A Psychotic Attack After Steroid Therapy in Clinically Isolated Syndrome Manifesting as Optic Neuritis

Background: Corticosteroids have been widely used in attacks of Multiple Sclerosis (MS) and Clinically Isolated Syndromes but may rarely cause psychiatric manifestations, such as depression, mania, psychosis and delirium. Steroid-induced mood disorders have common clinical features, such as subacute onset, manic predominance and having psychotic history.Case Presentation: A 28 year-old housewife who had presented with a sudden blurring of vision had been diagnosed MS and applied 1000 mg/day intravenous methylprednisolone therapy for 10 days as a MS attack therapy in another hospital 20 days ago. One week after the steroid therapy she was taken to our outpatient clinic with paranoia, aggressive behaviors and disorientation. Neurological examination was normal except right optic neuritis. Brain MRI revealed periventricular and cerebellar demyelination. In her medical history she had behavioral pathologies as paranoia, aggression, visual hallucinations 5 years ago and her symptoms recovered without any psychiatric treatment less than one month. She didn't have another attack except optic neuritis, therefore we considered her diagnosis as Clinically Isolated Syndrome. After psychiatry consultation olanzapine at 20 mg/day was initiated and psychiatric excitations were taken under control.Conclusions: Intravenous methylprednisolone is usually administered in 0,5-1 gr/day dosage for 3-10 days in MS. It is considered that there's no significant difference between the administration periods in terms of the efficacy. We consider that it's important to take the psychiatric history before the steroid therapy and to reevaluate the necessity of the high dose steroid therapy and to choose the minimum dosage and period for the patients that have psychotic attack history.