This case report and literature review investigates steroid-induced nocturnal hallucinations in a 58-year-old female patient with rheumatoid arthritis receiving corticosteroid treatment. Corticosteroids like prednisolone, commonly used for inflammatory and autoimmune disorders, are recognized for infrequently inducing harmful mental consequences. This report details a patient on a daily regimen of 20 mg of prednisolone who experienced strong auditory and visual hallucinations primarily throughout the night, resulting in considerable sleep disturbance. A thorough assessment, comprising blood testing and a brain MRI, ruled out organic disease and validated a diagnosis of steroid-induced psychosis. The prompt cessation of prednisolone, in conjunction with short-term benzodiazepine therapy, led to a fast alleviation of hallucinations and stability of mental condition. The discourse underscores the dose-dependent correlation between corticosteroid administration and psychotic symptoms, indicating that steroids can alter neurotransmitter equilibrium and disrupt the hypothalamic-pituitary-adrenal axis, leading to cognitive and emotional disturbances, even in individuals without prior psychiatric conditions. The paper further contrasts current findings with earlier studies, observing that although steroid-induced psychosis is infrequent, its manifestation can range from minor mood alterations to severe hallucinations and delusions. These data highlight the significance of early diagnosis and multidisciplinary therapy in patients undergoing corticosteroid treatment, with the objective of reducing unfavorable outcomes and improving overall patient well-being. This instance underscores the necessity for doctors to meticulously observe patients receiving steroid medication for initial indications of neuropsychiatric problems. The incorporation of prompt psychiatric assessment and adjustment of steroid protocols can markedly enhance therapeutic results and protect overall patient quality of life.

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