New-Onset Psychotic Symptoms Following Abrupt Buprenorphine/Naloxone Discontinuation in a Female Patient with Bipolar Disorder: A Case Report

Buprenorphine and naloxone (Suboxone) is a combination medication-assisted treatment (MAT) for opioid use disorder. MAT withdrawal-induced psychosis is a rare clinical presentation. To our best knowledge, only three reports have summarized the characteristic manifestations of buprenorphine withdrawa...

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Bibliographic Details
Published in:	Psychopharmacology bulletin Vol. 52; no. 3; pp. 72 - 80
Main Authors:	Lin, Yezhe, Zhang, Alexander D, Sun, Ching-Fang, White, Justin B, Qi, Ansi, Farrell, Jessica A, Trestman, Robert L, Martin, Rachel K, Kablinger, Anita S
Format:	Journal Article
Language:	English
Published:	United States MedWorks Media Global 27-06-2022
Subjects:	Adult Antipsychotic Agents - therapeutic use Bipolar Disorder - drug therapy Buprenorphine - adverse effects Buprenorphine, Naloxone Drug Combination - therapeutic use Complicated Case History Female Humans Male Naloxone - adverse effects Psychotic Disorders - drug therapy Substance Withdrawal Syndrome - drug therapy Substance Withdrawal Syndrome - etiology buprenorphine two-hit hypothesis psychosis substance-withdrawal mania
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Summary:	Buprenorphine and naloxone (Suboxone) is a combination medication-assisted treatment (MAT) for opioid use disorder. MAT withdrawal-induced psychosis is a rare clinical presentation. To our best knowledge, only three reports have summarized the characteristic manifestations of buprenorphine withdrawal psychosis, yet all of them were male. In this case report, we present a 41-year-old female patient with bipolar disorder and comorbid substance use disorder who developed new-onset psychosis and relapse of manic symptoms following abrupt discontinuation of Suboxone. Manic and psychotic symptoms remitted after a short-term hospitalization with the treatment of an antipsychotic and a mood stabilizer. In addition to discussing this case presentation and treatment approach, we review existing literature and discuss possible underlying mechanisms to enhance understanding of this clinical phenomenon.
ISSN:	0048-5764 2472-2448