Betamethasoneによるステロイド精神病の1例

A Case of Steroid Psychosis Associated with Betamethasone

　ステロイド剤の副作用として，多幸感のみの軽症例を入れると精神障害は2〜3％と比較的高頻度にみられるといわれているが，その発現頻度はステロイド剤の種類により異なるとされている。今回我々はステロイド精神病を惹起しにくいといわれ，報告例の少ないbetamethasoneによる精神分裂病様の高度症状を呈した症例を経験したので報告する。進行性の末梢性顔面神経麻痺に対して1日平均7mgに当たるbetametha—soneを2週間投与したところ15日目より精神症状が出現した。症状は興奮と自閉，嫌人感などが断続的に出現する形で始まった。顔面神経麻痺の改善もあり，ステロイド剤は漸減していたが，精神症状はしばらくその程度が強くなり更に幻聴もみられるようになった。そこで予定より早くステロイド剤を漸減中止にもって行くとともに，haloperidolを投与した。精神症状はその後次第に軽減し，発症より40日程で消失した。

Psychotic side effects of steroids have been observed at relatively high frequency if mild cases, such as euphoria, are included, while it has been said that incidences differ among kinds of steroids. We reported a case developing severe schizophrenia-like symptoms following the treatment with betamethasone although this drug is believed to be rarely involved in steroid-induced psychosis, and its psychotic side effects have been rarely reported. When betamethasone was administered for progres-sive peripheral facial paralysis at a mean daily dose of 7mg, psychotic symptoms appeared from the 15th treatment day. Psychosis began with interrupted appearance of excitation, autism, and misanthropia. Although the steroid was gradually decreased in dose because of abatement of facial paralysis, not only psychotic symptoms were aggraveted, but also appeared hallucination. Thus the steroid was with-drawn before the scheduled date while its dose was gradually decreased, and haloperidol was adminis-tered. Psychotic symptoms were gradually eliminat-ed and completely disappeared about 40 days after onset.