Disulfiram therapy

Disulfiram Therapy (Antabuse Therapy) 1. Introduction Disulfiram is an aversive agent used in the treatment of alcohol dependence. It does not reduce craving for alcohol, but creates unpleasant reactions when alcohol is consumed. Used as part of de-addiction programs with motivation, counseling, and supervision. 2. Mechanism of Action Alcohol is metabolized in the liver: Ethanol → (Alcohol dehydrogenase) → Acetaldehyde → (Aldehyde dehydrogenase) → Acetic acid Disulfiram blocks aldehyde dehydrogenase → Acetaldehyde accumulates in the body. High acetaldehyde levels cause disulfiram–alcohol reaction. 3. Disulfiram–Alcohol Reaction (DAR) Occurs if patient drinks alcohol while on disulfiram: Flushing, throbbing headache Sweating, palpitations, chest pain Nausea, vomiting Hypotension, tachycardia Dyspnea, anxiety, confusion Severe cases: arrhythmia, cardiovascular collapse, convulsions, even death 4. Dosage Initial: 500 mg orally once daily for 1–2 weeks Maintenance: 250 mg daily (range: 125–500 mg/day) Effects may last up to 1–2 weeks after stopping (due to slow elimination). 5. Indications Chronic alcohol dependence (with high motivation and supervision). As part of comprehensive treatment including psychotherapy, counseling, family therapy. 6. Contraindications Severe cardiac disease Liver disease / Hepatic dysfunction Severe renal disease Psychosis Pregnancy & lactation Hypersensitivity to disulfiram 7. Nursing Responsibilities Pre-therapy assessment: Ensure patient has abstained from alcohol for at least 12 hours. Education: Inform about dangers of alcohol intake with disulfiram. Avoid hidden alcohol sources (cough syrups, sauces, perfumes, aftershave, mouthwash). Supervision: Sometimes given under family or medical supervision (compliance monitoring). Monitor: Liver function tests, cardiac status, mental state. Encourage: Motivation, follow-up counseling, support groups (e.g., AA – Alcoholics Anonymous). 8. Adverse Effects Drowsiness, fatigue, metallic/garlic-like taste Headache, dermatitis Hepatotoxicity (rare but serious) Neuropathy, psychosis (rare) ✅ Summary: Disulfiram therapy is an aversive deterrent in alcohol dependence. It requires careful patient selection, motivation, education, and monitoring. It is not a cure but a part of long-term rehabilitation.

Preventive psychiatry

Preventive Psychiatry 1. Definition Preventive psychiatry is the branch of psychiatry that focuses on preventing the occurrence, progression, or recurrence of mental disorders through early detection, timely intervention, and promotion of mental health. 2. Levels of Prevention in Psychiatry 🟢 A. Primary Prevention Goal: Prevent onset of mental illness before it occurs. Approach: Promote mental health, reduce risk factors. Examples: Health education in schools and communities Stress management, yoga, relaxation techniques Parental guidance, good parenting programs Prevention of substance abuse Immunization & nutrition programs (to prevent brain damage in children) 🟡 B. Secondary Prevention Goal: Early detection and prompt treatment of mental illness to reduce severity. Approach: Screening, case finding, early diagnosis, immediate care. Examples: Screening for depression, anxiety, postpartum depression Early diagnosis of schizophrenia and starting treatment Crisis intervention (suicidal tendencies, acute stress) Counseling services in schools, workplaces, hospitals 🔴 C. Tertiary Prevention Goal: Reduce disability, prevent complications and relapses, promote rehabilitation. Approach: Long-term treatment, rehabilitation, relapse prevention. Examples: Vocational rehabilitation for mentally ill patients Halfway homes, sheltered workshops Maintenance therapy in schizophrenia/bipolar disorder Family therapy, community support groups Alcoholics Anonymous (AA), Narcotics Anonymous (NA) 3. Strategies of Preventive Psychiatry Mental health promotion (positive coping, resilience building) Risk reduction (stress management, reducing substance use) Early identification (screening camps, school mental health programs) Treatment & rehabilitation (community psychiatry, psychosocial rehabilitation) 4. Role of Nurse in Preventive Psychiatry Provide health education and awareness in community. Conduct screening programs in schools, workplaces, hospitals. Identify early signs of mental illness. Provide counseling and crisis intervention. Involve families in care and rehabilitation. Encourage participation in support groups. ✅ Summary: Preventive psychiatry applies the principles of primary, secondary, and tertiary prevention to mental health. It emphasizes promotion, early detection, treatment, and rehabilitation to reduce the burden of mental disorders.