Four Case Reports of Acute Psychosis Secondary to Low Doses of Prednisone/Prednisolone

Prednisone, the prodrug of prednisolone, has been implicated as the cause of neuropsychiatric symptoms such as depression, mania, agitation, delirium, dementia, psychosis, and many other affective, behavioral, and cognitive changes. Although the literature suggests that patients on 40 mg or more of prednisone a day are at a greater risk for steroid-induced psychosis, patients on <40 mg are still at risk, and therefore, steroid-induced psychosis should not be excluded from the differential. Prednisone is the prodrug of prednisolone, and the two are comparable on a milligram (mg)-to-mg basis. Here are four case studies, three from the literature and one new, that demonstrate acute psychosis secondary to low-dose prednisone/prednisolone use.