Cases That Test Your Skills

Paranoia and slowed cognition

Author and Disclosure Information



Mr. K is poorly compliant with his psychotropics, which include divalproex, 1,000 mg/d, and olanzapine, 30 mg/d. Although he is discharged home with his family, his functional capacity is less than expected and he requires continuous support. Insisting that Mr. K abstain from steroids after the first psychiatric hospitalization might have prevented this seemingly irreversible dementia.

Related Resources

  • Sacks O, Shulman M. Steroid dementia: an overlooked diagnosis? Neurology. 2005;64(4):707-709.
  • Cipriani G, Picchi L, Vedovello M, et al. Reversible dementia from corticosteroid therapy. Clinical Geriatrics. 2012;20(7):38-41.

Drug Brand Names

  • Diphenhydramine • Benadryl
  • Divalproex • Depakote
  • Haloperidol • Haldol
  • Lamotrigine • Lamictal
  • Lithium • Eskalith, Lithobid
  • Lorazepam • Ativan
  • Memantine • Namenda
  • Methotrexate • Rheumatrex, Trexall
  • Mirtazapine • Remeron
  • Olanzapine • Zyprexa
  • Prednisone • Deltasone, Meticorten, others


The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.


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