Can Steroid Switching'' Improve Steroid-Induced Psychosis in a Patient with Advanced Cancer?

In palliative care, steroids are often used to alleviate symptoms such as pain, fatigue, anorexia, nausea, and vomiting. Steroids occasionally induce psychiatric adverse effects. It has been reported that treatment of the steroid-induced psychiatric symptoms involves dosage reduction or discontinuation of steroid, and concomitant administration of psychotropics. There were few reports on effectiveness of treatment of steroid-induced psychiatric symptoms by switching from one steroid to the other. We experienced the case of 67-year-old man with malignant pleural mesothelioma and pulmonary emphysema who developed psychiatric symptoms after switching from oral prednisolone 10mg/day to intravenous betamethasone 2mg/day. He began to complain that time repeats cycles of going and coming'' and that he was unable to distinguish between daytime and night,'' and his face became expressionless. He gazed at familiar healthcare professionals as if seeing them for the first time, complaining: I feel something obscure or strange in my head.'' He was unable to remember events on the same or the previous day at all, and made no verbal response to questions by healthcare professionals. He did not know how to eat or use the toilet, and thus required assistance in daily life activities. He did not respond even when talked to by his family members. He continued gazing at them, sometimes saying: Where am I now? Am I sick?'' He behaved restlessly, repeating cycles of lying and sitting. The symptoms disappeared gradually after re-switching from intravenous betamethasone 2mg/day to oral prednisolone 10mg/day. Steroid switching'' may serve as a valid alternative treatment.