title: Psychosis After Switch in Opioid Maintenance Agonist and Risperidone-Induced Pisa Syndrome: Two Critical Incidents in Dual Diagnosis Treatment.
abstract: OBJECTIVE
  Dual diagnosis commonly occurs among patients with an opioid use disorder. Treatment is ideally performed in an integrated fashion. We present a case that illustrates the complex and challenging psychiatric and medical therapy of such patients in the light of the literature.
  
  
  METHODS
  We report on a 56-year-old patient with schizophrenia and opioid dependence who experienced both risperidone-induced Pisa syndrome and, 3 years later, acute psychosis after switching the opioid substitution medication from methadone to slow-release oral morphine due to QT prolongation.
  
  
  CONCLUSIONS
  With the current availability of a diversity of substitution opioids in Switzerland (methadone, buprenorphine, diacetylmorphine, sustained-release oral morphine), studies on differential effectiveness of these agents in opioid-dependent subpopulations with selective comorbidity profiles are desirable. The same is true for further investigation of the involvement of the opioid receptor system in schizophrenia. In clinical practice, any alteration of opioid medication in patients with dual diagnosis and a history of schizophrenia should be accompanied by close observation for psychotic symptoms.
authors.affiliation: a Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Sutter
authors.affiliation: a Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Walter
authors.affiliation: a Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Dürsteler
authors.affiliation: a Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Strasser
authors.affiliation: a Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Vogel
mesh_terms: D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D017831:Diagnosis, Dual (Psychiatry); D057915:Drug Substitution; D004421:Dystonia / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced; D008691:Methadone / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D011605:Psychoses, Substance-Induced / Q000209:etiology*; D018967:Risperidone / Q000009:adverse effects*; D012559:Schizophrenia / Q000188:drug therapy; D013577:Syndrome
chemical_list: D000701:Analgesics, Opioid; D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D009020:Morphine; D018967:Risperidone; D008691:Methadone
keywords: Pisa syndrome; QT prolongation; Schizophrenia; comorbidity; methadone; opioid maintenance treatment; opioid use disorder; risperidone; slow release morphine; substance use disorder