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Delusional disorder joined opioid dependence

Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online)
Sch. J. App. Med. Sci., 2015; 3(9D):3387-3390 ISSN 2347-954X (Print)
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Case Report
Delusional disorder joined opioid dependence
JamshidAhmadi1, Ali Sahraian2, Sareh Shariati3, Fatemeh Ghanizadeh Kazerooni4, Zahra Mehdipour5,
Maryam Rayatpisheh6, Saeed Samani7
1Professor of Psychiatry
2Associate Professor of Psychiatry
3,4,5Resident of Psychiatry
6General Physician
Substance Abuse Research Center, Department of Psychiatry,
Shiraz University of Medical Sciences; Shiraz; Iran
*Corresponding author
Jamshid Ahmadi
Abstract: Delusional disorder allied with opioid dependence is a proceeding conundrum. The main objective is to
portray a patient with delusional disorder affiliated with opioid dependence. In results opioid can persuadeor exist with
delusional disorder. In discussion our findings imply that opioid may evoke delusional disorder or be linked to delusional
disorder. In conclusion to our understanding there is not ample information on this issue, and this conclusion might sum
up a prominent concept to the literature.
Keywords: Delusional disorder; Opioid
Opioids such as methadone are synthetic
preparations of opium. Opium has a long history of
medical utilization on the earth [1, 2, 3]. Methadone is a
pure agonist of opioid mu receptor [1], but
buprenorphine is a partial agonist and has ceiling, hence
its use has less possibility of overdose and also has little
physical dependence. Methadone and buprenorphine
lessen the incidence of HIV and other issues which are
consequences of opiate dependence. Methadone is
absorbed very well after oral use but buprenorphine is
well absorbed after sublingual administration, reaching
60%70% of the plasma concentration, but poorly
absorbed when administered orally [4, 5, 6, 7, 8, 9, 10].
Nowadays, prevalence of physical and mental
diseases is ascending in the world [11-30]. Among
mental disorders, substance related disorders, especially
opioids and stimulants connected disorders are moving
up universally. At present, opioids and stimulants
associated mental problems are a growing riddle and
have caused more referrals to inpatient and outpatient
units [31-73].
We are now going to demonstrate a homicidal
patient with delusional disorder who slayed his wife. To
our understanding, there are not ample published
reports on this matter; hence, this report may disclose a
new finding.
We portray a homicidal patient with
impression of delusional disorder assorted with opium
dependence. The case was a retired married late forty
year man with primary school education. He lived with
his family in Fars province located in the south of Iran.
The patient began smoking opium once a while since 5
years prior to hospital admission, then step by step
raised the frequency of opium utilization.
Patient bit by bit developed depression after
appearing of a rough compulsive thought of
unfaithfulness of his wife 2 years prior to hospital
admission. He stepwise developed jealousy and
paranoid delusions, suicidal thoughts, irritability, and
insomnia. In this 2-year period he was brought to a
number of psychiatrists and they advised for admission
in psychiatric hospital but he refused to be admitted.
The patient’s condition was becoming worse
since 5 months prior to admission in which he had a
harsh argument with his wife and murdered her with
knife. Then he was incarcerated. In jail he took
methadone for the treatment of opium dependence.
JamshidAhmadi et al., Sch. J. App. Med. Sci., December 2015; 3(9D):3387-3390
Since he had suicidal attempts in the prison, he was
referred to the psychiatric hospital and was admitted.
During psychiatric interview and mental status
examinations he had depressed mood, suicidal thoughts,
severe agitation, restlessness, paranoid thoughts and
insomnia. In precise physical and neurological
examinations there were not, any abnormal findings.
Urine drug tests were positive for methadone
and benzodiazepine. Serology tests for viral markers
(HIV, HCV and HB Ag) were within normal limit.
According to the medical, psychiatric, and substance
use history and also DSM-5 criteria, he was initially
assumed as major depressive disorder associated or
related to opioid dependence.
