University of Salamanca Healthcare Complex, Psychiatry, Salamanca, Spain.
Eur Rev Med Pharmacol Sci. 2021 Jul;25(13):4554-4562. doi: 10.26355/eurrev_202107_26248.
This study's main objective is to carry out a systematic review of the onset of psychotic symptoms after opioid withdrawal. The opiate dependence correlated to psychiatric symptoms has been well described.
Following the PRISMA methodology. The consecutive search strategy was applied: (morphine OR buprenorphine OR oxycodone OR tramadol OR fentanyl OR remifentanil OR opioids OR heroin OR methadone) AND (Psychosis OR psychotic symptoms OR schizophrenia).
12 case reports, 3 series of cases, 2 clinical studies, and 2 reviews were found. It seems that the time association is present in all of them; symptoms appear days after the interruption of the opioid. Most of the articles reported are case reports that describe symptoms that appear after the suspension of the opioid substance; in most cases, the reintroduction of the opioid had therapeutic effects and provoked a remission of these symptoms. These preliminary findings indicate that opiates could have an antipsychotic effect; however, the literature is scarce. It is critical to consider, if needed, in opioid-dependent patients who start with psychosis after the opioid withdrawal the possible replacement or reintroduction of opioids to prevent further deterioration in the patient's mental status.
This study encompasses a comprehensive description of the literature concerning the possible not well-studied outcome of opioid withdrawal. There are some reports of temporal association between withdrawal and psychotic symptoms that improved after the reintroduction of the opioid; it could be taken into consideration in the clinical practice.
本研究的主要目的是对阿片类药物戒断后出现精神病症状进行系统评价。阿片类药物依赖与精神症状的相关性已有很好的描述。
遵循 PRISMA 方法。应用连续搜索策略：（吗啡或丁丙诺啡或羟考酮或曲马多或芬太尼或瑞芬太尼或阿片类药物或海洛因或美沙酮）和（精神病或精神病症状或精神分裂症）。
共发现 12 例病例报告、3 组病例、2 项临床研究和 2 篇综述。似乎所有病例都存在时间关联；症状出现在阿片类药物中断后几天。大多数报道的文章都是描述在停止阿片类物质后出现症状的病例报告；在大多数情况下，重新引入阿片类药物具有治疗效果，并促使这些症状缓解。这些初步发现表明，阿片类药物可能具有抗精神病作用；然而，文献很少。在阿片类药物依赖患者中，如果在阿片类药物戒断后出现精神病，需要考虑可能的替代或重新引入阿片类药物，以防止患者精神状态进一步恶化，这一点至关重要。
本研究全面描述了关于阿片类药物戒断后可能未被充分研究的结果的文献。有一些报告表明，戒断与精神病症状之间存在时间关联，这些症状在重新引入阿片类药物后得到改善；这在临床实践中可以考虑。
