HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2014, 16, 1 (pages: 49 - 54)

Does a buprenorphine augmentation control manic symptoms in bipolar disorder with a past history of heroin addiction? A case report.

Bizzarri J., V., Conca A., and Maremmani I.

Summary: Background and aim. Bipolar disorder (BD) is often associated with substance use disorders with resulting negative outcomes, including increased severity of symptoms, more hospitalizations and poor treatment response. The aim of this case study presentation is to support the hypothesis that augmentation treatment with an opiate agonist may be indicated in psychotic patients with a history of heroin addiction during an acute psychotic episode. Case Presentation. A 40-year-old female with BD and a previous history of opiate addiction was treated with a combination of an antipsychotic, mood stabilizers and benzodiazepine for an acute dysphoric manic episode. She did not show any significant clinical improvement until the introduction of an opiate agonist medication. Although the patient did not present with a relapse into heroin use, it was considered that the severity of her symptoms and the low level of her response to therapy could be related to a hypophoric/dysphoric syndrome induced by previous long-term opiate abuse. We decided to start with a very low dose, considering that our patient had no opiate tolerance. Buprenorphine treatment was initiated at a dose of 1 mg on day 14 and was increased to a maintenance dose of 2 mg on day 15. There was a consequent rapid reduction in levels of agitation and dysphoria. Conclusions: The good clinical outcome in this case suggests that augmentation with an opiate agonist may be indicated in patients with BD and a history of opiate addiction, even in those who have not had a recent opiate relapse.