OpenHealth Q&A

Auditory Hallucinations: Investigating the Role of Prednisone or Mental Health Issues

Summary: A 65-year-old female patient, with a medical history of lupus and rheumatoid arthritis, has been treated with prednisone (initially at 60 mg, then reduced to 40 mg) for temporal arteritis. Recently, she has been experiencing auditory hallucinations and increasing paranoia for a duration of two months, with a significant escalation over the last three. She has documented instances of hiding with weapons during the night, hearing voices commanding her to assume various positions until morning, and imagining a protective figure named “Kennedy.” She continues to fear arrest while hospitalized. An MRI of her brain appears mostly normal; however, psychiatric evaluation noted possible contributing factors, while her rheumatologist attributes the symptoms to prednisone. Currently, she is being treated with risperidone (dosage increased), showing slight improvement yet still encountering hallucinations, with potential discharge forthcoming. --- My mother, aged 65, has been diagnosed with lupus and rheumatoid arthritis. She was prescribed a high dosage of prednisone, starting at 60 mg for her temporal arteritis, and has since been reduced to 40 mg. Approximately two months ago, she began expressing that she hears voices, marking the first time she has discussed this phenomenon. Over the last three months, her condition has deteriorated, manifesting alarming symptoms including paranoia, emotional flatness, substantial weight loss of over 30 pounds, and notable behavioral shifts. She has been maintaining a journal, and some of her entries are deeply concerning. In various entries, she recounts incidents of concealing herself with a hammer and knives out of fear. She writes of hearing voices urging her to be cautious of supposed cultists outside her door, commanding her to “get down NOW” and to reposition herself continuously until morning arrives. She also claims to perceive persistent sounds outside her room. Additionally, her journal includes mentions of an individual named “Kennedy,” who she conceptualizes as a protector. Her handwriting displays significant variations throughout her writings. Even while admitted to the hospital, she retains the belief that she is on the brink of being arrested. Upon her admission to the hospital initiated through a court order related to mental health, the focus was on her medical status rather than psychiatric issues. The neurologist reviewed her MRI and deemed it largely normal. In contrast, a psychiatrist assessed the MRI, indicated possible "factors at play," and suggested that psychiatric elements might also be in effect. Both specialists have proposed that reducing her prednisone might alleviate, if not fully eliminate, the hallucinations in the upcoming weeks, while her rheumatologist attributes the symptoms to the steroid treatment. While hospitalized, she has begun a regimen of risperidone, with adjustments to the dosage already made. She reports feeling a bit better, though she is still experiencing daily auditory hallucinations and is on high alert. Nonetheless, physicians mentioned the possibility of her discharge as soon as Monday or Tuesday. We conveyed to the medical team that these issues aren’t entirely new; she has had a history of being somewhat “different,” but the severity of her symptoms has intensified in the past three months. It's important to note that these symptoms began before prednisone treatment, albeit the degree of severity is new. Inquiries: - What is the typical time frame for improvement in symptoms if they are indeed related to steroid use following a tapering process? - Is it common practice to consider discharging a patient who is still presenting with hallucinations, paranoia, and has documented engaging in unsafe behaviors such as arming herself at night? - Is risperidone a standard choice for addressing hallucinations attributed to prednisone, or could there be an underlying psychiatric rationale for its use in this case?

Answers (1)

9/8/2025, 3:41:16 AM

OpenHealth AI

Initial Summary: Your mother is experiencing troubling symptoms, which could potentially stem from prednisone treatment or underlying mental health issues. It's important to closely monitor her condition, understand the expected timelines for symptom improvement, and assess the appropriateness of her treatment plan moving forward.

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Explanation: Prednisone, a corticosteroid, can have various side effects, including mood changes and psychosis, especially at higher doses or during tapering. The auditory hallucinations and paranoia your mother is experiencing may be related to her use of prednisone, particularly given the recent dosage changes. However, it’s also essential to consider any underlying psychiatric factors that could be contributing to her symptoms, especially since she had previous behavioral changes before starting prednisone.

1. Timeframe for Improvement: If the hallucinations and associated symptoms are indeed linked to prednisone, improvements may begin within a few days to weeks after reducing the dosage. However, this can vary among individuals based on their medical history and sensitivity to the medication. It's crucial to prioritize her psychiatric care alongside any changes to her prednisone regimen.

2. Discharge Considerations: Discharging a patient with ongoing hallucinations and paranoia is complex. While psychiatric symptoms can vary significantly, it's common for clinicians to consider discharge when a patient shows moderate improvement and is deemed safe for discharge. However, the safety and stability of your mother’s mental health need rigorous assessment. If she is still exhibiting unsafe behaviors or if there are concerns for her safety or the safety of others, it may be advisable to continue treatment in a secure environment until her condition stabilizes.

3. Use of Risperidone: Risperidone is a typical antipsychotic medication often used to manage hallucinations and delusions, and it may be appropriate for addressing symptoms in patients with corticosteroid-induced psychosis. The choice of risperidone might also reflect the need to provide relief for her psychiatric symptoms since these might not solely be caused by prednisone.

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Next Steps:

1. Monitor Symptom Changes: Keep a close watch on your mother's symptoms over the next few days, especially as adjustments to prednisone and risperidone are made. Document any changes in her behavior or thoughts.

2. Communicate with Medical Team: Engage openly with her healthcare providers about your concerns regarding the potential risks associated with discharge. Ask specific questions about her safety and the plan for managing hallucinations after discharge.

3. Assess Safety Measures: If discharge occurs, establish safety measures at home, such as removing sharp objects or anything she might perceive as a threat. Consider a follow-up plan for therapy or psychiatric support to ensure she continues to receive care.

4. Seek Support: Look into local mental health resources or community support groups for families dealing with similar issues. They can provide guidance and support as you navigate this challenging situation.

Your concerns and your proactive approach will be vital in supporting your mother’s recovery.