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Michael G. Wise, MD; Stephen K. Brannan, MD; Stephen B. Shanfield, MD; Frederick G. Moeller, MD
The University of Texas Health Science Center at San Antonio

JAMA. 1988;260(23):3437.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The review article by Drs House and Thompson¹ is a welcome addition to the transplantation literature. As psychiatrists who are often asked to consult on transplant recipients, we are glad to see this publication.

We would like to emphasize two important postoperative psychiatric problems that warrant further discussion. First, severe psychiatric disturbances (eg, mania, severe depression, psychosis, and delirium) can develop in up to 10% of patients treated with large doses of steroids.² When mood alterations occur, most patients will experience mood elevation. For example, within the last month we have seen two cardiac transplant recipients with steroid-induced mania. Management of these patients involves reduction of the dosage of steroids, if possible. When steroid dosage cannot be reduced, treatment with lithium works well in the management of drug-induced mania, in our experience. Lithium treatment can also be started prophylactically³ when steroid therapy must be . . . [Full Text PDF of this Article]

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