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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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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Abstract	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.
AbstractList	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.
Author	Zhang, Alexander D White, Justin B Farrell, Jessica A Lin, Yezhe Kablinger, Anita S Qi, Ansi Trestman, Robert L Sun, Ching-Fang Martin, Rachel K
Author_xml	– sequence: 1 givenname: Yezhe surname: Lin fullname: Lin, Yezhe organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 2 givenname: Alexander D surname: Zhang fullname: Zhang, Alexander D organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 3 givenname: Ching-Fang surname: Sun fullname: Sun, Ching-Fang organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 4 givenname: Justin B surname: White fullname: White, Justin B organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 5 givenname: Ansi surname: Qi fullname: Qi, Ansi organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 6 givenname: Jessica A surname: Farrell fullname: Farrell, Jessica A organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 7 givenname: Robert L surname: Trestman fullname: Trestman, Robert L organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 8 givenname: Rachel K surname: Martin fullname: Martin, Rachel K organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 9 givenname: Anita S surname: Kablinger fullname: Kablinger, Anita S organization: Lin, MD, Sun, MD, White, MD, Farrell, MD, Trestman, MD, Martin, MD, Kablinger, MD, Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Zhang, BA, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Qi, MD, Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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Copyright	Copyright © 1964–2022 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States. Copyright © 1964–2022 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States. 2022
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Snippet	Buprenorphine and naloxone (Suboxone) is a combination medication-assisted treatment (MAT) for opioid use disorder. MAT withdrawal-induced psychosis is a rare...
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SubjectTerms	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
Title	New-Onset Psychotic Symptoms Following Abrupt Buprenorphine/Naloxone Discontinuation in a Female Patient with Bipolar Disorder: A Case Report
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