Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 27;52(3):72-80.

New-Onset Psychotic Symptoms Following Abrupt Buprenorphine/Naloxone Discontinuation in a Female Patient with Bipolar Disorder: A Case Report

Yezhe Lin  1 , Alexander D Zhang  1 , Ching-Fang Sun  1 , Justin B White  1 , Ansi Qi  1 , Jessica A Farrell  1 , Robert L Trestman  1 , Rachel K Martin  1 , Anita S Kablinger  1
Affiliations
Review

New-Onset Psychotic Symptoms Following Abrupt Buprenorphine/Naloxone Discontinuation in a Female Patient with Bipolar Disorder: A Case Report

Yezhe Lin et al. Psychopharmacol Bull. .

Abstract

Buprenorphine and naloxone (Suboxone) is a combination medication-assisted treatment (MAT) for opioid use disorder. MAT withdrawal-induced psychosis is a rare clinical presentation. To our best knowledge, only three reports have summarized the characteristic manifestations of buprenorphine withdrawal psychosis, yet all of them were male. In this case report, we present a 41-year-old female patient with bipolar disorder and comorbid substance use disorder who developed new-onset psychosis and relapse of manic symptoms following abrupt discontinuation of Suboxone. Manic and psychotic symptoms remitted after a short-term hospitalization with the treatment of an antipsychotic and a mood stabilizer. In addition to discussing this case presentation and treatment approach, we review existing literature and discuss possible underlying mechanisms to enhance understanding of this clinical phenomenon.

Keywords: buprenorphine; mania; psychosis; substance-withdrawal; two-hit hypothesis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Differential Diagnoses Among Substance-Induced Psychotic Disorder, Bipolar Disorder with Psychotic Features, and Primary Psychotic Disorder. (Positive symptoms were in Bold)
See this image and copyright information in PMC

References

    1. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug Use and Health. Annals of internal medicine . 2017;167:293–301. - PubMed
    1. Walsh SL, Nuzzo PA, Babalonis S, Casselton V, Lofwall MR. Intranasal buprenorphine alone and in combination with naloxone: Abuse liability and reinforcing efficacy in physically dependent opioid abusers. Drug Alcohol Depend . 2016;162:190–198. - PMC - PubMed
    1. Harris DS, Jones RT, Welm S, Upton RA, Lin E, Mendelson J. Buprenorphine and naloxone co-administration in opiate-dependent patients stabilized on sublingual buprenorphine. Drug Alcohol Depend . 2000;61:85–94. - PubMed
    1. Elkader A, Sproule B. Buprenorphine. Clinical Pharmacokinetics . 2005;44:661–680. - PubMed
    1. Emrich HM, Vogt P, Herz A. Possible antidepressive effects of opioids: action of buprenorphine. Annals of the new York Academy of Sciences . 1982;398:108–112. - PubMed

MeSH terms