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Of ninety-six alcoholic patients treated with antabuse, thirteen (13.5 percent) had psychotic reactions; ten of these cases are reported in detail. A review of the literature on this subject reveals reports of forty-seven other such cases and shows a divergence of opinion as to the cause of these psychotic reactions.
The authors feel that in general the psychogenic element in the development of psychosis under antabuse therapy has been understressed in the literature and too much attention paid to the possibility of a toxic origin. In support of this thesis, they point to the fact that in many cases recovery from the psychosis occurs while the patients continue to receive the drug, while in other cases no recurrence takes place when medication is continued later. The authors believe that a psychogenic explanation fits the facts better, and explain the psychotic episode as a reaction to the sudden interruption of the alcoholism which had served as a defense for the patient. Proper recognition of the psychogenic factor will prevent an unnecessary removal of the drug and will make possible more specific treatment for the psychotic reactions with consequent speedier recoveries. It will also enable more to have the continued benefit of antabuse treatment.