2247 – Manic Episode In An Elderly Patient Secondary To The Application Of Corticosteroid Eye Drops: a Case Report

Abstract

Introduction

An eighty-one-year-old lady presented with mood changes within days of the commencement of prednisolone eye drops, which was prescribed following a cataract operation. She had a history of chronic schizophrenia, with one previous episode of hypomania in the early1990s. She was admitted to our institution on this occasion, with symptoms including elated mood, disinhibition, insomnia, pressured speech, flight of ideas and grandiose ideation. This was a distinctly different presentation from her previous relapses and the duration of this episode was prolonged. Her symptoms persisted despite an aggressive titration of psychotropic medications. After a review of her medication, the possible causal relationship between the prednisolone eye drops and manic episode was made. As the steroid eye drops were necessary following her eye operation, we allowed the completion of its course. Within days of its discontinuation, we saw a dramatIc improvement in her mental state and she was discharged. She currently remains in remission two months from the cessation of prednisolone.

Discussion

The postulation that the prednisolone eye drops triggered this manic episode can be substantiated by the clear observation that her symptoms completely resolved after the steroid course was completed. This appeared to be the one single factor which coincided with the emergence, maintenance and termination of her symptoms. Steroid-induced psychiatric symptoms are a well documented phenomenon, but are typically seen with higher doses and systemic administration of corticosteroids. This case report is of a rare presentation, and to our knowledge there are no similar cases described.