Steroid Psychosis Case

Case 3: John Fast is a 26 year-old profession athlete
                 A 26 year-old male professional athlete began taking steroids surreptiously to improve strength. He had had a successful 4-year career, was well thought of as a “team player” and had no prior psychiatric history. After 3 months of steroid use he developed the belief that he was the strongest person in the world,  began spending lavishly and then developed the conviction that he was being persecuted by the team general manager because of jealousy and other players’ inability to accept his superiority. His behavior became increasingly erratic and his performance declined dramatically. He was referred for psychiatric evaluation and a diagnosis of substance induced (steroid) bipolar disorder, manic phase (also referred to as “steroid psychosis”) was made. After treatment and cessation of steroid use he returned to baseline.

                One year later he began worrying that his performance was declining and re-instituted steroid usage. He initially performed well but as the season progressed he became irritable, demanding and aggressive with teammates. He insulted the team owner and general manager and was quoted in the newspaper. At his insistence he was traded, despite the fact that his wife and children opposed the plan. At home he was often irritable and argumentative. This was initially attributed to the stress of adapting to a new city and team but the pattern ultimately persisted.