A case of chronic disulfiram (Antabuse) toxicity is described, in the context of a literature review, apparently the first such description from Ireland. The rare combination of encephalopathy with peripheral neuropathy occurred in this case, along with other probably related features. These included a fluctuating clinical course, cerebellar ataxia, grand mal seizures, impotence and a delay in improvement on discontinuing disulfiram. It is likely that symptoms of anxiety and depression in this man were also in part induced by disulfiram toxicity, but interpretation of events is complicated by developing arteriosclerosis. The difficulties in distinguishing toxic effects of disulfiram from complications of chronic alcoholism are emphasized, with resulting delay in recognizing disulfiram toxicity.

Rushing (1968) offers two hypotheses for the possible structural connection between suicidal and chronic alcoholic case groups : the “processual cause theory” is based on the idea that alcoholism leads through its problematic nature to suicide attempts. In the “common cause theory” alcoholism and suicidai acts are due to mutually shared factors, e.g., social isolation and enforced social integration.

Data on suicide and suicide attempts were obtained as a separate aspect of a comprehensive follow-up investigation. All patients from one particular region in Austria, who had been admitted to hospital between 1976 and 1978 for treatment of chronic alcoholism took part in this study. Follow-up time was 4 to 7 years. 101 patients died during this period. 356 patients remained under close follow-up investigation. In addition to information about basic drinking habits, we attempted to identify predictive factors regarding the course of alcoholism and investigated familial circumstances, development and interactions.

In contradiction with both theories forwarded by Rushing, we were able to isolate a special subgroup of chronic alcoholics attempting or committing suicide. This group is characterized by a depressive symptomatology (endogeneous-depressive syndrome, according to the Viennese Diagnostic Criteria), as well as by the presence of other psychiatrie disturbances underlying chronic alcohol abuse. Family histories also uncovered evidence of psychiatric illnesses. Cases of negative alteration in social status and problematical partnerships could be found in this subgroup. Drinking habits themselves did not differ from non suicide-prone alcoholics.