ABSTRACT | PDF
CASE CONFERENCE
Mental and behavioural disorder due to use of opioids
Arnab Bhattacharya
Patient Mr. B D, 28 years old Hindu married male working as a security guard in a private bank consulted in the Psychiatry Department with chief complaints of opioid consumption, both chasing and intravenous injection route for a period of three years (increased for three months), irritability towards people and household articles, threatening to harm himself and family for the past three months. There was history of tolerance, withdrawal features, neglect of alternate pleasure associated with his substance intake and a history of needle sharing was noted. Also his interpersonal relations were hampered, his hobbies were affected, his work output at office suffered, his role functioning at home deteriorated, his social and religious activities stopped and his self care and hygiene showed decline. His biological functions also were affected especially his sleep and appetite were reduced.
There was a past history of acute gastroenteritis needing admission 15 years ago. Family history revealed depression with suicidal death in his paternal uncle. Psychosexual history showed multiple unprotected exposures to female sex workers. Physical examination showed thrombosed antecubital veins bilaterally and penile warts. Investigation showed raised liver enzymes. Mental status examination revealed anxious mood, ideas of guilt over his substance use, intact memory, orientation, impaired judgement, precontemplation motivation and level one insight.
He was admitted to psychiatry ward and begun on Inj. Multivitamin, Tab. Buprenorphine-naloxone combination thrice daily reduced later to twice daily, Cap. Ursodeoxycholic acid 450 mg daily, Tab. Quetiapine 50mg a day and Tab. Hyosine 10mg thrice daily along with appropriate counseling, psychoeducation and psychotherapy. On the above regimen he showed response in his irritability, withdrawal features, desire to take sustance and anger to his family members and his biological functions also improved.
Diagnosis was mental and behavioural disorder due to use of opioids, withdrawal state, uncomplicated (F11.30).
Author is Postgraduate Trainee of Psychiatry at Silchar Medical College Hospital, Silchar.
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