SIMULTANEOUS ABUSE WITH OVERDOSE OF LONG-ACTING RISPERIDONE AND BUPRENORPHINE/NALOXONE IN A NEWLY DIAGNOSED PATIENT WITH BIPOLAR DISORDER: A CASE REPORT

Yıl 2024, Sayı: 1, 22 - 28, 14.03.2024

Neriman Aras

Öz

Background: Atypical antipsychotics are used for the treatment of alcohol-substance use disorders as well as various psychiatric disorders. In this article, a case of simultaneous abuse with an overdose of long-acting risperidone and buprenorphine/naloxone combination in a newly diagnosed patient with bipolar disorder without a history of substance is presented.
Case Presentation: A 34-year-old male abused the combination of long-acting risperidone and buprenorphine/naloxone alternately for 2-3 days (sometimes every day) for 6 months. Euphoria, irritability, logorrhea, insomnia, mild grandiosity, increased psychomotor activity, and anxiety were determined in the psychiatric examination. His marriage and familial relationships were negatively affected, also as economically, too. Serum CK and prolactin levels were high. The pulse was tachycardic. Significant rigidity and tremor were determined on his EPS examination. Affective symptoms regressed after treatment. EPS side effects continued for approximately 8 weeks and decreased gradually after this period.
Conclusions: Although quetiapine is the most commonly abused atypical antipsychotic, risperidone can also be abused among non-substance abusers. Risperidone is abused as an oral formulation, but the long-acting formulation can be abused with overdose as in this case. The level of active risperidone metabolite in serum is lower using the long-acting formulation than in the oral form. This can be advantageous in terms of side effects, especially with overdose. Cardiac side effects are common with overdose and the symptoms related to EPS. The potential for abuse of buprenorphine-naloxone which is used for opioid addiction treatment is low. The buprenorphine-naloxone combination could be abused by people without opioid experience, and other atypical antipsychotics such as risperidone can be abused simultaneously as in this case.

Anahtar Kelimeler

Risperidone, long-acting, buprenorphine/naloxone, bipolar disorder, parenteral, abuse

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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YENİ TANI KONMUŞ BİPOLAR BOZUKLUĞU OLAN BİR HASTADA YÜKSEK DOZDA UZUN ETKİLİ RİSPERİDON VE BUPRENORFİN/NALOKSONUN EŞ ZAMANLI KÖTÜYE KULLANIMI: BİR OLGU SUNUMU

Öz

Arka plan: Atipik antipsikotikler çeşitli psikiyatrik bozuklukların yanı sıra alkol-madde kullanım bozukluklarının tedavisinde de kullanılmaktadır. Bu makalede, daha önce madde kullanım öyküsü olmayan yeni tanı almış bipolar bozukluğu olan bir hastada yüksek dozda uzun etkili risperidon ve buprenorfin/nalokson kombinasyonunun eş zamanlı kötüye kullanım vakası sunulmuştur.
Olgu Sunumu: 34 yaşında erkek hasta, 6 ay boyunca ortalama 2-3 günde bir (bazen her gün) dönüşümlü olarak uzun etkili parenteral risperidon ve buprenorfin/nalokson kombinasyonunu kötüye kullanmıştı. Yapılan psikiyatrik muayenede öfori, irritabilite, logore, uykusuzluk, hafif grandiyözite, artmış psikomotor aktivite ve anksiyete tespit edildi. Evliliği, aile ilişkileri ve ekonomik durumu olumsuz etkilenmişti. Serum CK ve prolaktin düzeyleri yüksekti. Nabız taşikardikti. Ekstrapiramidal sistem (EPS) muayenesinde belirgin rijidite ve tremor saptandı. Tedavi sonrasında afektif semptomlar geriledi. EPS yan etkileri yaklaşık 8 hafta boyunca devam etti ve bu süreden sonra giderek azaldı.
Sonuçlar: En sık kötüye kullanılan atipik antipsikotik ketiapin olmasına rağmen, risperidon madde bağımlısı olmayan kişiler arasında da kötüye kullanılabilmektedir. Risperidonun genellikle oral formu olarak kötüye kullanılmaktadır, ancak bu vakada olduğu gibi uzun etkili formülasyon da yüksek dozda kötüye kullanılabilir. Serumdaki aktif risperidon metaboliti seviyesi, oral forma göre uzun etkili formülasyon kullanıldığında daha düşüktür. Bu, özellikle aşırı dozda yan etkiler açısından avantajlı olabilir. Kardiyak yan etkiler yüksek dozda ve EPS ile ilgili semptomlarda yaygındır. Opioid bağımlılığı tedavisinde kullanılan buprenorfin-naloksonun kötüye kullanım potansiyeli düşüktür. Buprenorfin-nalokson kombinasyonu opioid deneyimi olmayan kişiler tarafından kötüye kullanılabilir ve bu vakada olduğu gibi risperidon gibi diğer atipik antipsikotikler ile eş zamanlı olarak kötüye kullanılabilir.

Anahtar Kelimeler

uzun etkili, bipolar bozukluk, buprenorfin/nalokson, kötüye kullanım, risperidon, parenteral

Proje Numarası

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Kaynakça

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