Rare presentation of intrathecal morphine withdrawal psychosis.
We report a case of a 57-year-old male patient with intrathecal morphine pump failure who presented with psychosis as part of a clinical presentation of opioid withdrawal. The patient was being treated for chronic back pain with an intrathecal morphine pump for several years. The patient spontaneously started to experience psychotic symptoms which included disorganized thinking, delusional thoughts, paranoia, auditory and visual hallucinations. Upon interrogation of intrathecal pump, it was found not to be functioning, thereby not delivering intrathecal morphine. After opioid rotation with administration of oral oxycodone, the patient's psychosis improved dramatically within a few days, clinically confirming psychosis due to morphine withdrawal. Therefore, it is important for physicians to consider opioid withdrawal in patients experiencing isolated psychosis.
Department of Psychiatry, Hofstra Northwell Health - Staten Island University Hospital, Staten Island, NY, USA.
Rohit
R
Aiyer
Department of Psychiatry, Hofstra Northwell Health - Staten Island University Hospital, Staten Island, NY, USA.
Vivek
V
Jain
Department of Anesthesiology, Hofstra Northwell Health - Staten Island University Hospital, Staten Island, NY, USA.
Anurag
A
Bhatia
Department of Psychiatry, Hofstra Northwell Health - Staten Island University Hospital, Staten Island, NY, USA.
Boris
B
Mekinulov
Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical School, New York, NY, USA.
Semih
S
Gungor
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001416:Back Pain / Q000188:drug therapy; D059350:Chronic Pain / Q000188:drug therapy; D003702:Delusions / Q000139:chemically induced* / Q000188:drug therapy; D006212:Hallucinations / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011605:Psychoses, Substance-Induced / Q000175:diagnosis* / Q000188:drug therapy; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000188:drug therapy
D000701:Analgesics, Opioid; D009020:Morphine
intrathecal morphine pump; opioid withdrawal; psychosis