Disulfiram Induced Psychosis

Affiliation

¹Assistant Professor, Department of Psychiatry, Ramaiah Medical College, Bengaluru

²Junior resident, Department of Psychiatry, Ramaiah Medical College, Bengaluru

³Junior Resident Department of Pharmacology, Ramaiah Medical College, Bengaluru

⁴Professor Department of Psychiatry, Ramaiah Medical College, Bengaluru

Abstract

Background: Disulfiram was widely used as an aversive agent for treatment of alcohol dependence since its discovery. Various adverse drug reactions have been documented. Psychosis due to disulfiram is not a common side effect.
Methods & Discussion: We report two cases of disulfiram associated psychosis. We also highlight the biological mechanism of the psychosis associated with disulfiram use. The Dopamine (DA) hypothesis of schizophrenia states that an increase in DA activity in certain brain areas is associated with psychotic symptoms in schizophrenic patients. The possible explanation for the development of psychosis, might be inhibition of Dopamine-Betahydroxylase (DBH) enzyme due to metabolites of disulfiram. This enzyme catalyzes the metabolism of DA into norepinephrine. Inhibition of DBH increases dopamine level. Furthermore, alcoholics who developed psychosis due to disulfiram were found to have low levels of amine and monoamine oxidase, suggesting DBH blockage.
Conclusion: Disulfiram induced psychosis is not an uncommon side effect. Biological mechanism of Disulfiram induced psychosis, probably via its DBH inhibiting effects, which lead to an increase in DA activity. Hence, careful monitoring is required for emergent of psychotic symptoms in vulnerable patients while on disulfiram treatment.