Methadone withdrawal psychosis – case report

Abstract

Introduction Opiates's substitution therapy with methadone is one of the main approaches used for drug-addicted patients, in Portugal. The symptoms of withdrawal of methadone are the same as the classical abstinence syndrome of opiates. In a minority of cases, withdrawal of methadone has been related to the sudden appearance of affective disorders and to a minor degree with psychotic disorders. Objectives The authors propose to do a brief literature review about methadone and it is neuromodulation in central opiate-dopamine system. Aims The authors intend to report a clinical case illustrative of a psychosis possible related to methadone rapid withdrawal, in a 39-year-old woman without previous personal or familiar psychiatric illness, except for the use of toxic substances. Methods Literature review in scientific databases – Pubmed; ScienceDirect. Case report of a patient admitted in Psychiatry Department of Vila Nova de Gaia Hospital Center. Results During admission, the patient's condition consisted of disorganized behavior, paranoid delusions and the presence of auditory hallucinations. Was excluded other possible causes of psychotic conditions and was admitted rapid methadone detoxification as the probable etiology. Neuroleptic treatment was prescribed and psychotic symptoms improved progressively. Conclusions In test animals, the behavioral effects of methadone withdrawal have been related to its effects on cerebral amines, especially on dopamine. A change in the neuromodulation of the central opiate-dopamine systems, due to opiates's substitution therapy with methadone, could be related to psychotic pathogenesis. This work supports other authors that suggest that methadone withdrawal can cause psychosis in individuals without previous psychiatric conditions.