Affective symptoms are one of the most common psychiatric side effects associated with corticosteroids treatment (Manzo et al., 2018). Specifically, short-term and high doses, particularly above 40 mg of prednisone per day, are more likely to trigger such symptoms. Among corticosteroid-induced psychiatric symptoms, what kind of patients under corticosteroids develop manic and/or psychotic symptoms and which risk factors are associated with their development remain unclear. Steroid psychosis is a condition characterized by psychiatric symptoms that emerge after using certain medications called corticosteroids. This uncommon side effect can cause symptoms ranging from subtle mood shifts to more pronounced psychotic features. Background ~5% of patients on ≥40 mg daily of prednisone have psychiatric symptoms [1] Incidence rises to just under 20% for patients receiving more ≥80 mg per day Mechanism unproven but thought to be increased dopamine due to induction of tyrosin hydroxylase by corticosteroids [2] Clinical Features Time of onset variable Steroid-induced psychosis represents a severe psychiatric adverse effect that can occur shortly following treatment with high-dose glucocorticoids. Clinicians who prescribe these therapies must be alert to their potential for adverse effects, including psychiatric manifestations. Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania. Conversely, long-term therapy tends to induce depressive symptoms. Corticosteroids are commonly used for pain management and inflammatory conditions but can cause neuropsychiatric complications ranging from anxiety to severe mood and psychotic symptoms. Learn about steroid-induced psychosis, a rare side effect of corticosteroids causing mood changes, paranoia, and more. Includes causes, symptoms, and treatment. These agents are known to induce psychiatric adverse effects, ranging from subtle mood changes and memory deficits to frank psychosis (2,3). This Fast Fact will focus on the identification and management of corticosteroid-induced psychosis. Systemic corticosteroids, taken orally or by injection, are the class of medications most commonly associated with triggering psychosis. Agents like prednisone, methylprednisolone, and dexamethasone carry the highest risk for causing these side effects.