Schizophrenia: Alternative Treatments

1. Schizophrenia:Alternative Treatments By Rachel Martinez and Holley Williamson

2. Overview of Schizophrenia • Symptoms: Positive, Negative • Diagnostic Criterion • Phases: Prodromal, Active, Residual • Types: Catatonic, Disorganized, Paranoid, Undifferentiated, Residual • Related disorders: Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder • Alternative treatments we will investigate: • Orthomolecular Psychiatry • Acupuncture treatment

3. Orthomolecular Psychiatry as Treatment for Schizophrenia • Orthomolecular psychiatry claims to use dietary supplements and other treatments to effectively treat mental illness, including schizophrenia, mood disorders, and other mental illnesses. • Orthomolecular psychiatric treatments have been around since the 1920’s. Abram Hoffer established the orthodoxy of the field in the 1950s. In 1973, the APA rejected the practice of orthomolecular psychiatry, which is why it is now considered an alternative therapy. The APA’s conclusions have been criticized strongly based on political motivations. Current scientific research is consistent with some of the hypotheses advanced by orthomolecular psychiatrists, but most orthomolecular practices have not been extensively tested by conventional clinical trials. Instead practitioners rely on their interpretations of biochemical research and case reports. Recent efforts to rigorously establish the efficacy of some concepts associated with orthomolecular psychiatry have been recognized in mainstream sources. • Subcategories to be examined: B Vitamins (Folic Acid and Niacin)

4. Folic Acid Treatment • Folic acid deficiency occurs in 10 to 30% of hospitalized psychiatric patients. In addition to psychosis, the deficiency is associated with depression, confusion, disorientation and dementia as well as with neurological symptoms such as numbness, stiffness, spasticity and weakness, both with and without muscular atrophy. (Hoffer notes that niacin is primarily effective for early and acute schizophrenics, while it is ineffective -- especially when given alone -- for the chronic schizophrenics who were included in the negative trials. ) • Though we aren’t sure about the specific mechanisms that associate folic acid deficiencies with schizophrenia, they are starting to be identified in research. Folic acid may be an essential cofactor in the conversion of the omega-6 fatty acids to prostaglandins, and early evidence suggests that impaired prostaglandin metabolism may provoke a schizophrenic picture. • However, elevated levels of blood folate are also associated with increase in psychotic episodes– there must be a balance.

5. Niacin Treatment • In 1952, Abram Hoffer, PhD, MD, had just completed his psychiatry residency. What’s more, he had proven, with the very first double-blind, placebo-controlled studies in the history of psychiatry, that vitamin B-3 (Niacin) could “cure” schizophrenia. You would think that psychiatrists everywhere would have beaten down a path to Saskatchewan to replicate the findings of this young Director of Psychiatric Research and his colleague, Humphrey Osmond, MD. • The way it is thought to work is that Niacin and ascorbate are antagonistic to copper. Many schizophrenics have an excess of copper, which is a cofactor in dopamine production. When there is too much copper, dopamine may be overproduced causing the downregulation of serotonin, accounting for some of the negative symptoms. Since Niacin and ascorbate antagonize copper, adding Niacin to a schizophrenic’s diet could help combat some of the negative symptoms. • An excess of copper can be toxic, causing a hallucinogenic endproduct. Niacin and ascorbate could also theoretically help with some of the positive symptoms of schizophrenia if they are exascerbated by elevated levels of copper.

6. Acupuncture for Treating Schizophrenia • Acupuncture has been used for 2000 years to treat physical and mental ailments in Traditional Chinese Medicine (TCM) • Some studies have indicated that the treatment of Schizophrenia with acupuncture is safe and effective. (These were mainly small studies with limited participants, more like case studies than clinical trials.) • However, other clinical trials have been inconclusive in determining the efficacy of acupuncture for treating schizophrenia.

7. Acupuncture Research • One study examined the efficacy of acupuncture combined with chlorpromazine against a control of just chlorpromazine. • The results were inconclusive, neither was determined to be more effective than the other on treating the schizophrenic symptoms of the patient. • However, the acupuncture group was able to take a reduced dosage of the antipsychotic, reducing negative side effects from the drugs. • The conclusion from this study was that acupuncture itself may not be effective in treating schizophrenia, but may be helpful alongside traditional treatments to reduce negative side effects.

8. Acupuncture Research • Other studies indicated a marked improvement of certain symptoms for schizophrenic patients. • Patients treated with acupuncture showed a decrease in auditory hallucinations, an improvement in patients with catatonic stupor, and a reduction in medication levels. • However, delusions were unaffected by the acupuncture treatments. • Again, the results are not conclusive, though they point in a positive direction for the use of acupuncture at least to relieve some of the negative symptoms and side effects of drugs.

9. Possible Mechanism for Acupuncture Efficacy • One hypothesis behind utilizing acupuncture for treating schizophrenia is the release of serotonin due to acupuncture stimulation • Research on mice has shown that acupuncture stimulates the release of serotonin in the brain, but not dopamine. If there is an excess of dopamine causing negative symptoms of schizophrenia, the acupuncture may help in combating those symptoms. • Cultural differences– Helping the patient feel better or conforming to social norms?