This article is a concise refreshment for psychiatrists to update their knowledge and understanding of corticosteroid-induced psychiatric symptoms. It summarises the diverse presentation associated with this clinical phenomenon, how frequently it occurs and some pathophysiological considerations. There is a focus on early identification and management, highlighting the importance of an integrated multidisciplinary approach, withdrawal or reduction of the corticosteroid treatment and adjunctive psychotropic medication options for clinicians to consider.

Until 2003 the long case was the clinical component of the two summativeexaminations for the Membership of the Royal College of Psychiatrists(MRCPsych). This changed to an Objective Structured Clinical Examination(OSCE) format, initially for the Part I examination, and more recently tothe Clinical Assessment of Skills and Competencies (CASC) at the end of 3years of basic training. Although there are distinct advantages to theobjective, competency-based assessment, questions remain on its validity.The expectation that formative workplace-based assessments would fill in thevoid left by the loss of the long case has not materialised. The options forretaining the advantages of the long case within the CASC framework whileminimising the shortcomings of the CASC are suggested as a way forward.