Anabolic steroids-induced delirium: A case report
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Anabolic steroids are commonly used by athletes, body builders, and young adults to improve muscle strength. Deleterious effects of anabolic steroids on physical health are well-established. Psychiatric aspects are of particular importance and includes psychosis, delirium, mania, depression, and aggression.

A 33-year-old gentleman with no family history of mental illness, previously diagnosed as bipolar disorder in 2018, was brought to the emergency department of a general hospital after his colleagues found him in a confused state in his apartment. He presented with altered level of consciousness and displayed disorganized and agitated behavior in terms of entering a female cubicle and trying to take another patient's mobile phone, damaging an intravenous drip stand, taking a hook from the wall and damaging the tap of an oxygen supply, which was managed by physical and chemical restraints. His manager reported that he was absent from work for three days and that he found anabolic steroids in his apartment. He was then transferred to the psychiatric inpatient unit for further management, with a provisional diagnosis of substance-induced confusion.

At the beginning of his admission, his mental state examination was significant for labile affect, irrelevant speech, derailment, flight of ideas, and persecutory delusions. He was on high risk one-to-one observations precautions and nursing team have reported disorganized behavior in terms of eating cigarettes, tried to burn his genitals with cigarettes, jumping over the nursing station, unable to dress himself, tried to use the female nursing staff washroom, talkativeness, and disturbed sleeping pattern, in addition to altered level of sensorium throughout the day. He was vitally stable and he had a BMI of 29. Physical examination was unremarkable except for testicular atrophy. He also reported taking tadalafil 20 mg for erectile dysfunction.

Past psychiatric history is significant for 1 similar episode in 2018 for which patient was admitted in a psychiatric hospital under the impression of bipolar disorder and was discharged on sodium valproate 2 g daily, olanzapine 20 mg daily, haloperidol 5 mg twice daily, and procyclidine 5 mg BID. He took the medications for 3 months and stopped them because of sedation and weight gain. Collateral history obtained from parents were negative for manic symptoms.

Substance use history is positive for anabolic steroids. He took 5 courses of injectable testosterone propionate and cyprionate, and trenbolone acetate from the age of 21 for bodybuilding purposes. Last had the injectable in May 2019. He described 1 course as 100 to 200 mg daily for 90 days. One month prior this admission he used to take metandienone tablets 20 mg daily.

He was managed as a case of anabolic steroids induced delirium. Treatment comprised mainly antipsychotics, although at the start of his presentation in the emergency department he necessitated multiple as needed parenteral benzodiazepines and antipsychotics. He was discharged on Haloperidol 7.5 mg and Quetiapine 700 mg daily and left to his home country.

Physicians and psychiatrists alike should be aware of the dimensions of use of AAS and the complex connection between neuropsychiatric and behavioral presentation.

Source: https://journals.lww.com/md-journal/subjects/Mental Health/Fulltext/2020/08140/Anabolic_steroids_induced_delirium__A_case_report.61.aspx
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