naloxone and Psychotic-Disorders

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.

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Female; Humans; Male; Naloxone; Psychotic Disorders; Substance Withdrawal Syndrome

The chemical relationships among the 3 major families of endorphins are summarized, and the CNS distribution and possible circuit functions are discussed. The overlapping distributions of enkephalin and dynorphin pathways is intriguing, and their existence in classical hippocampal pathways has implications for limbic function which are not understood. Functionally the predominant effect of these systems is 'disenabling', in contrast with the 'enabling' effects of monoamines, although specific and reversible excitatory responses in hippocampal pyramidal neurons may have important behavioral implications. The complex theoretical and methodological issues that arise in attempting to establish transmitter correlates of psychiatric disorders defy simplistic hypotheses. Endorphin research, where well established agonists and antagonists are available, illustrates the problems facing other areas of peptide research in conceptualizing a peptide related pathophysiology of the major psychoses. The structural, functional and chemical indices of hypothetical forms of endorphin pathology, and the reliability of various radio-immunoassays used now to quantify known endorphins are discussed. The complex range of behaviors produced in animals by endorphin antagonists continue to make research in this area important to psychiatry.

Topics: Animals; Brain Chemistry; Depression, Chemical; Endorphins; Enkephalins; Hippocampus; Humans; Naloxone; Neurons; Pituitary Hormones, Anterior; Pro-Opiomelanocortin; Protein Precursors; Psychotic Disorders; Pyramidal Tracts; Rats; Receptors, Opioid

The rate of substance-use disorders in patients with mental illnesses within the psychotic spectrum, such as schizophrenia, schizoaffective disorder, and bipolar disorder, is higher than the rate observed in the general population and is associated with significant morbidity and mortality. Although there are currently 3 medications approved by the Food and Drug Administration for the treatment of alcohol dependence, no medications have been approved for the specific treatment of dually diagnosed patients. A small but growing body of literature supports the use of 2 of these medications, disulfiram and naltrexone, in dually diagnosed individuals. This article outlines a review of the literature about the use of disulfiram and naltrexone for alcoholism and in patients with comorbid mental illness. In addition, results are presented of a 12-week randomized clinical trial of disulfiram and naltrexone alone and in combination for individuals with Axis I disorders and alcohol dependence who were also receiving intensive psychosocial treatment. Individuals with a psychotic spectrum disorder, including schizophrenia, schizoaffective disorder, and bipolar disorder, had worse alcohol outcomes than those without a psychotic spectrum disorder. Individuals with a psychotic spectrum disorder had better alcohol-use outcomes on an active medication compared with placebo, but there was no clear advantage of disulfiram or naltrexone or of the combination. Retention rates and medication compliance in the study were high and exceeded 80%. Pharmacotherapeutic strategies should take into account the advantages and disadvantages of each medication. Future directions of pharmacotherapeutic options are also discussed.

Topics: Adult; Alcohol Deterrents; Alcoholism; Bipolar Disorder; Combined Modality Therapy; Comorbidity; Diagnosis, Dual (Psychiatry); Disulfiram; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Motivation; Naloxone; Narcotic Antagonists; Psychotic Disorders; Schizophrenia; Treatment Outcome; Veterans

The subjects were 13 psychiatric inpatients with tardive dyskinesia. Each subject participated in two sessions. Either naloxone (10 mg) or placebo was administered intravenously during each session. In a subset of subjects (n = 7), blood samples for beta-endorphin were drawn before and at 30 and 60 minutes after the injection. The Abnormal Involuntary Movement Scale was administered before and at 10, 20, 40, 60, 120, and 360 minutes after the injection. Double-blind procedures were maintained throughout the experiment. Neither naloxone nor placebo had any appreciable effect on the involuntary movements. Naloxone elicited a significant increase in the plasma beta-endorphin.

