Abstract

Obsessive-compulsive disorder (OCD) has a prevalence of approximately 2% and in rare instances, can be induced by medications. Previously, lamotrigine, clozapine and olanzapine have been associated with inducing obsessive-compulsive symptoms. Corticosteroids can also cause various psychiatric side effects, although obsessive-compulsive symptoms are rarely observed as an adverse effect. To date, there has been scant literature available on dexamethasone-induced obsessive-compulsive disorder. The recommended treatment in cases of dexamethasone-induced obsessive compulsive and related disorders is corticosteroid discontinuation. In previous case reports, Selective Serotonin Re-uptake Inhibitors (SSRI) medications have been used as an adjunct therapy, especially if the patient requires continuous corticosteroid therapy to maintain medical stability. Due to the rarity of dexamethasone-induced OCD and the inherent limitations of a case report, there would be benefit from future research to further investigate these findings. In our patient, he had previously taken two subsequent 6-day courses of dexamethasone 4 mg daily, in the context of dental surgery complications with no prior symptoms of OCD experienced. Three days after the last dose of dexamethasone, he started a third course of dexamethasone 4 mg daily and developed obsessive thoughts about dying on the same day. He recovered spontaneously after 5 days of steroid discontinuation with no return of psychiatric symptoms at outpatient follow up 11 days later. This is the first case report of spontaneously resolved dexamethasone-induced OCD from low dose steroids in an adult patient without any prior psychiatric history or structural brain pathology.

Introduction

Obsessive compulsive disorder (OCD) is diagnosed by the presence of obsessions (unwanted, repetitive thoughts causing distress) and/or compulsions (repetitive physical or mental acts meant to reduce the distress experienced by the obsessions). The lifetime prevalence of OCD is 1.6–۲٫۳% and the specific pathophysiology responsible for OCD remains unclear (Brock and Hany, 2023). However, current theories include neurotransmitter imbalance, sequelae of structural brain injury, and medication use. In previous literature, substance/medication-induced obsessive-compulsive symptoms have been documented from high dose corticosteroids (Grabe et al., 1998; Scheschonka et al., 2002), anti-psychotics (Fonseka et al., 2014), mood stabilizer medications (Sharma and Doobay, 2019) and stimulants (Jhanda et al., 2016). In patients with schizophrenia, clozapine and olanzapine was found to induce de-novo obsessive-compulsive symptoms in 20–۲۸% and 11–۲۰% of patients respectively (Fonseka et al., 2014). Lamotrigine was also noted to induce obsessive-compulsive symptoms in a case series of 8 patients with bipolar disorder (Sharma and Doobay, 2019). However, there is no amalgamated prevalence rate of medication-induced OCD in the literature.

Conclusion

Here we present a unique case of low-dose dexamethasone-induced obsessive-compulsive and related disorder with sudden onset after taking the first dose of a third course of dexamethasone treatment, and abrupt resolution of symptoms 5 days after stopping the medication. Our patient was not started on regular or as needed mood stabilizers or anti-psychotic medication as he did not show overt signs of mania or psychosis in the acute inpatient setting. In cases of OCD induced by dexamethasone, the recommended treatment from currently available literature includes steroid cessation, with a gradual taper if taking a high dose. If corticosteroids cannot be discontinued, the initiation of fluvoxamine or fluoxetine can be considered. This is the first case report of dexamethasone-induced obsessive compulsive related disorder from low dose steroids in an adult patient without any prior psychiatric history or structural brain pathology.