Am J Psychiatry 1993; 150:423-428
Copyright © 1993 by American Psychiatric Association
Organic mood syndrome associated with detoxification from methadone maintenance
PD Kanof, MJ Aronson and R Ness
Psychiatry Service, VA Medical Center, Bronx, N.Y.
OBJECTIVE: The authors delineate the clinical characteristics of mood state
changes that occur in stable opioid-dependent patients undergoing
therapeutic detoxification from methadone maintenance treatment. METHOD:
Twenty-four patients participated in a blinded protocol for gradual
methadone dose reduction that included weekly assessments of affective
state using the Profile of Mood States (POMS) as well as weekly assessments
of signs and symptoms of opioid withdrawal. Data obtained before methadone
dose reduction and during the 2-week period of maximal dysphoric symptoms
were compared. Changes in affective and opioid withdrawal measures were
compared in patients who differed in their success in completing the
detoxification regimen. RESULTS: Sustained increases in POMS scores of
greater than 20 points were observed in 12 of the 24 patients during the
course of detoxification. The emergence of symptoms of dysphoria was
accompanied by insomnia, loss of appetite, and somatic complaints
consistent with symptoms of opioid withdrawal but only minimal levels of
objective signs of withdrawal. Greater changes from baseline in mood state
and opioid withdrawal measures occurred in patients who were unable to
complete the detoxification regimen. CONCLUSIONS: The development of an
organic mood syndrome is a common occurrence in patients undergoing slow
detoxification from methadone maintenance treatment and is associated with
a poor outcome.
