Prednisolone

[Charlyparly]

Just thought I'd post this because after almost twenty years, it was an entirely new one on me and I thought others might find it helpful.

Got to work on Sunday night and was told by staff during the handover that one lady had started hallucinating and behaving in a very odd way (thinking water was running down her bedroom walls, that people were wandering in / out of her room and then vanishing through the windows)

It had started that afternoon although they weren't sure what was going on or why the sudden onset. Anyway, I went straight up to her room and found her very distressed and having quite frightening hallucinations. Initially, she said this improved a little when she put her glasses back on which made me query whether her eyesight might have been the culprit (i.e. Charles Bonnet Syndrome) but over the course of the night, she steadily grew worse and was completely delirious and so I rechecked her medication. She'd been prescribed Prednisolone (steroid) just a day or two earlier which I didn't imagine was related but just to be sure, I carefully read through the Patient Information Leaflet and found this -

“Tell your doctor immediately if you develop any of the following symptoms:
Mental health problems such as feeling depressed (including thinking about suicide), feeling high (mania) or moods that go up and down, feeling anxious, difficulty sleeping, difficulty thinking, feeling confused and losing your memory, feeling, seeing or hearing things which do not exist, having strange or frightening thoughts, changing how you act or having feelings of being alone”

After calling the surgery first thing the following morning, it was discontinued immediately however, symptoms may take several days or weeks to subside.

I have never heard of Prednisolone having this effect on anyone and never imagined it would / could either. Thought it worth sharing.

 

[copsham]

Thank you for sharing

This post is relevant to me as my mother is the best she has been for a long time after her nursing home and GP have weaned her off most medication including prednisolone.

It is all so complicated and so difficult to get ahead of everything!

 

[Saffie]

Thankn you for that. I have a packet in my drawer as I speak. It was given to me by my GP last November, along with ABs, for a cough. I took the ABs but left the Prednisolone alone - didn't agree with the G that my asthma was causing the problem and don't like to take steroids without good reason anyway.
I know where they are going now!

 

[Charlyparly]

In fairness, I don't think the mental health problems are a common side-effect at all and like I say, in all the years I've been in this line of work, it's the first time I've ever heard of what I've since learned is often referred to as “Steroid Dementia Syndrome”

Don't want to put people off and I certainly wouldn't discourage anyone from taking it as prescribed but I just thought it worth sharing given that in this lady's case – she'd have been fobbed off and had the confusion filed under the “Old age” category.

When staff rang the surgery to flag it up after I'd left, the initial response was that it was “probably related to her existing problems with mild-moderate memory loss and her age” (94yrs) Only when they persisted and told them I'd highlighted the side effects and instructed staff not to administer the next due dose until she'd been seen by the GP did he agree to come out.

 

[nitram]

The SPC says:-

"...Patients/and or carers should be warned that potentially severe psychiatric adverse reactions may occur with systemic steroids (see section 4.8). Symptoms typically emerge within a few days or weeks of starting the treatment..."

Para 4.4
http://www.medicines.org.uk/emc/medicine/24113/SPC/Prednisolone+1mg+Tablets/

 

[Linbrusco]

My husband was on high dose steroids - Dexamethasone following brain surgery in 2004.
He had severe mood swings, bordering on agression, insomnia , and in his words felt highly strung.
Thankfully his dose was for a short period of time.
A year later he had to have a further brain surgery and again on steroids.
He absolutely hated it. For me it was also the worst time of my life, as far as our relationship and marriage and coping with 2 small children.

He then required 7 mths of chemo.
Low dose Steroids being used as anti nausea and injected in his IV line.
He categorically refused, so they gave him an alternative.

Thank you for this. Mum with AD is not on any steroids, but will bear it in mind.

 

[Izzy]

That's interesting. I am currently on a two week course of Prednisilone for nasal polyps. I've been getting a prescription for this more regularly recently - around every 6 weeks. It reduces the swelling g of the polyps almost immediately and the relief is wonderful. On Monday, however, the GP said he would give me the course this time but he has referred me to the hospital with a view to having the polyps removed.

I had seen that part in the leaflet but hadn't heard of anyone who had suffered that side effect. Really quite scary.

 

[cragmaid]

Husband was on Prednisolone once....amusingly high as a kite while taking them and down to earth with a huge bump after because he'd run a half marathon and was suffering withdrawal...gp gave him 2 more days to even it all out. Luckily he doesn't have dementia!!

 

[Izzy]

My husband was given Prednisolone,he lost his voice,a common side effect.

Bet Bill wishes that would happen to me!!!

 

[Charlyparly]

An update on my original post and this lady's hallucinations. As it happens, the hallucinations appear to be caused by what I originally suspected (Charles Bonnet Syndrome) than as a result of the Prednisolone!

Things eased relatively quickly after her GP stopped the medication and the lady concerned was fine and back to herself within a few days. Then the hallucinations started again late one evening as I was due in for a night shift. I was particularly careful to observe her behaviour even closer than before and over the next few hours, sussed out that her apparent confusion and bouts of delirium were really more a case of her almost losing herself in these incredibly complex hallucinations she was having which at times included entire landscapes.

At one point she genuinely believed we were sitting at the top of a cliff which, when you consider that's exactly what she could see in front of her – is understandable. However, she was quickly “brought back” and orientated again when I reminded her of her whereabouts etc.

Her GP was called the following afternoon and said it was probably still the effects of the meds wearing off but prescribed antibiotics anyway “just in case” it was an infection. He also said that should there be little improvement after the seven day course, he'd consider alternative, long-term medication to help manage symptoms of dementia (referring to a certain drug I particularly dislike )

Not keen on copping out and ploughing folk with medication unnecessarily, I asked a friend / work colleague and the OT lead if she'd bob in and complete some assessments with the lady. She was absolutely fine.

I also contacted her optician and asked about the results of her more recent eye tests and she explained that the lady has rapidly deteriorating vision as a result of macular degeneration. When I asked if this could cause visual hallucinations like the ones I was describing, she replied “It can and it does – very often. In fact the ones you say she's been having are almost textbook CBS”

So there you go. Even though it's looking less likely that Prednisolone was the culprit, I've at least learned that it CAN cause mental health problems.

I've also learned that CBS is massively misdiagnosed and still relatively unknown.

Then I learned about a chap named Dr Oliver Sacks and found this video of his which is brilliant and definitely worth watching with a brew and biscuit. http://youtu.be/SgOTaXhbqPQ

I then learned via Dr Sacks that this same part of the brain dealing with sensory perception is what causes my son's bouts of “Alice in Wonderland Syndrome” - which is equally unheard of for the most part.

I'm learning new stuff every day.