A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit

Background. Butalbital-containing combination (BCC) analgesics have the potential for the development of tolerance and dependence. Misuse and withdrawal of these agents should be considered in patients presenting with new-onset psychosis. This case highlights how butalbital withdrawal may be missed...

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Autores principales:	Alejandro Rodulfo, Alberto Augsten, Erin Wainwright, Gil Abramovici
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Psychiatry RC435-571
Acceso en línea:	https://doaj.org/article/8f51da5e4c574071920c279d53e811c8
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spelling	oai:doaj.org-article:8f51da5e4c574071920c279d53e811c82021-11-22T01:09:50ZA Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit2090-683810.1155/2021/6371953https://doaj.org/article/8f51da5e4c574071920c279d53e811c82021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/6371953https://doaj.org/toc/2090-6838Background. Butalbital-containing combination (BCC) analgesics have the potential for the development of tolerance and dependence. Misuse and withdrawal of these agents should be considered in patients presenting with new-onset psychosis. This case highlights how butalbital withdrawal may be missed in the emergency department setting and underscores how early identification may affect management and prognosis. Case Presentation. A 40-year-old female with a history of migraine, depression, and anxiety presented to the emergency department (ED) with new-onset psychosis following a recent seizure-like episode. At home, the patient was prescribed butalbital-acetaminophen-caffeine (Fioricet), duloxetine, alprazolam, and zolpidem for these conditions. On arrival to the ED, the patient was disoriented and appeared to be responding to internal stimuli. Following initial medical evaluation, the patient was cleared for further psychiatric assessment, during which she developed acute-onset autonomic instability while waiting for a bed on the inpatient psychiatric unit. She then became agitated, requiring multiple emergency medications, and eventually required emergent intubation and was admitted to the intensive care unit (ICU). Following extubation, a psychiatric consultation was performed. On assessment, the patient was alert and oriented and no longer exhibited psychotic symptoms. She admitted to using butalbital-acetaminophen-caffeine (Fioricet) daily for the past 10 years and had recently run out of her prescribed medication. She acknowledged that she was taking more than prescribed and requested substance use treatment resources, for which she was subsequently discharged to an inpatient drug rehabilitation facility. Conclusions. Given the time constraints inherent to the ED setting, a complete substance use history (both illicit and prescribed) may be challenging to obtain. However, it remains critical for providers to identify patients at risk for life-threatening withdrawal from sedative, hypnotics, and anxiolytic agents.Alejandro RodulfoAlberto AugstenErin WainwrightGil AbramoviciHindawi LimitedarticlePsychiatryRC435-571ENCase Reports in Psychiatry, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Psychiatry RC435-571
spellingShingle	Psychiatry RC435-571 Alejandro Rodulfo Alberto Augsten Erin Wainwright Gil Abramovici A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit
description	Background. Butalbital-containing combination (BCC) analgesics have the potential for the development of tolerance and dependence. Misuse and withdrawal of these agents should be considered in patients presenting with new-onset psychosis. This case highlights how butalbital withdrawal may be missed in the emergency department setting and underscores how early identification may affect management and prognosis. Case Presentation. A 40-year-old female with a history of migraine, depression, and anxiety presented to the emergency department (ED) with new-onset psychosis following a recent seizure-like episode. At home, the patient was prescribed butalbital-acetaminophen-caffeine (Fioricet), duloxetine, alprazolam, and zolpidem for these conditions. On arrival to the ED, the patient was disoriented and appeared to be responding to internal stimuli. Following initial medical evaluation, the patient was cleared for further psychiatric assessment, during which she developed acute-onset autonomic instability while waiting for a bed on the inpatient psychiatric unit. She then became agitated, requiring multiple emergency medications, and eventually required emergent intubation and was admitted to the intensive care unit (ICU). Following extubation, a psychiatric consultation was performed. On assessment, the patient was alert and oriented and no longer exhibited psychotic symptoms. She admitted to using butalbital-acetaminophen-caffeine (Fioricet) daily for the past 10 years and had recently run out of her prescribed medication. She acknowledged that she was taking more than prescribed and requested substance use treatment resources, for which she was subsequently discharged to an inpatient drug rehabilitation facility. Conclusions. Given the time constraints inherent to the ED setting, a complete substance use history (both illicit and prescribed) may be challenging to obtain. However, it remains critical for providers to identify patients at risk for life-threatening withdrawal from sedative, hypnotics, and anxiolytic agents.
format	article
author	Alejandro Rodulfo Alberto Augsten Erin Wainwright Gil Abramovici
author_facet	Alejandro Rodulfo Alberto Augsten Erin Wainwright Gil Abramovici
author_sort	Alejandro Rodulfo
title	A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit
title_short	A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit
title_full	A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit
title_fullStr	A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit
title_full_unstemmed	A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit
title_sort	case of severe fioricet withdrawal presenting during admission to an inpatient psychiatric unit
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/8f51da5e4c574071920c279d53e811c8
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A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit

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