Maintenance dose of disulfiram-induced mania: A case report

Disulfiram is an aldehyde dehydrogenase inhibitor that interferes with the metabolism of ethanol and produces a marked increase in blood acetaldehyde levels. Adverse reaction may arise when alcohol is ingested during extended use of disulfiram. There are a few case reports in relevant literature related to disulfiram and psychiatric symptomatology. A high dose of disulfiram intake induced psychosis or mania, or disulfiram exacerbates psychotic and mood symptoms in patients who had a psychiatric history. This case is presented because of mania induced by maintenance dose of disulfiram in a patient without a psychiatric history. Mr. S is 40 year-old alcohol abusing male, who had stopped taking alcohol a month ago, and had taken disulfiram(500mg/day) for a month. He applied to a psychiatry emergency after getting the last dose of disulfiram 24 hours ago. In psychiatric mental status examination, he had increased psychomotor activity, somatic hallucinations, mystic - megalomanic and persecutory delusions. He admitted to the hospital for further investigations and for clinical observation. He diagnosed, treated and followed by the diagnosis of mania. He observed for three months in the outpatient unit and had no more psychotic or manic symptoms during the three months observation period. In the literature there is no data about psychotic or manic symptoms after the sudden discontinuation of disulfiram. Disulfiram is highly dissolved in the fat tissue that, elimination fate is low, and it can be discovered in blood until two weeks after the last intake. For that reason psychiatric symptoms that may due to withdrawal are excluded. It makes authors to think-that genetic tendency.-could be a reason in such a psychiatric disorder which was induced by disulfiram in maintenance dosages. However, wide case reports needed to verify such an hypothesis.