Schizophrenia
Schizophrenia is a psychiatric illness marked by symptoms of psychosis such as hallucinations, delusions, and disorganized speech and behaviors. The symptoms are frequently severe enough in schizophrenia to make basic self-care, interpersonal relationships, and normal daily functioning impossible. These symptoms must be present for six months or longer for a diagnosis of schizophrenia to be made. The conventional treatment for schizophrenia includes the use of anti-psychotic medications (also called "major tranquilizers").
Lifestyle changes that might be helpful:
Exercise has long been recognized for its benefits in treating mild to moderate depression and there is some evidence that it may also be helpful in reducing anxiety.1 In one reported case, physical activity improved the functioning of a man diagnosed with schizophrenia.2 In another reported case, aggressive outbursts in a schizophrenic patient were reduced after he began exercising.3 A preliminary trial of an exercise program for hospitalized psychiatric patients with varying diagnoses resulted in significantly reduced symptoms of depression and an insignificant trend towards reduced anxiety.4 Additional research is needed to determine the specific benefits of exercise in people with schizophrenia.People with schizophrenia and other psychiatric patients have been identified as people who, in general, consume poor diets.5 6 Lack of exercise and heavy smoking are common among people with schizophrenia7 and obesity is common due, in part, to the medications used to treat schizophrenia.8 9 10 While it may be reasonable to speculate that general dietary and lifestyle improvements may lead to better health and functioning for people with schizophrenia, there is no research to support or refute the value of these types of changes.
Dietary changes that may be helpful:
For many years there has been speculation that certain dietary proteins may contribute to the symptoms of schizophrenia.11 12 13 Gluten, a protein from wheat and some other grains, and to a lesser extent casein, a dairy protein, have been the targets of research on food sensitivities as contributors to schizophrenia.14 Schizophrenic patients have been shown to be more likely to have immune-system reactions to these proteins than the general population.15 An uncontrolled trial of a gluten-free/dairy-free diet found that patients with schizophrenia improved on the diet and had shorter hospital stays than those eating normal diets.16 The results of double-blind placebo-controlled studies, however, have been inconsistent. The gluten-free/dairy-free diet improved responses to medications in one controlled trial.17 These improvements were lost and symptoms of schizophrenia were exacerbated when gluten was re-introduced in a "blinded" fashion. Another controlled study found similar positive responses in only 2 of 24 patients.18 Other controlled trials have found no improvement when gluten and dairy were removed from the diet.19 20 In one study, improvement occurred when gluten was blindly re-introduced.21 These results suggest that some, but not all, people with schizophrenia may benefit from a gluten-free/dairy-free diet.Nutritional supplements that may be helpful: The term "orthomolecular psychiatry" was coined by Linus Pauling in 1968 to refer to the treatment of psychiatric illnesses with substances (such as vitamins) that are normally present in the body. In orthomolecular psychiatry, high amounts of vitamins are sometimes used, not to correct a deficiency per se, but to create a more optimal biochemical environment. The mainstay of the orthomolecular approach to schizophrenia is niacin or niacinamide (vitamin B3) in high amounts. In early double-blind trials, 3 grams of niacin daily resulted in a doubling of the recovery rate, a 50% reduction in hospitalization rates, and a dramatic reduction in suicide rates.22 In an uncontrolled trial, some schizophrenic patients continued a course of vitamins (4 to 10 grams of niacin or niacinamide, 4 grams of vitamin C, and 50 mg or more of vitamin B6) after being discharged from the hospital, while a control group of patients discontinued the vitamins upon discharge. Both groups continued to take their psychiatric medications. Those who continued to take the vitamins had a 50% lower re-admission rate compared with those who did not.23
A number of later double-blind placebo-controlled trials, including studies undertaken by the Canadian Mental Health Association, have been unable to reproduce these positive results.24 25 Early supporters of niacin therapy contend that many of these studies were poorly designed.26 One controlled study reported no greater improvement in a group of schizophrenic patients given 6 grams of niacin than in others given 3 mg of niacin; all patients were also being treated with psychiatric medications.27
There are a number of potential side-effects of niacin therapy, including an uncomfortable flushing sensation, dermatitis, heartburn, aggravation of peptic ulcers, increased blood sugar, increased panic and anxiety, and elevation of liver enzymes, which may indicate damage to liver cells. A positive side-effect is reduction of serum cholesterol. Some of these effects, such as flushing, gastric upset, and reduction of serum cholesterol, do not occur with the use of niacinamide.28 Because of the seriousness of some of these side-effects, high amounts of niacin should not be used without the supervision of a healthcare practitioner.
