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Rare presentation of intrathecal morphine withdrawal psychosis. 2017

Rohit Aiyer, and Vivek Jain, and Anurag Bhatia, and Boris Mekinulov, and Semih Gungor
Department of Psychiatry, Hofstra Northwell Health - Staten Island University Hospital, Staten Island, NY, USA.

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.

UI MeSH Term Description Entries
D007278 Injections, Spinal Introduction of therapeutic agents into the spinal region using a needle and syringe. Injections, Intraspinal,Injections, Intrathecal,Intraspinal Injections,Intrathecal Injections,Spinal Injections,Injection, Intraspinal,Injection, Intrathecal,Injection, Spinal,Intraspinal Injection,Intrathecal Injection,Spinal Injection
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009020 Morphine The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. Morphine Sulfate,Duramorph,MS Contin,Morphia,Morphine Chloride,Morphine Sulfate (2:1), Anhydrous,Morphine Sulfate (2:1), Pentahydrate,Oramorph SR,SDZ 202-250,SDZ202-250,Chloride, Morphine,Contin, MS,SDZ 202 250,SDZ 202250,SDZ202 250,SDZ202250,Sulfate, Morphine
D011605 Psychoses, Substance-Induced Psychotic organic mental disorders resulting from the toxic effect of drugs and chemicals or other harmful substance. Psychoses, Drug,Psychoses, Toxic,Substance-Induced Psychoses,Toxic Psychoses,Drug Psychoses,Psychoses, Substance Induced,Substance Induced Psychoses
D003702 Delusions A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. Delusion
D006212 Hallucinations Subjectively experienced sensations in the absence of an appropriate stimulus, but which are regarded by the individual as real. They may be of organic origin or associated with MENTAL DISORDERS. Hallucination of Body Sensation,Hallucinations, Auditory,Hallucinations, Dissociative,Hallucinations, Elementary,Hallucinations, Formed, of People,Hallucinations, Gustatory,Hallucinations, Hypnagogic,Hallucinations, Hypnapompic,Hallucinations, Internal Body Sensation,Hallucinations, Kinesthetic,Hallucinations, Mood Congruent,Hallucinations, Mood Incongruent,Hallucinations, Olfactory,Hallucinations, Organic,Hallucinations, Reflex,Hallucinations, Sensory,Hallucinations, Somatic,Hallucinations, Tactile,Hallucinations, Verbal Auditory,Hallucinations, Visual,Hallucinations, Visual, Formed,Hallucinations, Visual, Unformed,Auditory Hallucination,Auditory Hallucination, Verbal,Auditory Hallucinations,Auditory Hallucinations, Verbal,Body Sensation Hallucination,Body Sensation Hallucinations,Dissociative Hallucination,Dissociative Hallucinations,Elementary Hallucination,Elementary Hallucinations,Gustatory Hallucination,Gustatory Hallucinations,Hallucination,Hallucination, Auditory,Hallucination, Dissociative,Hallucination, Elementary,Hallucination, Gustatory,Hallucination, Hypnagogic,Hallucination, Hypnapompic,Hallucination, Kinesthetic,Hallucination, Mood Congruent,Hallucination, Mood Incongruent,Hallucination, Olfactory,Hallucination, Organic,Hallucination, Reflex,Hallucination, Sensory,Hallucination, Somatic,Hallucination, Tactile,Hallucination, Verbal Auditory,Hallucination, Visual,Hypnagogic Hallucination,Hypnagogic Hallucinations,Hypnapompic Hallucination,Hypnapompic Hallucinations,Kinesthetic Hallucination,Kinesthetic Hallucinations,Mood Congruent Hallucination,Mood Congruent Hallucinations,Mood Incongruent Hallucination,Mood Incongruent Hallucinations,Olfactory Hallucination,Olfactory Hallucinations,Organic Hallucination,Organic Hallucinations,Reflex Hallucination,Reflex Hallucinations,Sensory Hallucination,Sensory Hallucinations,Somatic Hallucination,Somatic Hallucinations,Tactile Hallucination,Tactile Hallucinations,Verbal Auditory Hallucination,Verbal Auditory Hallucinations,Visual Hallucination,Visual Hallucinations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000701 Analgesics, Opioid Compounds with activity like OPIATE ALKALOIDS, acting at OPIOID RECEPTORS. Properties include induction of ANALGESIA or NARCOSIS. Opioid,Opioid Analgesic,Opioid Analgesics,Opioids,Full Opioid Agonists,Opioid Full Agonists,Opioid Mixed Agonist-Antagonists,Opioid Partial Agonists,Partial Opioid Agonists,Agonist-Antagonists, Opioid Mixed,Agonists, Full Opioid,Agonists, Opioid Full,Agonists, Opioid Partial,Agonists, Partial Opioid,Analgesic, Opioid,Full Agonists, Opioid,Mixed Agonist-Antagonists, Opioid,Opioid Agonists, Full,Opioid Agonists, Partial,Opioid Mixed Agonist Antagonists,Partial Agonists, Opioid
D001416 Back Pain Acute or chronic pain located in the posterior regions of the THORAX; LUMBOSACRAL REGION; or the adjacent regions. Backache,Back Ache,Back Pain with Radiation,Back Pain without Radiation,Vertebrogenic Pain Syndrome,Ache, Back,Aches, Back,Back Aches,Back Pains,Backaches,Pain Syndrome, Vertebrogenic,Pain Syndromes, Vertebrogenic,Pain, Back,Pains, Back,Syndrome, Vertebrogenic Pain,Syndromes, Vertebrogenic Pain,Vertebrogenic Pain Syndromes

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