Increased sympathetic nervous system activity in alcoholic patients treated with disulfiram.

The authors measured plasma levels of norepinephrine (NE) and dopamine beta-hydroxylase (DBH), pulse rates, and blood pressures of 81 hospitalized alcoholic patients. Treatment with 500 mg/day of disulfiram (but not 250 mg/day or placebo) resulted in small but significant increases in plasma NE and in blood pressure. The 500-mg dose did not appreciably inhibit DBH. Patients receiving high doses of disulfiram should have their blood pressure monitored and their dose decreased to 250 mg/day when possible.

Disulfiram-induced fulminating hepatitis: guidelines for liver-panel monitoring.

Although psychiatrists have medical responsibility for many alcoholic patients, the psychiatric literature, in contrast with the general medical literature, contains few reports of disulfiram-induced hepatotoxicity. For that reason, the authors review the literature on disulfiram hepatitis and report a case of severe fulminating hepatitis associated with disulfiram use, despite careful and currently accepted standard-of-care clinical and biochemical monitoring. All but two of the 17 disulfiram-associated hepatotoxic cases reviewed developed symptoms after 2 weeks to 2 months of use. Six patients died. This article discusses strategies for avoiding that rare but life-threatening side effect. The strategies include more frequent initial measurements of liver enzymes than is now accepted. Currently, only two reports recommend liver-function studies on a regular schedule for patients taking disulfiram. The authors believe that liver-function tests should be administered before treatment, at 2-week intervals for 2 months, and at 3- to 6-month intervals thereafter. The authors emphasize that the hepatotoxicity reaction is rare and do not discourage the use of disulfiram in appropriate patients; rather, they wish to heighten the index of suspicion to disulfiram-induced hepatotoxicity.

The acute psychiatric diagnostic interview.

The general outline of a psychiatric diagnostic interview given in Table 1 includes some broad suggestions for the amount of time to spend on each section. As a structured interview based on a symptom checklist questionnaire yields higher frequency of reports of symptoms, it is advisable to follow this type of format rather than a totally unstructured interview technique. Sim recommends a structured format that lends itself to computerization. Griest and colleagues suggest a computer interview, and there are data supporting the diagnostic accuracy of such a system. Within the framework of any diagnostic interview, a thorough exploration of the 10 critical elements listed in Table 5 is essential for accurate diagnosis. This information, which is usually obtainable in about 30 minutes, will enable the clinician to make a preliminary diagnosis, decide upon pharmacotherapy, and determine if hospitalization is warranted. A more intensive but lengthy and time-consuming structured diagnostic interview is the Schedule for Affective Disorders (SADS), which is more appropriate for inpatients or patients being considered for a research protocol.