During admission, he received methadone 15
mg per day for the treatment of opioid withdrawals,
sertraline 150 mg, propanolol 20 mg, sodium valproate
600 mg, doxepin 50, lorazepam1 mg per day for the
treatment of depression and agitation.
Since he did not responded well to the
prescribed medications, consultation was done with
some experts whom their first impression was
delusional disorder, followed by major depressive
disorder as the second impression.
Electro convulsive therapy (ECT) was started
for the treatment of delusion, agitation, suicidal
thoughts and depression. In addition to ECT, patient
received venlafaxine (extended release form) 225 mg
per day and sertraline was discontinued. After taking 11
sessions of ECT, patient’s condition became much
Delusional disorder or major depressive
disorder could be followed by opium consumption or
accompanied with opium utilization.
These findings suggest that opium might bring
forth delusional disorder/major depressive disorder or
joined delusional disorder/major depressive disorder.
To our knowledge and understanding there is
not ample data on this topic, and this conclusion might
sum up a distinguished concept to the literature.
Beforetime fraction of these findings has been
adopted for printing elsewhere.
Conflict of interests: None
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... In regard to psychiatric disorders, substance induced disorders and substance use disorders, have been reported as moving forward problems. Nowadays, psychiatric presentations to the psychiatric inpatient and outpatient centers and general hospitals are advancing problems [6][7][8][9][10][11][12][13][14][15][16]. Now we are explaining our patient who began abusing substance at age of eight. ...
Background: Severe substance use disorder in children is rare. Objective: To scrutinize the beginning severe substance use disorder in the period of childhood. Method: To report and discuss an admitted patient with an extensive, and early-onset, history of poly-substance use and mental disorder at age of eight. Results: The current report displays severe substance use disorder which occurred in childhood. Discussion: This report illuminates that substance use disorder in childhood can induce severe psychiatric disorders in adolescence and early adulthood. So, these findings can add new data to the literature. Conclusions: It can be concluded that extensive, early-onset poly substance abuse in childhood induce severe psychiatric disorders in the adolescence and adulthood.
Background: Misuse of zolpidem tablets is an unusual enigma. Objective: To illuminate the possibility of zolpidem misuse. Results: This vignette displays that some patients ill-use zolpidem tablets to turn high. Discussion: Our sketch implies that some patients misuse zolpidem to go high. Therefore, this report could significantly add to the literature. Conclusions: We reached to this issue that some people misuse zolpidem to reach high. So, healthcare workers, especially physicians should be conscious of possibility of zolpidem misuse when advising this hypnotic medication.
Background: Buprenorphine administration is accompanied with speedy-acting antidepressant effects. Objective: To describe the antidepressant potentials of buprenorphine. Discussion: Buprenorphine has rapid-acting and continuous antidepressant properties. Buprenorphine intake is associated with enhanced psychoactivity and demotion in depression. Regulation of mood and emotion are seen following buprenorphine administration. Most of the time buprenorphine is well tolerated. Conclusion: Buprenorphine use can be safe and has fast-acting and continuous antidepressant effects.
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Background: Administration of high dose buprenorphine is associated with rapid-acting anti-depressive and ant-suicidal effects. Objective: To examine the effect of high dose buprenorphine on the refractory major depression with severe suicidal tendencies. Method: In the current study we tested the competency of buprenorphine for the treatment of depression and suicide. Results: High dose buprenorphine was resulted to fast treatment of refractory depression and suicide. Moreover, promotion in psychoactivity, high demotion in depression, regulation of emotion and mood, were observed following buprenorphine administration. Buprenorphine was well tolerated as well. Discussion: Our results illuminated that buprenorphine has rapid and sustained antidepressive potentials. These findings should be replicated in randomized, placebo-controlled, double-blind trials. Conclusion: This report indicated that a single high dose of buprenorphine appears to be clinically effective and safe. Our study advises that a single high dose buprenorphine can provide a speedy, simple and safe means of treatment of depression and suicide. Usage of a single high dose of buprenorphine appears to concerns about compliance, and also to diminish the chance of buprenorphine being diverted for abuse. As yet fast-acting and sustained antidepressive effects of a high dose of buprenorphinehave not been printed, hence this result could be a significant addition to the literature.
