Mania after long-term treatment with daily 10 mg prednisolone

BackgroundHigh-dose corticosteroids may be accompanied by central nervous system side-effects, including psychiatric disorders. These psychiatric disorders tend to appear relatively early in treatment. We report an unusual case of mania after long-term administration of a small dose of prednisolone.Case PresentationA patient was treated for relapsed Crohn's disease with a small dose of prednisolone (10 mg/day). After 6 months, she became severely manic. There was no family history of psychiatric disorders. The mania was resistant to olanzapine and sodium valproate, but improved with the reduction of the prednisolone dose. Prednisolone was tapered off while confirming with the gastroenterologist that there was no flare-up of Crohn's disease. She is now off prednisolone and is doing well, with no outbreaks of Crohn's disease or manic episodes.ConclusionThis case of severe mania after 6 months of low-dose prednisolone is unusual. Physicians should be aware that even small doses of long-term prednisolone may cause the emergence of severe mania. We present a case of mania after long-term administration of 10 mg prednisolone q.d. to a patient with a Crohn's disease flare-up. The mania did not resolve despite treatment with olanzapine and sodium valproate until the prednisolone dose was tapered and discontinued. image