Delusional disorder joined opioid dependence

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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
7Psychologist
Substance Abuse Research Center, Department of Psychiatry,
Shiraz University of Medical Sciences; Shiraz; Iran
*Corresponding author
Jamshid Ahmadi
Email: Jamshid_Ahmadi@yahoo.com
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
INTRODUCTION
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.
CASE PRESENTATION:
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
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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
better.
RESULTS:
Delusional disorder or major depressive
disorder could be followed by opium consumption or
accompanied with opium utilization.
DISCUSSION:
These findings suggest that opium might bring
forth delusional disorder/major depressive disorder or
joined delusional disorder/major depressive disorder.
CONCLUSION:
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.
Acknowledgement:
Beforetime fraction of these findings has been
adopted for printing elsewhere.
Conflict of interests: None
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