Psychosis following Tramadol Withdrawal
Patient was an unemployed 30-year-old single male with high school diploma from Kerman and was admitted in Beheshti Hospital for the first time. The reason for his referral was severe agitation and anxiety in past week following sudden tramadol cessation. He said that the cause of his agitation and anxiety was fear of the security police force that had been following and threatening him and wanted to kidnap him. He also believed that some black points were formed in his memory and he could see god in television and could see some tiny creatures around him. He also had some severe withdrawal symptoms as rhinorrhea, epiphora, nausea, diarrhea, musculoskeletal pains, tremors, tic in his shoulders and head, agitation, headache, and sleeplessness.\nHe had a history of heroin and opiate addiction for several years and during cessation started using tramadol. After complete heroin and opiate cessation about 2 years ago, he was taking 300mg of tramadol per day until a week ago when he suddenly stopped taking tramadol and was referred to this center with the above mentioned symptoms. In his history there was no evidence of opioid abuse in past 2 years. He had no family history of any specific mental or physical illness.\nIn psychological examination, he was well alert and had time, place and person orientation. His concentration and attention was reduced. He was anxious and had normal affection. Restlessness was revealed in his psychomotor examination.\nHe had persecutory delusion, delusional mood, and first stage of trema, and had Lilliputian hallucinations.\nNeurological examination was normal and EEG, brain CT scan, and MRI showed no organic abnormalities. Based on DSM-IV, tramadol withdrawal syndrome was considered at the admission and psychosis following drug cessation was the differential diagnosis. The patient was treated with analgesic, sedative, and hypnotic drugs but antipsychotic was not prescribed. After 3 days all physical and mental symptoms including hallucinations and delusions completely subsided. Therefore tramadol cessation diagnosis was confirmed and psychosis following drug withdrawal syndrome was ruled out.