Vitamin B6 in the form of pyridoxine has been used in combination with niacin in the orthomolecular approach to schizophrenia. Pioneers of orthomolecular medicine reported benefits from this combination. Two placebo-controlled trials, however, found significant improvement when schizophrenic patients were given either 3 grams of niacin or 75 mg of pyridoxine along with their psychiatric medications, but this improvement became small and statistically insignificant when the two vitamins were combined.29 30 In a double-blind trial, schizophrenic patients were given either a vitamin program based on their individual lab work or a placebo (25 mg of vitamin C) in addition to their psychiatric medications. The vitamin program included large amounts of various B vitamins, as well as vitamin C and vitamin E. After five months, the number of patients who improved was not different in the vitamin group compared with the placebo group.31
Studies of the effects of the pyridoxine form of vitamin B6 alone have yielded differing results. The results of pyridoxine supplementation at 100 mg daily in one schizophrenic patient included dramatic reduction in side effects from medication, as well as reduction in schizophrenic symptoms.32 In a four-week uncontrolled trial, 60 mg of vitamin B6 resulted in symptomatic improvement in only 1 of 20 schizophrenic patients.33 Another uncontrolled trial, however, found that a higher amount of vitamin B650 mg three times daily given for eight to twelve weeksin addition to psychiatric medications, did bring about significant improvements in 15 schizophrenic patients. These patients experienced a better sense of well-being, increased motivation, and greater interest in their "personal habits and their environment."34
There have been several reports of glycine reducing the symptoms of schizophrenics who were unresponsive to drug therapy.35 Large amounts of glycine (0.8 g per 2.2 pounds of body weight per day) have been shown to reduce negative symptoms of schizophrenia and improve psychiatric rating scores in an unblinded trial.36 Earlier double-blind studies found significant improvements in depression and mental symptoms in schizophrenics who took glycine for six weeks.37 38
Vitamin B12 deficiency can cause symptoms that are similar to those of schizophrenia and one case has been reported in which such symptoms cleared after supplementation with vitamin B12.39 Some studies have reported finding lower levels of vitamin B12 in schizophrenics than in the general population,40 but others have found no difference.41 No trials of vitamin B12 supplementation in schizophrenic patients have been published.
People with schizophrenia may have a greater tendency to be deficient in folic acid than the general population42 and they may show improvement when given supplements. A preliminary, uncontrolled trial found that, among schizophrenic patients with folic acid deficiency, those given folic acid supplements had more improvement and shorter hospital stays than those not given supplements.43 In a double-blind, placebo-controlled trial, a very high amount of folic acid (15 mg daily) was given to schizophrenic patients being treated with psychiatric medications who had low or borderline folic acid levels. The patients receiving the folic acid supplements had significant improvement, which became more significant over the six-month course of the trial.44 As with vitamin B12 deficiency, the symptoms of folic acid deficiency can be similar to those of schizophrenia, and two cases of "schizophrenia" misdiagnoses have been reported.45 46 In one of these cases, an initial supplement of 20 mg daily of folic acid and a maintenance supplemental intake of 10 mg daily led to resolution of symptoms.47
Up to 6 grams daily of vitamin C has been reported in case studies to be beneficial for people with schizophrenia48 49 and in one case the addition of 400 IU daily of vitamin E enhanced this benefit.50 An uncontrolled study using 8 grams daily of vitamin C showed decreases in hallucinations, suspiciousness, and unusual and disorganized thoughts in 10 of 13 schizophrenic patients.51 In all reported cases, patients were being treated with appropriate psychiatric medications. Some early reports found no difference between blood and urine vitamin C levels in schizophrenics and non-schizophrenics, either before or after supplementation.52 53 54 However, later studies found that blood and urinary levels of vitamin C were lower in schizophrenics than in non-schizophrenics before and after a 1,000 mg "load" of vitamin C was given once. After four weeks of supplementation with 1,000 mg daily of vitamin C, blood levels became the same but urinary levels remained lower in the schizophrenic group, leading the researchers to conclude that vitamin C needs for schizophrenics are greater than for the general population.55 56
L-tryptophan is the amino acid precursor of serotonin, a neurotransmitter (chemical messenger). There is evidence that L-tryptophan levels in schizophrenic people are lower than in non-schizophrenics57 and the way the body uses L-tryptophan is altered in people with schizophrenia.58 59 In an uncontrolled trial, patients with schizophrenia were given 28 grams of L-tryptophan and 100 mg of vitamin B6 daily. This resulted in decreased agitation and less fear and anxiety, but these improvements were not as great as those achieved with psychiatric medications.60 It is not clear whether the benefits seen in this study were due to vitamin B6, L-tryptophan, or a combination of the two. No other clinical trials using L-tryptophan have been published.
There are two different classes of essential fatty acids (necessary components of the diet): the
omega-6 and omega-3 fatty acids. There is considerable evidence these fatty acids are deficient or are not used properly in people with schizophrenia.61 62 63 64 65 66 Some investigators suggest this altered fatty acid metabolism may be involved in the increased need for niacin seen in some schizophrenic patients.67 A case has been reported in which a man with schizophrenia had dramatic and sustained improvement while being supplemented with 2 grams daily of omega-3 fatty acids.68 In an uncontrolled pilot study, schizophrenic patients receiving omega-3 fatty acids showed improvement in schizophrenic symptoms, as well as a reduction in adverse effects from their anti-psychotic medications.69 Another study found that schizophrenic patients had lower levels of both omega-3 and omega-6 fatty acids, compared with non-schizophrenic individuals, even though both groups were consuming similar amounts of these fatty acids.70 In a separate preliminary study, higher intake of omega-3 fatty acids was associated with less severe disease, and supplementation with 10 grams of concentrated Fish oil, a source of omega-3 fatty acids, led to significant improvement in symptoms over a six-week period.71 To date, there are no controlled studies on the effects of fatty acid supplementation in schizophrenia.Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.Checklist for Schizophrenia
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Ranking |
Nutritional Supplements |
Herbs |
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Primary |
Folic acid (if deficient) Glycine |
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Secondary |
Niacin/niacinamide (vitamin B3) Omega -3 fatty acids (Fish oil)Vitamin B6 Vitamin C |
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Other |
L-tryptophan Vitamin B12 |
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Information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing the supplements for particular conditions is also categorized. The criteria for the categorizations are: "Primary" indicates there are reliable and relatively consistent scientific data showing a health benefit. "Secondary" indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. "Other" indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.
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