Disulfiram-induced psychosis in covert use: A case series

Abstract

Disulfiram was the first medication approved by the FDA for alcohol dependence. Important adverse effects of disulfiram are hepatological, dermatological, neurological (polyneuritis, encephalopathy), and psychiatric. Psychiatric manifestations include confusion, loss of memory, psychosis, mania with psychotic symptoms. In India, it is very frequently used by general people covertly by mixing with food without doctors’ advice. These patients are highly susceptible to alcohol disulfiram reactions as well as adverse reactions associated with disulfiram. In this report, we are going to discuss 4 cases of psychosis induced by disulfiram when used covertly we came across in our clinical practice. All 4 cases had acute onset psychosis, with a temporal relationship of disulfiram use. No other causes of psychosis were found. Naranjo Casualty Scale ( adapted) was found to be 6 suggestive of probable ADR, providing strong evidence toward disulfiram-induced psychosis. All 4 patients recovered completely on withdrawal of disulfiram and conservative management without any antipsychotic. Disulfiram-induced psychosis should be differentiated from alcohol withdrawal delirium tremens and alcohol-induced psychosis, which may prevent unnecessary antipsychotic use. A lower dose should be considered in case of previous history or family history of psychosis. Psychiatrists and general practitioners in the community should discourage its covert use to avoid the incidence of disulfiram-induced psychosis as well as the severe alcohol disulfiram reaction.