Topics: Adult; Affective Disorders, Psychotic; Aged; beta-Endorphin; Dyskinesia, Drug-Induced; Endorphins; Female; Humans; Male; Middle Aged; Naloxone; Psychotic Disorders; Receptors, Dopamine; Schizophrenia

Topics: Bipolar Disorder; Clinical Trials as Topic; Depressive Disorder; Double-Blind Method; Endorphins; Humans; Naloxone; Naltrexone; Psychotic Disorders; Receptors, Opioid; Schizophrenia

In 20 psychotic patients with frequent hallucinations and/or actual delusional experience a possible antipsychotic action of the opiate antagonist naloxone (N-allyl-noroxymorphone) was investigated, using a double-blind placebo-controlled cross-over design. 18 of these patients were not treated with neuroleptic drugs; 13 suffered from an acute episode of schizophrenia. Psychopathological changes were assessed by the use of the IMPS-scale and of a symptom-specific rating scale (VBS). Intravenous injection of naloxone (in most cases 4.0 mg) induced a reduction of psychotic symptomatology (especially hallucinations) in the majority of patients. Compared with placebo this effect reached statistical significance within 2-7 hours after injection. From this result a possible involvement of endogenous ligands of opiate receptors in the pathogenesis of schizophrenia may be concluded.

Topics: Adult; Aged; Antipsychotic Agents; Clinical Trials as Topic; Double-Blind Method; Female; Hallucinations; Humans; Male; Middle Aged; Naloxone; Placebos; Psychiatric Status Rating Scales; Psychotic Disorders; Time Factors

The distribution of naloxone to heroin users is a suggested intervention to reduce overdose and death rates. However, the level of willingness of drug users to administer this medication to others is unclear. Drug users recruited from the community between January 2002 and January 2004 completed a structured interview that assessed topics including drug use, overdose history, and attitudes toward using overdose remedies to assist others. Of the 329 drug users, 82% had used heroin and 64.3% reported that they had injected drugs. Nearly two thirds (64.6%) said that they had witnessed a drug overdose and more than one third (34.6%) had experienced an accidental drug overdose. Most participants (88.5%) said that they would be willing to administer a medication to another drug user in the event of an overdose. Participants who had used heroin (p = .024), had injected drugs (p = .022), had witnessed a drug overdose (p = .001), or had a history of one or more accidental drug overdoses (p = .009) were significantly more willing to treat a companion who had overdosed. Drug users were willing to use naloxone in the event of a friend's overdose. Specific drug use and overdose histories were associated with the greatest willingness to administer naloxone.

Topics: Adolescent; Adult; Cocaine; Cocaine-Related Disorders; Drug Overdose; Female; Friends; Helping Behavior; Heroin; Heroin Dependence; Humans; Interpersonal Relations; Male; Naloxone; Narcotic Antagonists; Psychotic Disorders

Topics: Adult; Aged; Depressive Disorder; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Male; Naloxone; Narcotic Antagonists; Preanesthetic Medication; Psychotic Disorders; Treatment Outcome

Topics: Adult; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Naloxone; Pilot Projects; Progesterone; Psychotic Disorders; Testosterone

The main achievements in the field of genetics, biochemistry, and immunology of schizophrenia in the laboratories of European research centers are surveyed. Despite the rapid development of scientific research techniques and methodology, the abundant hypotheses on the pathogenesis of schizophrenia are riddled with so many contradictory facts that it is impossible to formulate any concrete model of the disease. One factor impeding the progress of biological research in schizophrenia is the inadequate development of standardized clinical descriptions. This is an obstacle to the study of clinical-biological correlates, which are among the principal criteria used to verify the importance of biological parameters chosen for study in the pathogenesis of the disease. A current strategy in the biology of schizophrenia, which may obviate some of those problems, is the discovery and study of biological markers.

