Shared Psychotic Disorder Associated With Bipolar Disorder in the Primary Case in the Context of Opioid Misuse.

Bipolar disorder (BD) is a serious chronic mood disorder associated with high rates of co-occurring substance use disorders. Shared psychotic disorder (SPD) is a rare clinical phenomenon and has been reported in only a few cases of individuals diagnosed with BD. Furthermore, reports concerning SPD being induced by substance use or withdrawal are lacking. We report the case of a married couple endorsing simultaneous psychosis, a form of SPD. The primary case (the wife) had a diagnosis of BD, without any history of psychotic episodes before the current episode, while the secondary case (the husband) had a diagnosis of posttraumatic stress disorder. Both individuals were misusing prescribed synthetic opioids, and their psychosis was most likely induced by a withdrawal state. Cases of SPD involving patients with BD have rarely been reported. Considering the high rates of dual diagnoses among patients with BD, clinicians should be aware of the risk of substance-induced psychosis among these individuals and the manifestation of these psychotic episodes. This case report strengthens previous reports suggesting that SPD is a clinical entity that can occur not only in situations where the primary case involves an individual diagnosed with delusional disorder or schizophrenia, but that it may also occur when the primary case has a diagnosis of BD.

Olanzapine intramuscular shows better efficacy than zuclopenthixol acetate intramuscular in reducing the need for restraint, but not in comparison to haloperidol intramuscular.

Many psychotic patients are treated with antipsychotic medications during acute agitation and aggressive behavior episodes in an attempt to achieve a rapid calming effect. Those medications include olanzapine, zuclopenthixol acetate, and haloperidol intramuscular administration. This study compared the effectiveness of these injections in reducing the need for restraint during agitated-psychotic episodes that include aggression. Sociodemographical and clinical data were retrieved from the electronic medical records of 179 patients who needed rapid calming while hospitalized in a mental health center with acute psychosis. The treatments administered were olanzapine intramuscular, zuclopenthixol acetate intramuscular, and haloperidol intramuscular. The assessed outcomes were rate of restraint and violent behavior. Olanzapine was found significantly more effective in reducing the need for restraint compared to zuclopenthixol acetate. No significant differences were found between haloperidol and the other two with regard to restraint. Neither were other significant differences found between the groups with regard to violent or self-harming behaviors. No significant differences were found in the rate of violent behavior and antipsychotic dosage at discharge. In conclusion, in inpatients with acute agitated psychosis, olanzapine intramuscular shows better efficacy in reducing the need for restraint, at least as compared to zuclopenthixol acetate intramuscular.