Central Nervous System Effects

Treatment with steroids may initially evoke euphoria. This reaction can be a consequence of the salutary effects of the steroids on the inflammatory process or a direct effect on the psyche. The expression of the unpredictable and often profound effects exerted by steroids on mental processes generally reflects the personality of the individual. Psychiatric side effects induced by gluco-corticoids may include mania, depression, or mood disturbances. Restlessness and early-morning insomnia may be forerunners of severe psychotic reactions. In such situations, cessation of treatment might be considered, especially in patients with a history of personality disorders. In addition, patients may become psychically dependent on steroids as a result of their euphoric effect, and withdrawal of the treatment may precipitate an emotional crisis, with suicide or psychosis as a consequence. Patients with Cushing's syndrome may also exhibit mood changes, which are reversed by effective treatment of the hypercortisolism.

The hippocampus is a principal neural target for glu-cocorticoids. It contains high concentrations of gluco-corticoid and mineralocorticoid receptors and has marked sensitivity to these hormones.

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