Schizophrenia - Adjunctive Naturopathic Care
by: Philip Rouchotas, MSc, ND
Bolton Naturopathic Clinic
64 King St W, Bolton, ON, L7E 1C7
Schizophrenia is a mental health condition that involves a distortion of reality. The symptoms of schizophrenia vary depending on the patient, but are often described as either positive or negative symptoms (1). Positive symptoms are things that are not normally there, but that people with schizophrenia experience. These can include things like delusions, hallucinations (of many types), and disordered thinking. Negative symptoms are normal items that are lacking in people with schizophrenia. For example, a flat affect, poor speech, trouble forming relationships or a lack of pleasure or motivation. Negative symptoms are usually considered to have more of an impact on quality of life than positive symptoms. Many symptoms can also be categorized as cognitive symptoms, meaning they are related to the processing of information (1). Patients with cognitive symptoms may have trouble learning and using information appropriately. There are multiple types of recognized schizophrenia. Diagnosis is usually guided by the DSM-5, the manual that describes various mental health conditions. Diagnosis is usually performed by a psychiatrist or psychologist.
The causes of schizophrenia are considered be a combination of genetic and environmental factors. One of the biggest risk factors is having an immediate family member who has schizophrenia. For example, if one parent has been diagnosed, the risk that a child will have it is approximately 13% (2). Many potential genes have been proposed as being implicated in the development of schizophrenia. The environmental factors include drug use, living and social environment, and stressors in utero. Of these, drug use is a major factor. Many of those who suffer from schizophrenia utilize drugs or alcohol. Some drugs on their own can result in psychosis. Those with schizophrenia also use nicotine and tobacco at much higher rates than the rest of the population.
The management of schizophrenia is complex. First-line medication involves the use of antipsychotics (3). Antipsychotics can reduce some of the positive symptoms, but are not very good at improving the negative symptoms. In the experience of some Naturopathic Doctors who treat schizophrenia, the majority of patients who take medications remain unwell and debilitated (4). Antipsychotic medications are associated with brain damage, cardiac and metabolic problems, and sexual dysfunction. They appear to tranquilize patients to some degree. This article will review some of the natural approaches in treating schizophrenia.
The first nutritional supplements used to treat schizophrenia were vitamin B3 (niacin) and vitamin C (4). Based on trials conducted in acute schizophrenic patients, vitamin B3 was able to reduce the number of suicides, improve recovery rates, and cause less of a burden to the health care system. It is suggested that vitamin B3 reduces the production of adrenochrome, a toxic derivative of adrenalin.
Vitamin C, also known as ascorbic acid, is typically prescribed in gram doses and is usually increased until it causes diarrhea. At this point, the dose is scaled back so that it is not causing diarrhea. This is called dosing until ‘bowel tolerance’. Vitamin C acts as an antioxidant and also prevents the formation of adrenochrome (4). Vitamin C also performs a number of functions in the body, such as the production of collagen, and the production of various neurotransmitters.
Glycine is an inhibitory neurotransmitter that is sometimes supplemented in the treatment of schizophrenia (5). Glycine is purported to possibly help with memory, since it is involved in the transmission of many signals in the brain. Glycine could also be added through diet; sources of glycine in the diet include meat, fish, dairy, and legumes.
Herbs could be used as adjunctive treatments. They can be provided in capsule, tablet, tea, or tincture form. Ginkgo biloba is one herb that may have evidence for use in the management of schizophrenia (6). There are currently clinical trials in progress to better determine the effect of Ginkgo in patients with schizophrenia. However, a number of studies have shown that Ginkgo, either on its own or in conjunction with antipsychotics can reduce the negative symptoms, enhance the effect of the antipsychotics, reduce the side effects of the drugs, or enhance the efficiency of the drugs. All of these are promising outcomes and with no to minimal side effects. Cannabis is a drug that is often used by schizophrenic patients, but the available evidence suggests it is not helpful; and could be quite harmful (7).
The negative symptoms of schizophrenia are associated with poor quality of life. For this reason, these types of symptoms have a high priority for intervention. There are 3 categories of psychosocial treatments: cognitive behavioural therapy (CBT), social skills training (SST), and combined treatment interventions (8).
The CBT approach suggests that the way in which events are interpreted have consequences for how people think, feel, and behave. The goals of CBT can be individualized to the patient, but often attempt to decrease specific symptoms, increase the understanding of the condition, reduce distress, and develop adaptive coping skills. It has been used for the treatment of multiple mental health conditions, including psychosis, and guides are available. CBT usually involves the identification of thoughts that are not supporting health, and then evidence for and against these thoughts is generated. Oftentimes, it becomes clear that the thoughts are maladaptive, and simply the awareness of the evidence can help set the groundwork for behavioural modification.
The theory behind SST is that patients should be helped to gain personal skills to achieve social competence, including properly expressing themselves, receiving information, and being able to maintain a conversation appropriately with others (8). SST can also help people become more assertive and be better at managing their medications. For those with schizophrenia, this can be particularly important, in that it can allow for clear communication and better long-term management. It may also decrease affiliated costs for the health care system.
Combining both treatments does not have clear evidence of benefit above and beyond what each treatment offers alone. CBT has a large body of evidence supporting its use, and also has evidence showing that it can help with the maintenance of negative symptom improvement for 6 months after treatment (8). Psychosocial treatments can be delivered by a number of health care providers, but those best positioned to deliver them are psychiatrists or psychologists, who have special training in their application. The available evidence does not necessarily dictate what the best way to intervene is for any given patient.
Schizophrenia is a very difficult condition to live with. It is also extremely difficult to manage from the perspective of caregivers. If there are significant cognitive symptoms or intense positive symptoms, hospitalization is sometimes the only way to get started with care. The mainstay of therapy is antipsychotic medications. Although they may reduce some of the positive symptoms, the evidence suggests that they are not very good at reducing the negative symptoms. In addition, many patients report feeling flat, or tranquilized while on the medications.
Natural therapies are typically adjunctive and come in many forms. Vitamin B3 and vitamin C were discussed as being potentially helpful at reducing the production of adrenochrome, a toxic adrenaline derivative. Glycine was discussed as an inhibitory neurotransmitter that can potentially help with memory. Lastly, Ginkgo was discussed as a herbal option that is currently undergoing further research, but with many promising outcomes. Cannabis was not recommended.
Psychosocial treatments are extremely safe. Both CBT and SST may be useful for schizophrenic patients. The benefit is likely to be correlated to the degree of symptom intensity. There is solid evidence behind both therapies and they should be delivered by regulated professionals. Overall, there are a number of different adjunctive natural therapies that can be considered. Please see your Naturopathic Doctor for further evaluation.