Opiates and Psychosis: a Case of Psychosis After Methadone Withdrawal

Abstract

Introduction Opioids modulate dopaminergic transmission in the pathophysiology of psychosis. Methadone, a pure agonist opioid synthetic contains a slightly higher potency, a longer lasting duration and reduced euphoric effect. Opiates may contain beneficial effects on psychosis. We report a case of psychosis after a complete opiate withdrawal. Objectives To describe the possible antipsychotic effects of methadone on a patient who displays psychotic symptoms following the cessation of this treatment. Methods X is a 35 year old female ex-heroin addict who came into the psychiatry emergency because of a psychomotor agitation episode. The patient reported delusions and impaired sensory perception with a behavioural change coincided with the cessation of methadone treatment. Results During admission, the patient’s condition consisted of injuries and erotomanic delusions partial structure. Furthermore, there were delusional interpretations of the environment and the presence of auditory and kinesthetich hallucinations. Behaviour was disorganised and affective blunting dominated. Neuroleptic treatment was prescribed and psychotic symptoms improved progressively. Conclusions Opiate use in patients with psychosis has been linked to a reduction of psychotic symptoms and worsening in periods of abstinence. The caring of these patients should take into account these potential side effects, noting caution in times of detoxification or dose reduction that may exacerbate psychotic symptoms. Although the efficacy of methadone for the treatment of opioid dependence has been demonstrated, there remains insufficient specific scientific evidence in patients with schizophrenia and dual diagnosis. Therefore, it’s recommended that further research into this field of study is both required and necessary.