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Ali A Sulais

King Fahd Specialist Hospital- Dammam, Saudi Arabia

Presentation Title:

Opioid-induced mania in a sickle cell disease patient with major depressive disorder: A case report and literature review

Abstract

Opioids are well-known potent analgesics. They act mainly through μ-opioid receptors in the brain; and they also have an inhibitory effect on serotonin and noradrenalin reuptake centrally, thus, increasing their levels. Considering that Selective Serotonin Reuptake Inhibitors (SSRIs) act in a similar way, concurrent use of SSRIs and opioids can induce mania.

In this report, we discuss a patient known to have sickle cell disease with frequent painful crises managed with opioids, namely Tramadol, Pethidine and morphine. Additionally, the patient has unipolar depressive disorder and was taking Paroxetine. There was no history of mania until few weeks prior to her current atypical presentation which coincided with her escalating misuse of opioids. She was brought to the emergency department with mixed features of depression and mania with bouts of severe agitation. She was admitted to the psychiatric ward; her medical workup and brain imaging were unremarkable. 

She was diagnosed with bipolar disorder type 1 with the possibility of opioid induced mania.  Her management was challenging especially with her comorbid opioid misuse. She was stabilized on Aripiprazole, education about the importance of proper and cautious use of opioids was conducted to the patient and her family. The case, alongside with comprehensive review of literature, highlights the importance of careful inquiry of concurrent opioid use in chronic painful conditions as well as adjunct use of antidepressants. Also, it emphasizes the need to conduct longitudinal studies of effects opioids may exert on mood and behavior especially in individuals with mental and chronic pain disorders.

Biography

Ali A Sulais has completed his bachelor degree in Medicine and Surgery as well as his Psychiatry residency in the Kingdom of Saudi Arabia. He is currently a Child and Adolescent Psychiatry Fellow at McGill University in Montreal, Canada.