The Postorgasmic illness syndrome (POIS) is a rare syndrome, recently described by two Dutch doctors Waldinger and Schweizer in 2002 1 which includes a set of physical and cognitive symptoms, appearing electively after ejaculation. It can last for several days. 2 About only 50 cases have been reported in the medical literature. 2 The Prevalence of POIS remains unknown, likely underdiagnosed still mysterious, owing to a paucity of studies, but is most probably underreported. Symptoms occur for a few seconds to a few hours after ejaculation, whether after intercourse, masturbation, or spontaneously during sleep. These disorders reproduce almost every ejaculation.We report a rare case of POIS that illustrates the clinical polymorphism and therapeutic difficulties of this syndrome and discusses etiopathogenic hypotheses. | CLINICAL CASEMr. MT, 32-year-old has been married to his cousin for 11 years and has 5 children. He had no somatic or psychiatric history. The patient has a secondary school level and works as a builder. He has no history of past or present substance use a side of smoking weaned for 4 years.He was referred to the psychiatric examination at Mannouba's Razi Hospital, Tunisia, after seeing urologists, neurologists, and general practitioners. Indeed, a few

Tramadol withdrawal symptoms are either natural (typical) or unnatural (atypical). In this context, psychotic symptoms as atypical Tramadol withdrawal symptoms have been rarely reported. Methods: A case report and review of literature by a research on medline database. Key words: 'psychosis', 'psychotic symptoms', 'tramadol withdrawal', 'opiate withdrawal' Case Report: Mr. A. L. is 35 years-old man with a past medical history of alcohol dependence and cannabis abuse. He was admitted in 2012 for an alcoholic pancreatitis. Following this episode he began taking 650 mg/d of tramadol. He was put on Acetaminphen, clorazepate and paracetamol. When he started tapering Tramadol, he began experiencing auditory and cenesthetic hallucinations. He presented in our outpatient unit with restlessness, grandiosity thoughts, messianic delusions and sleeplessness. He was treated with antipsychotic medication and could stop taking Tramadol a week after his first consultation. After 8 days mental symptoms including hallucinations and delusions persisted. Therefore the diagnosis of Tramadolinduced Psychotic disorder with onset during withdrawal was the most likely diagnosis. Neurological examination was normal and brain CT scan showed no organic abnormalities. Discussion: There is evidence that only a few patients with tramadol dependency are susceptible to atypical withdrawal symptoms. Atypical withdrawal symptoms may include severe anxiety, panic attacks, unusual CNS symptoms such as confusion, delusion, derealization, depersonalization, paranoid thoughts, visual and auditory hallucinations. There have been some reports in the literature on psychotic episodes related to opiate withdrawal but only one previous case with Tramadol.

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