A Case of Psychosis Following Delayed Encephalopathy of Transdermal Fentanyl Intoxication / 대한정신약물학회지

ABSTRACT

Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action. Recently, there have been many case reports that overuse or misuse of fentanyl patch resulted in fatal intoxication. Delayed hypoxic leukoencephalopathy typically manifests 2 to 40 days after apparent recovery from hypoxic event, and patients suffer from cognitive impairment, upper motor neuron signs, gait disturbance, or psychosis. We report first case of delayed encephalopathy with psychotic symptoms after overuse of fentanyl patch. Patient was found to have respiratory failure and mental change due to transdermal fentanyl overdose. She made a complete recovery in 2 weeks. After 4 weeks of the event, she readmitted with declining mental status. At 30 weeks after overdose, she complained of auditory and visual hallucination and showed paranoid delusion and odd behavior. Since admission into psychiatric unit, her psychotic symptoms have improved with antipsychotics. In conclusion, fentanyl patch should be used in order to prevent psychotic symptoms as well as medical complications.