EPA-1011 - A case series of codeine cough syrup induced psychotic illness in a national addictions management service

Abstract

Introduction Codeine Induced Psychotic Disorder is a poorly characterized illness but is increasingly being reported amongst cough mixture abusers. A study done in Hong Kong found that substance induced psychotic disorder is the most common psychiatric diagnosis amongst cough mixture abusers. Objectives/Aims We aim to describe the clinical characteristics of patients referred to our National Addictions Management Service with a diagnosis of Substance Induced Psychotic Disorder secondary to Codeine cough syrup use. Methods A retrospective audit of clinical records was done for patients seen at our National Addictions Management Service from Apr 2007 to Mar 2013 with a diagnosis of Substance Induced Psychotic Disorder secondary to codeine use. Patients with a prior primary psychotic disorder diagnosis were excluded from the study. Results 11 patients (9 male, 2 female) out of a total of 48 patients with substance induced psychotic disorder had used codeine cough syrup. 4 of the patients had concomitantly used other substances as well. The age range of the patients was 28-45 yrs with a mean of 37.3 yrs. The duration of hospitalization during their psychotic episode ranged from 4-38 days with a mean of 13.5 days. 10 out of 11 patients were started on antipsychotics at baseline. At the end of a one year follow up period, two patients had their diagnosis revised to that of schizophrenia. Conclusions Codeine Induced Psychotic disorder is increasingly being seen amongst codeine abusers and more research is needed to better characterize this condition and determine the biological mechanisms behind it.