Background: High-dose corticosteroids (CS) (1g IV methylprednisolone or 1250 mg oral prednisone for 3-5 days) is the most common treatment currently used to treat acute MS relapses (Vasheghani-Farahani et al., 2011). While CS are beneficial for increasing the rate of recovery of a relapse, adverse neuropsychiatric complications such as psychosis are possible following this treatment (Ozakbas et al., 2017; Dubovsky et al., 2012). The general standard of care for MS relapses includes the treatment of insomnia using a benzodiazepine or Z-drug (Lie et al., 2015). A search of Medline and Embase databases did not find any articles discussing the use of antipsychotic agents to reduce symptoms of psychosis in MS patients receiving high-dose steroids. This suggests that psychosis following high-dose CS treatment may be underreported in the MS field and that the use of antipsychotics, such as quetiapine, may be beneficial for treating these symptoms.
Objectives: To highlight the importance of recognizing and treating steroid psychosis in MS patients receiving high-dose steroid treatment by comparing the clinical outcomes of patients who received the antipsychotic quetiapine with those who did not.
Methods: This case review examined 10 case reports (8 female) of patients who were identified by MS nurses as having significant psychiatric symptoms post steroid treatment. The charts were reviewed to identify whether patients were treated with the antipsychotic quetiapine. The clinical outcomes of patients treated with quetiapine were qualitatively compared to those who did not receive an antipsychotic.
Results: Of the 10 patients that demonstrated steroid-induced psychosis, 8 received the antipsychotic quetiapine (6 female, 2 male). All 8 recipients reported a benefit, including decreased irritability, reduced psychological distress and improved sleep. These are all benefits associated with quetiapine treatment in non-MS specific trials (Riedel et al., 2007). The 2 patients (2 female) who did not receive quetiapine did not demonstrate acute improvement in their symptoms.
Conclusions: As a result of the small sample size and case report methodology, more research is needed to determine the efficacy of antipsychotics for managing steroid-induced psychosis in MS patients. Importantly, a greater clinical awareness is needed for early recognition of steroid-induced psychosis to minimize symptoms and improve patient quality of life.