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An epidemiological study by Fardet et al. (CME, p. 491) of British general practice patients who received oral glucocorticoids showed that patients who received these drugs were seven times as likely to attempt suicide as were patients with the same illness who did not receive steroids (figure). The increase was most prominent in younger people. Mania and delirium were also significantly more common, particularly in older men. Neuropsychiatric effects were more common in patients receiving higher doses and those with previous mental disorders. Brown (p. 447) notes in an editorial that this is the first large-scale study of the effects of steroids, with over 300,000 patients exposed to the drugs.