Covert Administration of Unprescribed Disulfiram in Uttarakhand: A Case Series of Disulfiram Induced Psychosis

Abstract Disulfiram is an alcohol-aversive agent widely utilized in the management of alcohol use disorder. Nevertheless, its unsupervised administration is associated with significant adverse outcomes, including the emergence of psychotic symptoms. This case series reports four patients who developed psychosis following covert administration of non-prescribed disulfiram. Discontinuation of the drug was undertaken in all cases, followed by treatment with antipsychotic agents, resulting in complete clinical resolution. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale indicated a probable association between disulfiram exposure and the onset of psychosis in all patients. Symptomatic improvement was observed within seven days of drug withdrawal and short-term low-dose antipsychotic therapy. These findings underscore the legal and ethical implications of unauthorized medication administration and highlight the need for enhanced public awareness, improved access to evidence-based addiction treatment services, and stricter regulatory oversight to prevent the unsupervised use of disulfiram.