Disulfiram Induced Psychosis in Patients Seeking Over the Counter Treatment

Disulfiram is a deterrent in the management of alcohol use associated with neuropsychiatric manifestations, of which psychosis is common. The postulated mechanism is being its metabolite diethyldithiocarbamate being an inhibitor of dopamine beta-hydroxylase (DBH), an enzyme that catalyses the metabolism of dopamine (DA) to norepinephrine (NE) which results in an increase of DA concentrations in mesolimbic system resulting in psychosis. Other mechanisms are also postulated, like direct CNS toxicity, free radical damage. Here, are the two cases that were dependent to opioid given disulfiram surreptitiously land up with psychosis.