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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0017

Co-occurring schizoaffective disorder and opiate dependence: challenges in pharmacotherapy and patient stabilization (case report)

COMORBIDITY OF SCHIZOAFFECTIVE DISORDER AND OPIATE ADDICTION: CHALLENGES IN PHARMACOTHERAPY AND PATIENT STABILIZATION (CASE REPORT)

Clinical stability was achieved in a patient with a dual diagnosis through comprehensive clozapine-based treatment and strict medication supervision, without the need for opioid substitution therapy.

The aim is to present the clinical course and diagnostic and therapeutic complexities in a patient with a dual diagnosis of schizoaffective disorder and opiate dependence, examine the effects of substance use on psychopharmacotherapy, and emphasize the importance of an individualized, integrated, family-supported approach. The case, reported by the Department of Psychiatry at the Clinical Center of the University of Sarajevo, concerns a 43-year-old man with a history of schizophrenia and opioid use disorder who was admitted with a psychotic exacerbation following nonadherence to psychopharmacotherapy. The clinical presentation included hallucinations, paranoid symptoms, ideas of reference, mood instability, and reduced volitional functioning. The patient had a long history of polysubstance use, predominantly involving heroin. Despite previous participation in methadone and buprenorphine substitution programs, daily use continued before admission, and urine toxicology screening on admission was positive for heroin. Treatment included clozapine, sodium valproate, diazepam, pregabalin, and aripiprazole. Gradual improvement was observed during hospitalization, with a marked reduction in psychotic symptoms, improved emotional stability, and recovery of motivation and daily functioning. At discharge, the patient was clinically stable, with no signs of opioid withdrawal and no need for opioid substitution therapy. The discussion notes that methadone, as a mu-opioid receptor agonist, may interact pharmacokinetically with antipsychotics, increase the risk of sedation, prolong the QT interval, and cause metabolic disturbances. It also notes that long-term benzodiazepine use blurs the distinction between anxiety and withdrawal symptoms, complicating the assessment of psychotic symptoms. In conclusion, the key to stabilization in patients with a dual diagnosis is coordinated, multidisciplinary, individualized care that includes concurrent psychiatric and addiction treatment, family education, and strict supervision of medication intake.

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