for the past 50 years disulfiram is the commonly prescribed drug for the treatment of alcohol dependence .
important side effects of disulfiram are hepatological , dermatological , neurological ( polyneuritis , encephalopathy)1,2 ) and psychiatric in nature .
psychiatric manifestations include confusion , loss of memory , psychosis,36 ) mania with psychotic symptoms.7,8 ) disulfiram s major metabolite diethyldithiocarbamate is an inhibitor of dopamine - betahydroxylase ( dbh ) , an enzyme that catalyzes the metabolism of dopamine ( da ) to norepinephrine ( ne).9 ) by inhibiting this metabolic pathway from da to ne in the central nervous system , disulfiram results in an increase of da concentrations in mesolimbic system resulting in psychosis .
alcoholics who developed psychotic symptoms during disulfiram treatment are found to have low levels of amine and monoamine oxidase , suggesting dbh blockage.10 ) we present a case of 32-year - old male who developed psychosis with the use of disulfiram .
a 32-year - old male without past of psychiatric and neurological illness reported to psychiatry outpatient department with complaint of daily alcohol intake of 250750 ml ( 40% alcohol by volume ) for the last 5 years . with the informed consent of the patient
, disulfiram was administered at the dosage of 250 mg twice daily for 1 month , while the patient abstained from alcohol .
then the patient presented complaint of fearfulness , suspiciousness , easy irritability , muttering to self , decreased sleep for last one month .
haematological and biochemical indices were within normal limits . on mental status examination delusion of persecution and auditory
his fearfulness , suspiciousness , irritability , muttering to self and impaired sleep gradually improved over a period of 10 days .
risk factors for development of disulfiram related psychotic symptoms include past history or family history of psychosis , overly rapid increase in dosage or greater than recommended total dosage , old age , impaired liver function and concurrent dopaminergic medications or psycho - stimulant abuse.5,11 ) our patient has family history of schizophrenia in his father .
his psychotic symptoms improved after stoppage of disulfiram and use of lorazepam tablet only without any additional requirement of anti - psychotic treatment .
these factors support the association between with disulfiram use and emergence of psychotic symptoms in our patient .
the usual recommended initial dosage is 500 mg per day for the first 1 or 2 weeks , followed by a maintenance dosage of 250 mg per day.12 ) disulfiram related psychosis usually involve either therapeutic or higher than recommended dosages.13 ) our patient has developed psychotic symptoms with 500 mg per day of disulfiram .
we recommend that disulfiram should be used at the lowest effective dose , possibly 250 mg daily .
our case highlights the relevance of a careful history of patient s symptoms and family history that should be performed before starting treatment with disulfiram and caution should be taken while prescribing disulfiram for patients with personal and familial antecedents of psychosis .
disulfiram - related psychiatric complications are reported to be more prevalent in eastern countries,3 ) which suggests that genetic factors may play a role in disulfiram induced psychosis .
 disulfiram is the commonly prescribed drug for the treatment of alcohol dependence . 
 it s major metabolite ( diethyldithiocarbamate ) is an inhibitor of dopamine - betahydroxylase , an enzyme that catalyzes the metabolism of dopamine to norepinephrine resulting in psychosis . 
 we recommend that disulfiram should be used at the lowest effective dose , possibly 250 mg daily and caution should be taken while prescribing disulfiram for patients with personal and familial antecedents of psychosis . 