Background: Although alcohol use disorders and induced disorders are common in the world, however, only few medications, naltrexone, acamprosate, disulfiram, topiramate and baclofen are recommended for the reduction and cessation of alcohol withdrawal craving. Therefore it is required to develop new medications. Objective: To test the efficacy of low dose of buprenorphine on the reduction or cessation of alcohol withdrawal craving. Method: To evaluate the competence of four mg of buprenorphine in the treatment of alcohol craving in a case. Results: Buprenorphine administration was associated with ending of alcohol craving. In addition, buprenorphine was well endured. Discussion: Our findings demonstrated that buprenorphine has fast-acting and sustained anti-alcohol craving properties. This effect should be replicated in randomized, double-blind, placebo-controlled trials. Conclusion: To our understanding obvious effect of buprenorphine in this condition has not been issued yet.
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Introduction: The aim of this study is to describe the use of electroconvulsive therapy (ECT) in the treatment of methamphetamine-induced withdrawal delirium and craving in a single case. Case presentation: A 44-year-old male presented to the hospital in Fars province, Iran, with Methamphetamine-Induced Withdrawal Delirium who responded to ECT. Conclusions: The electroconvulsive therapy can be a suitable option for the treatment of methamphetamine withdrawal delirium and craving. Also, it can be usefully employed in these very serious conditions which may represent a risk to life.
Full-text available
Heroin abuse is a universal problem. The main objective is to demonstrate the benefits of low doses of clonidine, baclofen and ibuprofen (NSAID) in the management of heroin abuse. The method was to appraise blindly a single patient. In results usage of clonidine 0.3 mg, baclofen 75 mg and ibuprofen 1200 mg per day is very beneficial in the treatment of heroin withdrawal symptoms and craving. Our data display that low dosage of clonidine, baclofen and ibuprofen (NSAID) is very useful in the treatment of heroin abuse. This is an influential finding. In conclusion to author understanding this finding is a substantial addition to the literature.
Full-text available
Background: Hashish abuse and hashish induced disorders are common in the world Objective: To present an interesting patient with hashish-induced olfactory hallucination. Results: Our patient developed olfactory hallucination after hashish abuse. Discussion: Hashish commonly induces auditory or visual hallucinations. Our case developed olfactory hallucination which may be finding rarely. Therefore this case-study represents a novel and significant information. Conclusion: Hashish caused olfactory hallucination, so this case-study adds an innovative and important finding to the literature.
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Abstract: At present, methamphetamine abuse is a considerable problem. To present usefulness of ECT in the management of methamphetamine induced psychosis.ECT can be a good choice in the treatment of this serious condition. Keywords: ECT, methamphetamine.
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Objective: The objective of this study was to assess the prevalence of addiction to the Internet, computer games, DVD, and video and its relationship to anxiety and depression in a sample of Iranian high school students. Methods: In this cross-sectional study 1020 high school students (males and females) were selected randomly from different areas of Shiraz city in southern Iran. They were interviewed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) criteria. Results: About 50% of the students were females, 277 students (27.2%) were studying in the first year of high school, 242 (23.7%) were in the second year, and others in the third year. The prevalence of anxiety was significantly higher in females than in males (p < 0.05). The prevalence of anxiety was lower among students of the third year (p < 0.05). The prevalence of depression was significantly higher in students with lower economic status defined as family monthly income. Internet dependence was seen only in 5 students. The prevalence of anxiety was significantly higher in the students who used internet for chatting, amusement, and reading news (p < 0.05). The prevalence of anxiety was significantly higher in students who were DVD or video CD dependents (p < 0.05). The students who used especial drugs or had especial diseases had higher rates of depression and anxiety (p < 0.05). Conclusion: Internet addiction may cause depression and anxiety in high school students. It seems necessary to develop an Internet addiction prevention program for adolescents taking into account the psychological factors such as depression and Internet use habits.
