A 49 year old woman presented with a severe flare up of ulcerative colitis. Intravenous hydrocortisone, aminosalicylates, and ciclosporin treatment was started, and after seven days oral prednisolone was introduced. This letter was one of a series of 12 written by the woman over the subsequent six days, and received by a member of the medical team. An examination of the patient's mental state showed a florid psychosis. Steroid psychosis is an important, but often overlooked, dose related adverse drug reaction. The onset is most common with oral steroid treatment and higher doses of steroids. This patient recovered fully after steroid withdrawal, although up to 10% of affected patients have ongoing psychiatric problems.

Samer …