Psychosis Following Tramadol Withdrawal: a Case Report

Abstract

Tramadol withdrawal symptoms are either natural (typical) or unnatural (atypical). In this context, psychotic symptoms as atypical Tramadol withdrawal symptoms have been rarely reported. A case report and review of literature by a research on medline database. Key words: 'psychosis', 'psychotic symptoms', 'tramadol withdrawal', 'opiate withdrawal' Mr. A. L. is 35 years-old man with a past medical history of alcohol dependence and cannabis abuse. He was admitted in 2012 for an alcoholic pancreatitis. Following this episode he began taking 650 mg/d of tramadol. He was put on Acetaminphen, clorazepate and paracetamol. When he started tapering Tramadol, he began experiencing auditory and cenesthetic hallucinations. He presented in our outpatient unit with restlessness, grandiosity thoughts, messianic delusions and sleeplessness. He was treated with antipsychotic medication and could stop taking Tramadol a week after his first consultation. After 8 days mental symptoms including hallucinations and delusions persisted. Therefore the diagnosis of Tramadol-induced Psychotic disorder with onset during withdrawal was the most likely diagnosis. Neurological examination was normal and brain CT scan showed no organic abnormalities. There is evidence that only a few patients with tramadol dependency are susceptible to atypical withdrawal symptoms. Atypical withdrawal symptoms may include severe anxiety, panic attacks, unusual CNS symptoms such as confusion, delusion, derealization, depersonalization, paranoid thoughts, visual and auditory hallucinations. There have been some reports in the literature on psychotic episodes related to opiate withdrawal but only one previous case with Tramadol.