Risperidone in the Treatment of Corticosteroid-Induced Mood Disorders, Manic/Mixed Episodes, in Systemic Lupus Erythematosus: A Case Series

Corticosteroid therapy is frequently associated with adverse psychiatric effects, including dysregulated mood psychosis and delirium. Recent reports have shown that the effects of short-term, high-dose corticosteroid therapy appear to be primarily associated with manic rather than depressive or psychotic symptoms, or delirium, while depressive symptoms may be more common and severe than manic symptoms during long-term corticosteroid therapy at relatively low dosages. Management includes tapering corticosteroids, with or without the addition of medications to treat acute psychiatric symptoms. Use of adjunctive psychotropic medications may be necessary, particularly if corticosteroids cannot be tapered or discontinued. However, little information is available on the treatment of corticosteroid-induced mood disorders (CIMDs). One controlled study suggested lithium therapy may prevent CIMDs. None of the 27 patients given open-label lithium developed CIMDs while receiving corticosteroids, whereas 6 (14%) of 44 retrospectively reviewed patients not receiving lithium developed CIMDs. One open-label trial on olanzapine has been conducted in 12 patients with multiple medical diagnoses. In several case reports/series, various classes of psychotropic medications, including second-generation antipsychotics (SGAs), e.g., olanzapine, risperidone, and quetiapine, have been successfully used to treat CIMDs, mainly for manic symptoms. Mood stabilizers, e.g., lithium, valproate, and carbamazepine, have also been used to treat CIMDs. Overall, these reports have had methodical limitations that complicate the assessment of the effects of psychotropic medications, namely multiple medical diagnoses, as well as the parallel effects of tapering the corticosteroids dosage during the study because of CIMDs dose-