Work

Psychotic symptoms following synthetic opioid withdrawal: A case report

Year: 2026

Type: article

Abstract: Psychosis during opioid withdrawal is rare but clinically significant and may complicate detoxification and delay accurate diagnosis, particularly with synthetic opioids such as tramadol. We report the case of a 41-year-old married male with no prior personal or family psychiatric history who developed acute psychotic symptoms following abrupt cessation of tramadol. The patient had a 25-year history of alcohol dependence but had been in sustained remission for 3.5 years. After stopping tramadol, he initially developed classical opioid withdrawal symptoms, followed several days later by second-person auditory hallucinations and persecutory delusions. On admission, the Clinical Opioid Withdrawal Scale (COWS) score was 25/60, indicating moderate to severe withdrawal. He was managed with opioid agonist substitution, benzodiazepines, and short-term antipsychotic therapy, resulting in rapid resolution of both withdrawal and psychotic symptoms. The patient was discharged symptom-free on day 11 and remained asymptomatic without recurrence during four weeks of follow-up. This case highlights tramadol withdrawal–induced psychosis as an uncommon but important clinical entity and underscores the importance of careful substance use history, close monitoring during withdrawal, and appropriate short-term antipsychotic use to avoid misdiagnosis as primary psychosis or delirium. • Psychosis can rarely emerge during withdrawal from synthetic opioids like tramadol. • Case shows persecutory delusions and auditory hallucinations after opioid cessation. • Symptoms resolved rapidly with codeine tapering and short-term antipsychotics. • Chronic alcohol history may heighten vulnerability to withdrawal-related psychosis. • Early recognition avoids misdiagnosis as primary psychosis and guides treatment.

Source: Medical Reports

DOI: 10.1016/j.hmedic.2026.100421