Topics: Brain; Brain Chemistry; Dopamine; Endorphins; Environment; Europe; Genetic Markers; HLA Antigens; Humans; Hydroxyindoleacetic Acid; Male; Models, Genetic; Monoamine Oxidase; Naloxone; Norepinephrine; Prolactin; Psychotic Disorders; Receptors, Dopamine; Schizophrenia

Plasma prolactin (PRL), cortisol, and growth hormone (GH) were measured before, and at 15-min intervals for 1 hr after, electroconvulsive therapy (ECT). This was repeated over a series of 6 consecutive treatments for each of 12 depressed drug-free inpatients. Patients received naloxone, 2 mg or 20 mg, by intravenous infusion before the third and fifth treatment. ECT was consistently followed by a release of PRL and cortisol, although two patterns of PRL response could be distinguished. In eight patients, the PRL response did not change significantly with repeated ECT, whereas in four patients, the plasma PRL increased tenfold after the first treatment and decreased after each successive treatment. The GH level varied widely, with no evidence of a reliable response to ECT. Opiate receptor blockade with low- or high-dose naloxone did not alter the release of PRL or cortisol after ECT. These findings demonstrate a reliable PRL and cortisol response to ECT, but do not support a role for endogenous opiates in these hormonal changes.

Topics: Adult; Aged; Depressive Disorder; Dose-Response Relationship, Drug; Electroconvulsive Therapy; Female; Growth Hormone; Humans; Hydrocortisone; Male; Middle Aged; Naloxone; Premedication; Prolactin; Psychiatric Status Rating Scales; Psychotic Disorders; Receptors, Opioid

Topics: beta-Endorphin; Depressive Disorder; Double-Blind Method; Endorphins; Humans; Hydrocortisone; Naloxone; Prolactin; Psychotic Disorders; Psychotropic Drugs; Receptors, Opioid; Schizophrenia

A woman with a schizophreniform syndrome, drug-induced dyskinetic movements, and partial adrenocortical 21-hydroxylase deficiency was given short-term treatment with naloxone, which ameliorated the psychiatric symptoms and eliminated the dyskinetic movements.

Topics: Adrenal Hyperplasia, Congenital; Adult; Dyskinesia, Drug-Induced; Female; Humans; Naloxone; Psychiatric Status Rating Scales; Psychotic Disorders; Steroid 21-Hydroxylase; Steroid Hydroxylases

The authors conducted a double-blind placebo-controlled study in which patients with a wide range of manic symptoms were administered 20 mg of naloxone subcutaneously. Naloxone failed to improve manic severity, activation-arousal, or elation-grandiosity for intervals up to 3 hours. Global nurse ratings of mania did not improve over an 8-hour period. The authors suggest that the question of endorphin involvement in mania has not been resolved and recommend clinical studies with longer acting oral narcotic antagonists such as naltrexone.

Topics: Affective Disorders, Psychotic; Bipolar Disorder; Double-Blind Method; Humans; Naloxone; Psychotic Disorders

Topics: Animals; Haloperidol; Haplorhini; Humans; Macaca; Male; Methadone; Morphine; Naloxone; Opioid-Related Disorders; Prolactin; Psychotic Disorders; Receptors, Dopamine

The potencies of beta h-endorphin, Met (O)5-beta h-endorphin, and synthetic Leu5-beta h-endorphin have been compared in three bioassays of opioid activity, and in two radioimmunoassays. In all assays, a peptide isolated from hemodialysates from a psychotic patient behaved like Leu5-beta h-endorphin; it has been distinguished unambiguously from beta h-endorphin and Met(O)5-beta h-endorphin. Leu5-beta h-endorphin was one-fifth as potent as beta h-endorphin in guinea pig ileum myenteric plexus, but was only slightly less active in mouse vas deferens and in guinea pig brain opiate receptor binding assay. The low cross-reactivity of Leu5-beta h-endorphin relative to beta h-endorphin with an antiserum raised to beta-endorphin suggests that the preferred solution conformations of these peptides are different. In all bioassays beta h-endorphin was 2- to 3-fold less potent than beta c-endorphin.

Topics: Animals; Brain; Endorphins; Gastrointestinal Motility; Guinea Pigs; Humans; Ileum; Male; Mice; Molecular Conformation; Naloxone; Psychotic Disorders; Radioimmunoassay; Receptors, Opioid; Sodium; Vas Deferens

Topics: Cyclazocine; Heroin; Heroin Dependence; Humans; Naloxone; Psychotic Disorders