Schizophrenia & Complementary Treatments Including Acupuncture

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Schizophrenia & Complementary Treatments Including Acupuncture

Abstract

Schizophrenia is a complex and multifaceted disease and one of the most difficult for complete recovery. There are many types of schizophrenia described in the literature. All common types of schizophrenia are described here. A new classification of schizophrenia is described from an etiologic point of view as genetic and nongenetic. No exact mechanisms are yet known to our best scientists and researchers. Clinical guidelines are given for treatments with acupuncture and other modalities from the clinical experiences of day-to-day psychiatric and medical practice.

Schizophrenia is characterized by anxiety, depression, definite emotional blunting, which signals by mild to severe flattening of facial expression, insidious onset and at times psychosis, with feeling of unreality, thought disorders, hallucination, delusion and autism. This disease is so serious that Social Security benefits are always granted.

The disease afflicts 1% of the population of the world approximately. Usually it begins before the age of 25 and most patients say that it is lifelong. Symptoms clearly appear at about age 9 when proper history is taken. The early symptoms are described as stormy character disorder. This affects all social classes. When psychosis occurs, the family and the patient suffer from social ostracism because of the chronicity of the disease and difficulty in understanding it. This disease includes many conditions with similar behavioral symptoms. It will be convenient to say that it is one disease with different clinical presentations, some allopathic treatment responses and an inevitable chronic course.

History

Benedict Morel (Belgium, 1809-1873), "demence precoce" for deteriorated patient whose illness began in adolescence; Karl Kalbaum (1828-1899) described catatonia, in a boy of 14, in 1884. Ewold Hecker (1843-1909) described hebephrenia in adolescence. Emily Kraepalin, well-known psychiatrist (German, 1856-1926), Eugene Bleuler (Swiss, 1857-1939). Kraepalin organized the seriously mentally ill patient by 3 categories: Dementia precox, manic depressive psychosis, and paranoia. Kraepalin's description of dementia precox emphasized a chronic deteriorating course; in addition, this includes such clinical phenomena as hallucinations and delusions. Kraepalin reported that about 4% of her patients had complete recoveries and 13% had significant remissions. The term "manic depressive psychosis" identified patients who experienced an episode of illness separated by virtually complete remissions. Patients diagnosed as having paranoia had a major symptom of persistent persecutory delusions. Bleuler( 1, 2) coined the term "schizophrenia," which means split mind, in reference to the theoretical schism (division) between thought, emotion, and behavior. Patients may laugh (emotion and behavior) while speaking about the death (thought and speech) of their mother. This is sometimes confused with split personality, now called multiple personality which is not related to schizophrenia.

Bleuler's definition of schizophrenia differed from Kraepalin's dementia precox in two important ways.( 2) Bleuler did not feel the deterioration was fundamental, but a symptom of disorder. Secondly, Bleuler divided the symptoms into fundamental (primary) and accessory (secondary) symptoms. The most fundamental symptom was thought disorder characterized by associational (relating to thought process) disturbances, particularly looseness. The other fundamental symptoms included hallucinations and delusions.( 1) Both Kraepalin and Bleuler assumed an underlying biological basis for this disorder. Modern psychiatrists who theorized about schizophrenia included Adolf Meyer, Harry Stack Sullivan, Gabriel Langfeldt, and Kurt Schneider. Meyer, the founder of psychobiology, famous in American psychiatry, believed that schizophrenia and other mental disorders were a reaction to a variety of life stresses, so he called the syndrome a "schizophrenic reaction." Sullivan, the founder of the inte rpersonal psychoanalytic school, emphasized social isolation as both a cause and a symptom of schizophrenia. Gabriel Langfeldt derived his criteria from empirical experience, rather than a theoretical formulation. Langfeldt divided the disorder into true schizophrenia and schizophreniform psychosis. Schizophreniform psychosis is now known as Schizoaffective psychosis. In reality, the diagnosis of schizophrenia rests on the findings of depersonalization, autism, emotional blunting, insidious onset, and feelings of unreality. True schizophrenia is often referred to as nuclear schizophrenia, process schizophrenia, or nonremitting schizophrenia. These true schizophrenias include paranoid schizophrenia and the schizophrenic who thinks his or her actions and soul is controlled by some other entity. Paranoid schizophrenia is described below but the second true schizophrenia most probably belongs to the manic-depressive disorder, as in my practice I exclude diseases by acupuncture.

Kurt Schneider described a number of so-called first rank symptoms of schizophrenia that had great pragmatic value in making a diagnosis. Schneider's first rank symptoms included the hearing of one's thoughts spoken aloud (thought echoing), auditory hallucinations that comment on the patient's derogatory behavior (maybe with vulgar language), somatic nihilistic hallucinations (patient thinks somebody tells him to destroy parts of the body), and the experience of having one's thoughts controlled. Thought control and passivity of thoughts are due to manic depressive illness, personally discovered in 1983, and audible thought, the spreading of one's thoughts to others (thought broadcasting), delusions (self or others), and the experience of having one's actions controlled or influenced from the outside. Thoughts are a continuous process in normal people. This process is blocked in schizophrenia and other thought disorders fill in. Schneider pointed out that schizophrenia can be dia gnosed exclusively on the second rank symptoms, along with an otherwise typical clinical experience. Second rank symptoms include other forms of hallucination, perplexity, depressive and euphoric disorders of affect, and emotional blunting. Schneider did not mean these symptoms to be rigidly applied, and he warned the clinician that the diagnosis should be made in certain patients even though they failed to show first rank symptoms. This warning is frequently ignored, and the absence of such symptoms in a single interview is taken as evidence that the person is free of schizophrenic disorder.( 2)

