Anabolic steroids
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Anabolic steroids Various toxicities: case report
A 33-year-old man developed delirium, disorganised and agitated behaviour, flight of ideas, talkativeness, hostility, destructive impulses and testicular atrophy during treatment with testosterone cipionate, testosterone propionate, metandienone and trenbolone acetate [not all routes and outcomes stated; not all dosages and durations of treatments to reactions onsets clearly stated]. The man, who was diagnosed with bipolar disorder in 2018, was brought to hospital after being found in a confused state. At the emergency department, he exhibited altered level of consciousness, hostility, destructive impulses and showed disorganised and agitated behaviour (increased aggression) in terms of taking a hook from the wall and damaging the tap of an oxygen supply, damaging an IV drip stand, entering a female cubicle and trying to take another patient’s mobile phone, which was managed by chemical and physical restraints. His manager stated that he was absent from work for 3 days and that anabolic steroids were found in his apartment. He was subsequently shifted to the psychiatric inpatient unit with a provisional diagnosis of substance-induced confusion. At the time of initial admission, his mental state examination was remarkable for labile affect, flight of ideas, persecutory delusions, irrelevant speech and derailment. He was on high risk one-to-one observations precautions and the nursing team reported disorganised behaviour in terms of eating cigarettes, jumping over the nursing station, trying to use the female nursing staff washroom, trying to burn his genitals with cigarettes, unable to dress himself, disturbed sleeping pattern and talkativeness, in addition to altered level of sensorium throughout the day. He also mistook the female occupational therapist for his mother and tried to kiss her feet. His physical examination was insignificant except for testicular atrophy. He had been receiving tadalafil for erectile dysfunction. His psychiatric history was significant for one similar episode in 2018, for which he had been admitted to a psychiatric hospital under the impression of bipolar disorder. He had been discharged on procyclidine 5mg BID, sodium valproate 2 g/day, haloperidol 5mg BID and olanzapine 20mg daily. However, he subsequently developed weight gain and sedation secondary to these medications, leading to their discontinuation after 3 months. During his current admission, substance use history was positive for anabolic steroids. He received 5 courses of injectable testosterone propionate, testosterone cypionate [testosterone cyprionate] and trenbolone acetate since the age of 21 years for bodybuilding purposes. He received his last injection in May 2019. One course comprised 100 to 200 mg/day for 90 days. One month before this admission, he used to take metandienone tablets 20 mg/day. He was managed considering a diagnosis of anabolic steroid-induced delirium. He was mainly treated with antipsychotics, although during initial admission, he required mu
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