Methadone Withdrawal-Induced Psychosis: A Case Report.

Methadone is a synthetic full µ-opioid receptor agonist and N-methyl-D-aspartate antagonist given to patients who have recently stopped using illicit opioids or are tapering off chronic opioid pain medication. Maintenance treatment with methadone is today the most widespread and effective way to treat opiate addiction, which achieves abstinence, decreases morbidity and mortality, improves quality of life, and reduces crime genesis, among other benefits. It is also approved by the Food and Drug Administration for treating moderate-to-severe pain that remains unresponsive to nonopioid medications. Patients sometimes abruptly discontinue the medication for several reasons and sometimes suffer distressing but non-life-threatening withdrawal symptoms. More common withdrawal symptoms include anxiety, agitation, rhinorrhea, nausea, and vomiting, like other opioid agonist medications. Psychosis has been reported in some rare cases of methadone withdrawal. However, more research is required because, although psychotic symptoms have been described in different case reports after the reduction or withdrawal of methadone, they have not been sufficient. This case report contributes to the literature on rare manifestations of psychosis in patients who abruptly discontinue the use of methadone.

Immune Thrombocytopenic Purpura Associated With Systemic Lupus Erythematosus, Helicobacter pylori, and Hepatitis B.

Immune thrombocytopenic purpura (ITP) is a hematologic condition characterized by decreased circulating platelets, resulting in bruising, bleeding gums, and internal bleeding. This disorder can be categorized into two primary forms based on the duration of symptoms and underlying causes. Acute ITP primarily affects young children, typically between the ages of two and six, but it can also impact older children and adults. Viral infections like chickenpox, respiratory infections, or gastroenteritis often precede it. Acute ITP manifests suddenly and lasts for a short period, typically less than six months and sometimes only a few weeks. On the other hand, chronic ITP primarily affects adults but can occur at any age, including childhood and adolescence. The main characteristic of chronic ITP is the persistence of symptoms for more than six months. It can be either idiopathic (primary), with no discernible etiologic cause, or secondary to various conditions such as autoimmune diseases (e.g., systemic lupus erythematosus), viral infections (e.g., human immunodeficiency virus (HIV), hepatitis C virus (HCV)), certain malignancies (e.g., chronic lymphocytic leukemia), or drug reactions. This case report presents the management of a 36-year-old African American female diagnosed with ITP associated with systemic lupus erythematosus, Helicobacter (H.) pylori, and hepatitis B infection.

Psychosis as a Manifestation of Focal Impaired Awareness Seizure in a Geriatric Patient.

Focal impaired awareness seizures (FIAS), previously known as complex partial seizures, refer to focal seizures that start in one hemisphere of the brain and are associated with an impairment in consciousness. FIAS of temporal lobe origin most often present with psychopathology, such as behavioral and affective symptoms. It has a bimodal age distribution peaking at the extremes of life. Geriatric presentations can often be subtle and go unnoticed asides from a few symptoms, such as confusion and memory lapses. Here, we present a unique case of a geriatric patient with FIAS presenting as transient psychosis.

Extensive Soft Tissue Swelling in the Larynx and Hypopharynx of a Young Female Patient After Haloperidol Use: A Case Report on Angioneurotic Edema.

Angioneurotic edema is a potentially life-threatening condition characterized by the rapid swelling of subcutaneous and submucosal tissues of the upper respiratory and gastrointestinal tracts. It may result in laryngeal edema, thus obstructing the airway, with a potentially fatal outcome if not diagnosed early. An allergic reaction typically causes it, but certain drugs can induce or contribute to the development of angioneurotic edema in rare cases. Haloperidol is one of the most commonly used antipsychotics to treat psychiatric disorders such as schizophrenia and, in the emergency room, acute delirium and acute psychosis. While it is generally well tolerated, in rare cases, individuals may experience a severe reaction in response to haloperidol administration. Here, we present the case of angioneurotic edema associated with intramuscular haloperidol use in a 29-year-old female patient with a history of bipolar disorder and no previous history of allergy. This case report aims to raise awareness among clinicians about this rare adverse reaction associated with haloperidol use.

Rebound Catatonia Associated With Injectable Paliperidone.

Paliperidone is an atypical antipsychotic medication commonly used to treat schizophrenia, schizoaffective disorder, and bipolar disorder. It is a metabolite of risperidone and has a similar mechanism of action, primarily blocking dopamine 2 receptors (D2 receptors) in the brain. Paliperidone has various adverse effects, including extrapyramidal symptoms, weight gain, and metabolic disturbances. Catatonia is rare but severe side effects can occur in the context of an underlying psychiatric, neurologic, or general medical condition. Paradoxically, antipsychotics for treating schizophrenia or bipolar spectrum disorders can precipitate or worsen catatonic symptoms. The report suggests that 17-19% of all cases diagnosed as catatonia due to other medical conditions are medication-induced. Catatonia is a neuropsychiatric syndrome that presents as a cluster of psychomotor signs and symptoms resulting in movement and behavior aberrations. Various symptoms, including mutism, stupor, rigidity, and abnormal movements, characterize catatonia. Catatonia is a potentially life-threatening condition requiring prompt recognition and management. Here, we present a case of a patient with catatonia associated with long-acting injectable paliperidone intramuscular therapy in a patient with schizophrenia.

Lithium-Induced Sialorrhea.

Lithium is a mood stabilizer frequently used in psychiatry to treat bipolar disorder. Because lithium has a narrow therapeutic index, it requires frequent monitoring for its toxicity. Lithium toxicity requires monitoring of serum lithium and clinical assessment by clinicians. Sialorrhea, also known as excessive drooling, hypersalivation, or ptyalism, is common among psychiatric patients. Sialorrhea, an infrequent and embarrassing side effect of lithium, has been reported at varying serum levels, either at subtherapeutic or in the normal range. Here, we present the case of a patient with sialorrhea associated with oral lithium therapy at the subtherapeutic serum level.