Quetiapine Therapy for Corticosteroid-Induced Mania
Bibliographic record
Abstract
Dear Editor: Corticosteroids are routinely used for immunosuppression in patients who have received liver transplants (1). Mood symptoms and psychosis have long been documented as potential adverse effects of corticosteroid treatment (2). We report a case of corticosteroid-induced mania that followed a liver transplant and that resolved with quetiapine therapy. A white man, aged 52 years, was admitted for a liver transplant. The donor was his biological brother. Approximately 5 years previously, he had been diagnosed with hepatitis B and hepatitis C. He had no psychiatric history; however, his daughter had been diagnosed with bipolar disorder. After the transplant, the patient was given methylprednisolone 50 mg intravenously every 6 hours (4 doses) and then 40 mg intravenously for an additional 4 doses. Cumulatively, he received more than 250 mg of steroids before the onset of behavioural symptoms. On postoperative day 3, psychiatry was consulted because he was talking incessantly, preoccupied with hyperreligious themes, and making hypersexual comments. He claimed that he was a prophet and that he could speak different languages; his speech contained numerous neologisms. He was grandiose and claimed to posses spiritual powers that enabled him to sense different pleasant odours. He refused to divulge his name for security reasons. He had not slept for the last 2 days. He was not physically aggressive or agitated. The Young Mania Rating Scale (YMRS, 3) was used to assess symptom severity; his total score was 31, indicative of mania. On a mental status examination, he was poorly groomed and disrobed repeatedly, but he was awake, alert, cooperative, and oriented as to place, person, and time. He displayed pressure of speech and rambling speech with incoherent narration, neologisms, and loose associations. His mood was significantly elevated and euphoric. His thought content revealed grandiose delusions, ideas of reference, and hyperreligious themes. His attention, concentration, insight, and judgment were poor. The presumptive diagnosis was steroidinduced mania. A CT scan of the head on postoperative day 3 was unremarkable. He had a benign neurological examination; there was no evidence of infection; and laboratory values were within normal limits. The patient was started on quetiapine 25 mg at bedtime and 12.5 mg as needed twice daily. Within 10 hours of quetiapine therapy, his mental status gradually improved. His YMRS score was less than 5 at discharge. His thought process and concentration improved significantly. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".