Severe cases of corticosteroid-induced psychosis are relatively rare, but can happen. People who start to notice unusual bursts of energy, sadness, and other strange mood changes on steroids may want to discuss this with the practitioner who prescribed the medication. An evaluation can determine if the patient appears to be developing a psychiatric problem, and can help with decision making about how to proceed with treatment. For patients who need to be on medication in the long term to treat a chronic condition, it is important to be aware that psychiatric symptoms could emerge at any time, although they are more common when first starting out on corticosteroids.
Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.
The physical examination should include a complete medical and mental status examination. Tachycardia or severe hypertension may indicate drug toxicity or thyrotoxicosis; fever may suggest encephalitis or porphyria. 18 Physical signs suggestive of underlying diagnoses include cushingoid appearance in certain endocrinopathies, arthritic deformities in autoimmune disorders, or movement and gait disturbances in conditions such as multiple sclerosis and Parkinson disease. 37 The neurologic examination should assess for focal signs, sensory deficits, myoclonus, or tremors. Tendon reflexes, cranial nerve testing, and ophthalmologic examination are important if a brain lesion, infection, or metabolic disease is suspected.