Background: In recent years there has been an increasing trend towards psychoactive substance use among youth, especially medical students. Aims: To assess Dubai Medical College for Girls students’ attitudes towards substance use and their use of substances. Participants: One hundred and three female medical students were selected randomly and were evaluated. Measurements: A confidential questionnaire was distributed, completed by the students and collected in the same sessions in 2007. Results: Of the subjects, 8.92% reported usage of substance(s) once or more sometime during their lives. Only 4.90% were currently using substance. The most common reason for initiation of substance use was to find out what it was like for most of the substances. The majority of the students reported religion as the most important reason for not using substances. Most of the students reported radio/television and newspaper/magazine as the usual source of information about substances. Conclusions: Tobacco was found to be the most prevalent form of substance use. There was no report of ecstasy, cocaine, LSD or heroin use. Drug use among Dubai Medical College students is much lower than that reported in the West.
Severe psychosis induced by methamphetamine abuse is a growing problem in the world. We report the usefulness of Electro Convulsive Therapy (ECT) as an alternative option in the management of methamphetamine psychosis. Our findings indicated that ECT was beneficially employed in the treatment of severe methamphetamine psychosis. This case illustrates although medications could be effective in treating methamphetamine psychosis, however, ECT is more useful and also faster than medications. This is an interesting result. In addition to our understanding we might say that ECT could be an appropriate option in the treatment of methamphetamine psychosis, therefore this experience of an Iranian patient could add innovative information to the literature.
Background: Heroin dependency is a globally problem. Objective: To explain the efficacy of low dose of clonidine, tizanidine and ibuprofen (NSAID) in the treatment of heroin dependency. Method: To evaluate a single case Results: Combination of clonidine 0.4 mg, tizanidine 8 mg and ibuprofen 800 mg per day is very effective in the management of heroin withdrawal symptoms and craving. Discussion: Our findings indicate that low dose of clonidine, tizanidine and ibuprofen (NSAID) is beneficial in the treatment of heroin dependency. This is a positive result. Conclusion: To the author’s knowledge positive effects of combination of clonidine, tizanidine and ibuprofen in these situations have not been published yet, and this finding is an important addition to the literature.
Objective: To assess the pattern of cocaine and heroin abuse in a sample of Iranian general population. Methods: Participants: 1400 subjects aged 15 years or older selected randomly in a household survey. Semi-structured interview by a questionnaire and a structured interview based on DSM-IV criteria for cocaine and heroin dependence and abuse. Results: The majority (35.9%) were in the age range of 15 to 24, 27.4% in 25 to 34, 17.6% in 35 to 44 and only 3.9% were older than 65 years. Of the subjects, 7 (0.5%) admitted the use of cocaine once or more during their lives [6 (0.9%) were men and 1 (0.1%) was a woman]. 2 (0.1%) were cocaine abuser [2 (0.3%) were men and none was woman]. 1(.07%) was cocaine dependent [1 (0.1%) was a man and there were no women]. The most common reason reported for initial cocaine use was curiosity, and for current use was seeking pleasure. Of the subjects, 39 (2.8%) admitted the use of heroin once or more during their lives [35 (5%) were men and 4 (0.6%) were women]. 8 (0.6%) were heroin occasional abusers [6 (0.9%) were men and 2 (0.3%) were women]. 22 (1.6%) were heroin dependent [18 (2.6%) were men and 4 (0.6%) were women). Use of heroin was significantly related to gender. The most common reason reported for initial heroin use was curiosity, and for current use, seeking pleasure. Conclusions: This study could be considered for planning preventive and therapeutic governmental programs.