Lastly, we agree that glucocorticoid treatment is a marker of disease severity and that it is difficult to differentiate its accountability on neuropsychiatric disorders occurrence to that of the disease severity itself. We addressed this issue in the Discussion section of our article. However, the effects of glucocorticoids can be separated from those of disease severity only in a randomized controlled trial that includes people with similar levels of disease severity receiving either glucocorticoids or placebo—an ethically unacceptable design. Drs. Meduri and Shih cite three studies regarding the link between some diseases (e.g., asthma, chronic obstructive pulmonary disease, and polymyalgia rheumatica) and depression (2–4). In these studies, the link between these diseases and a higher risk of depression is not as clear, and a direct link between glucocorticoids used to treat the somatic illness and the occurrence of depression has been raised (2, 3). In our study, we found a much stronger association between glucocorticoid exposure and mania or delirium/confusion than between glucocorticoid exposure and depression. This supports the view that glucocorticoids have a role in inducing neuropsychiatric disorders.