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Fentanyl is a potent Schedule II opioid agonist that has potency more than 80 times that of morphine. A high concentration of Fentanyl is contained in Fentanyl patches (MATRIFEN).
They should be used to manage pain for persons with chronic moderate to severe pain who are already physically tolerant to opiates.During the past years there has been an increase in misuse and abuse in the United States of Matrifen that has caused deaths from overdoses.Matrifen can also cause neurological and psychiatric adverse events such as: delirium anxiety, abnormal thinking, abnormal dreams, depersonalization and hostility.
In the literature Matrifen have not previously been associated with serious offences such as attempted murder but an association with suicide has been noted.
To describe a previously unreported and serious adverse effect of Fentanyl patches.
We followed up the clinical psychopathology of an elderly gentleman who attempted to murder his wife reportedly due to an altered mental state caused by the application of Fentanyl patch. We searched Pubmed and Google for any reported adverse effect of Fentanyl patches of a similar nature.
After ruling out all other Psychiatric, Organic and Forensic causes we came to the conclusion that Matrifen was the cause of altered mental state which led to the attempted murder.
Although adverse psychiatric effects of Fentanyl patches have been reported in the past we can add attempted murder to the list. Fentanyl patches can be dangerous particularly in the vulnerable elderly patients where they are most commonly used.
We have noticed in our clinical practice a few patients with psychoses whose mental health was affected by the use of Benzylpiperazine related compounds. Benzylpiperazine and related compounds were sold legally in the UK until March 2007 when they were declared illegal. They are still legal in New Zealand whilst it is classified as a Class one drug along with LSD, cocaine and cannabis in the USA, Sweden, Denmark and Greece.
To understand the effect of Benzylpiperazine based party pills on the mental health of a patient who already had a diagnosis of Schizophrenia.
We followed up the clinical psychopathology of the patient while he was in our acute Psychiatry ward in 2007 during an admission precipitated by the use of Benzylpiperazine based party pills. Also we went through his previous notes to find out the symptomatology during all his previous admissions and outpatient appointments.
Use of Benzylpiperazine based party pills resulted in manic symptoms in this patient with Schizophrenia who did not have these symptoms until he started using the party pills.
Benzylpiperazine based party pills have mood elevating properties and also induce insomnia in users. From our anecdotal experience it is seen that in patients with mental illness this leads to non compliance with medications and may also induce manic symptoms. Benzylpiperazine based drugs of abuse have been less well researched compared to other drugs of abuse.
The aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.
The study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an ‘orientation statement’ letter delivered 24–48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.
Follow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59–0.98, number needed to treat 16, 95% CI 10–187].
Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.
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