A Case of Psychosis Following Delayed Encephalopathy of Transdermal Fentanyl Intoxication / 대한정신약물학회지

Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action. Recently, there have been many case reports that overuse or misuse of fentanyl patch resulted in fatal intoxication. Delayed hypoxic leukoencephalopathy typically manifests 2 to 40 days after apparent recovery from hypoxic event, and patients suffer from cognitive impairment, upper motor neuron signs, gait disturbance, or psychosis. We report first case of delayed encephalopathy with psychotic symptoms after overuse of fentanyl patch. Patient was found to have respiratory failure and mental change due to transdermal fentanyl overdose. She made a complete recovery in 2 weeks. After 4 weeks of the event, she readmitted with declining mental status. At 30 weeks after overdose, she complained of auditory and visual hallucination and showed paranoid delusion and odd behavior. Since admission into psychiatric unit, her psychotic symptoms have improved with antipsychotics. In conclusion, fentanyl patch should be used in order to prevent psychotic symptoms as well as medical complications.

Relationship of Limb Movements during Sleep with Nocturnal Sleep Parameters in the Community-Dwelling Elderly with Sleep Complaints / 신경정신의학

OBJECTIVES: The aim of this study was to examine the differences in subjective sleep quality and objective sleep parameters between groups with different severities of limb movements during sleep in elderly persons with sleep complaints. METHODS: We recruited adult subjects with sleep complaints from four areas in Gangwon-do. Nocturnal polysomnography studies were conducted for 159 subjects at Kangwon National University Hospital. A total of 72 subjects older than 60 years were finally selected, and we classified them into three groups according to the limb movement index (LMI) : 29 subjects with LMI below 15, 21 subjects with LMI between 15 and 44, and 22 subjects with LMI above 44. RESULTS: The proportion of existing restless legs syndrome (RLS) symptoms differed between the three groups, but was not statistically significant (p=0.051). No difference in nocturnal sleep parameters was observed between the three groups. In the total group, the limb movement arousal index showed positive correlation with respiratory arousal index (r=0.252, p<0.05). CONCLUSION: In elderly persons with sleep complaints, a greater LMI severity was associated with a tendency of higher comorbidity of RLS. Frequent arousals due to limb movements were not associated with a greater severity of limb movements during sleep severity, but with increased arousals due to respiratory events.