not actually PMR related but the 83 year mother of a close friend of ours was hospitalised recently with what was diagnosed as an auto-immune skin condition. Within 24 hours of entering hospital she showed all the symptoms of severe dementia. Tests showed no infection or physical problems.
It was suggested that she is suffering from “ Steroid Psychosis) On arrival to hospital she was immediately put on 8 tablets (40 mg?) of Prednisolone. Now reduced to 4 tablets (20mg?) as a result of her dementia.
Can anyone cast any light on this condition and what we might expect
Thank you
Written by
Cycleman
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Could well be - I assume they have ruled out a UTI as that is the most common cause of confusion? And sometimes it doesn't show in a dip test - it is unlikely they ahve the results of a culture back so quickly, It does often improve with reduction in dose but it will be a wait and see thing I suspect.
There is a Related Post showing now you have posted. I haven't read it myself though.
My aged Mum went to Hospital after a bad fall. They gave her IV Paracetamol and Codeine. She hadn’t eaten for about 12. Hours (long wait time) and within a few hours she was talking nonsense. We had stayed with her as they had no bed available. Normally Mum was totally lucid. Anyway it turned out to be the Codeine and we were told Mum must never be given it again. Afterwards Mum was totally her normal self.
Actually my grandmother had something similar after high dose steroids for hip pain in the early 1960s. She was talking in her native language only and thinking a child was under her bed. This all stopped when the drug was discontinued. She was back to normal and lived on her own until age 84. No dementia.
An important point: elderly can often become dehydrated and confusion results. Some just forget to take fluids as thirst is diminished with age, they don't want to use the restroom at night thus restrict fluids, are on diuretics and don't replace the fluids they need.
It's much more common on higher doses. This 2021 paper says:
"The Boston Collaborative Drug Surveillance Program evaluated 718 hospitalized patients on prednisone and found that 4.6% of patients receiving doses greater than 40 mg/d of prednisone presented with psychiatric symptoms. The incidence rose to 18.4% for patients receiving more than 80 mg/d. A review by Lewis and Smith found similar patterns of increasing incidence with higher doses of prednisone."
Remember "psychiatric symptoms" include things like anxiety or depression, as well as psychosis. The cause is not known, but corticosteroids can upset the whole "hypothalamic-pituitary-adrenal (HPA) axis", including the levels of neurotransmitters in the brain.
The paper concludes:
"Steroid-induced psychosis is a severe adverse effect that can occur shortly after administering high doses of glucocorticoids. Although steroid-induced psychosis can typically be managed by tapering and discontinuing the offending steroid, patients may still experience persistent mood disturbances and psychosis. There is evidence from a small number of patient cases and studies to support the effectiveness of antipsychotics such as haloperidol and risperidone in adult patients experiencing delusions or hallucinations after administering corticosteroids. Fortunately, the great majority of patients completely recover from their acute psychosis within an average span of 2 weeks after treatment initiation. Clinicians must be judicious in the prescribing of corticosteroids in an effort to minimize the risk of this preventable adverse drug event."
Yes. I am 83 but about 4 years ago was on Prednisone 10 mg. I started having psychotic symptoms of visions and racing thoughts. Rheumatologist said it was Prednisone psychosis and he would put me on psychotic meds. I said no thanks and went to a psychiatrist at UTSW who put me on a low dose of 30 mg of Cymbalta. Then I worked on slowly getting off Prednisone. The PMR is gone; praise the Lord. And I have a sound mind!
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steroid mg's
Frustrated 
Good bye my friend 
Steroid injection
