient vulnerability. The underlying mechanisms involve dysregulation of the hypothalamicpituitary–adrenal (HPA) axis, alterations in neurotransmitter systems, neuroinflammation, and structural changes in brain regions such as the hippocampus, amygdala, and prefrontal cortex. Clinically, corticosteroid-induced neuropsychiatric effects manifest across a spectrum, including depression, mania, anxiety, psychosis, cognitive deficits, and behavioral disturbances. Risk factors such as high cumulative dose, rapid administration, older age, female sex, and pre-existing psychiatric illness increase susceptibility. Timely recognition and differentiation from primary psychiatric disorders are crucial for effective intervention. Management strategies encompass pharmacological approaches such as dose reduction, antipsychotics, antidepressants, and mood stabilizers, as well as non-pharmacological interventions including psychotherapy, lifestyle modification, and preventive monitoring protocols. This review synthesizes current evidence on the pathophysiology, clinical spectrum, risk factors, diagnostic considerations, and management of corticosteroid-induced neuropsychiatric manifestations. It also highlights research gaps and future directions aimed at mitigating these complications while preserving the therapeutic utility of corticosteroids. Understanding this complex interplay between corticosteroid therapy and neuropsychiatric health is essential for clinicians to optimize patient outcomes.</p>

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Corticosteroid-Induced neuropsychiatric manifestations: From pathophysiology to management

  • 期刊论文

  • 发表日期：

    2026年5月14日

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  • Adil Husain,
  • Firoz Ahmad

摘要

Corticosteroids are among the most widely prescribed medications in modern medicine, valued for their potent anti-inflammatory and immunosuppressive properties. Despite their therapeutic benefits, corticosteroids are frequently associated with adverse neuropsychiatric manifestations that range from mild mood disturbances to severe psychosis. These side effects, although often under recognized, can significantly impair quality of life and complicate clinical management. The incidence of steroid-induced psychiatric symptoms varies widely, from 5 to 20%, depending on dosage, duration of therapy, and patient vulnerability. The underlying mechanisms involve dysregulation of the hypothalamicpituitary–adrenal (HPA) axis, alterations in neurotransmitter systems, neuroinflammation, and structural changes in brain regions such as the hippocampus, amygdala, and prefrontal cortex. Clinically, corticosteroid-induced neuropsychiatric effects manifest across a spectrum, including depression, mania, anxiety, psychosis, cognitive deficits, and behavioral disturbances. Risk factors such as high cumulative dose, rapid administration, older age, female sex, and pre-existing psychiatric illness increase susceptibility. Timely recognition and differentiation from primary psychiatric disorders are crucial for effective intervention. Management strategies encompass pharmacological approaches such as dose reduction, antipsychotics, antidepressants, and mood stabilizers, as well as non-pharmacological interventions including psychotherapy, lifestyle modification, and preventive monitoring protocols. This review synthesizes current evidence on the pathophysiology, clinical spectrum, risk factors, diagnostic considerations, and management of corticosteroid-induced neuropsychiatric manifestations. It also highlights research gaps and future directions aimed at mitigating these complications while preserving the therapeutic utility of corticosteroids. Understanding this complex interplay between corticosteroid therapy and neuropsychiatric health is essential for clinicians to optimize patient outcomes.