I was working in the ER when a very nice middle-aged woman came in complaining of cough. Her work up showed me that she had an acute exacerbation of asthma, which prompted me to prescribe her a short burst of steroids.    

Less than 48 hours later, the triage nurse brought me a chart.  There was a middle age woman waiting to be seen with a very scared teenage daughter. The woman was pulling her hair, trying to take off her clothes and telling everyone that “they” were coming to get her. The daughter said that her mother was acting “very weird.” She didn’t know what to do, so she brought her mom to the ER.  

Just as we finished our conversation the mother raced out of the room, past the nurses station and was heading to the ambulance entrance.  She was loudly shouting words that made no sense.  She proceeded into the ambulance bay, where she laid down on the pavement, rolled around and took off her top, exposing her bare chest to the cold winter air.

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 After covering the woman up, my team and I were able to interact with her and talk her back into the ED. Her teenage daughter stood crying and worried about her mom. This was the woman for whom I had prescribed steroids.  She had steroid induced psychosis!  

We treated her that day, and she was later discharged. The woman and daughter came back a few months later, this time with the daughter as the patient.  The woman did not remember the psychosis episode at all, but her daughter did. The woman now lists steroids as one of her allergies.  

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