Incidence and Prevalence

Epidemiological studies of schizophrenia are confounded by lack of objective diagnostic methods, the difficulty of identifying all cases in a particular community and identifying an actual date of onset, and the variety of age groups that must be studied to obtain complete data. The rate of the group 15 years and over range from 0.30 to 1.20 per 1000. Pooled studies show an incidence of approximately 1 per 1,000 population. Approximately 200,000 new cases are diagnosed each year in the United States, with approximately 50 million worldwide.( 2) The variation in prevalence rates from studies around the world is much higher. In the United States, the lifetime prevalence is about 1%; that is, about 2 million Americans suffer from schizophrenia. Approximately .025 to .05% of the total population is treated for schizophrenia in any one year; two-thirds of these patients require hospitalization. The new treatment described in this article, if adopted, may change the schizophrenic preva lence.

Age, Sex, and Race

The peak age of onset for men is between ages 15 and 25 and for women is between 25 and 35. It is possible that the age differential reflects societal biases about the behavior of the two sexes rather than actual differences in age of onset. My personal observation reveals that estrogen in females, which is a growth hormone, causes the peak age of onset to go up between age 25 and 35. Although it is rare for the psychiatrist to diagnose schizophrenia before the age of 10 or after age 50, nevertheless it is seen in private practice. About 90% of patients in treatment are between 15 and 54 years old. Both sexes are affected equally.

Reproduction Rates, Suicide, and Mortality

Incidence and prevalence rates of schizophrenia are affected by the reproduction and mortality rates of patients. The risk of becoming schizophrenic for an individual is increased if one member of his family already suffers from the disease. There will be an increase in rates if marriage and fertility continues. Approximately 50% of patients with schizophrenia have attempted suicide and 10% succeeded sometime during a 20 year followup period. These schizophrenics also have a very high mortality rate from natural causes.

Cultural and Socioeconomic Considerations

Schizophrenia has been described in all cultures and socioeconomic groups. In industrial countries the lower socioeconomic classes are affected more than the upper socioeconomic group. Schizophrenia is more benign in forms in the third world countries where the patient and community integrate more than in technologically advanced societies.

Seasonality of Birth

In the northern hemisphere (USA) more schizophrenics are born in winter months of January to April. In the southern hemisphere, more schizophrenic patients are born in the months of July to September.

Financial Cost to Society

Schizophrenic patients occupy 50% of the mental hospital beds and account for 16% of the psychiatric patients who receive any type of treatment. Schizophrenia is the most expensive of the mental disorders in direct treatment cost, loss of productivity, and expenditure in public assistance. It has been estimated that the annual cost of schizophrenia in the US is about 2% of the gross national product. Today, the expenditure for schizophrenia treatment is 20 billion dollars per year in the US.

Etiology

The etiology of schizophrenia may be ascertained now to a greater degree than before, from clinical experience and acupuncture( 4) and functional SPECT scanning. Those psychotic patients who respond to acupuncture in the first 3 visits in 3 weeks' time are genetic in origin and may have a family history of this disorder. This is my experience for the past seventeen years in psychiatric practice.

Patients with schizophrenia who have been using drugs and alcohol for long periods of time may also have damage to their brain in addition to genetic defects, and are treated similarly with acupuncture and given biological medicine of cerebrum compositum,( 7) intramuscularly, from Heel of Germany or Alertness tablet of B.H.I. USA,( 7) Electromagnet( 6) and Flyberg sonic therapy( 5) (cerebrum and cervical sympathetic). These methods usually begin to show improvement in four months' time. On the first visit the patient is usually given intravenous cerebrum compositum( 7) from Heel Company of Germany, to see any improvement of mental process in schizophrenia. It is my experience that some improvement of the mental status of the patient occurs after i.v. injection of the cerebrum compositum when there is nongenetic or organic cause of the schizophrenia. This test can be done in all mental and emotional conditions when organic cause is suspected.

If due to brain damage from trauma at birth or head trauma or infection of the brain from meningitis or encephalitis, with or without history of temperature,( 3) same treatment as above. History of head trauma at birth is not available most of time to the physician, this should be kept in mind in history taking and patient evaluated by questioning and other psychological evaluation.

True paranoid schizophenia is due to excess growth hormone with enlarged thalamus and small skull above the tentorium cerebelli as seen in Functional SPECT scanning. These patients are tall or well-built and respond to acupuncture and Flyberg sonic therapy( 5) (Thalamus and hippocampus).

Manic depressive disorder presents as schizophrenia with or without drug addiction, and passivity of ideas and control (so-called nuclear schizophrenia) and are treated by acupuncture as well.

Hyperactive anterior pituitary syndrome, or ovarian andropathy; in my practice of psychiatry I found that many female patients have symptoms which are related to irregularity of menstruation, dysmenorrhea, premenstrual syndrome (late luteal phase dysphoria), seasonal depression (Seasonal affective disorder), which are present with another major or atypical depression in these patients. These female patients have depression, hirsutism with suprapubic hairs, acne on the face with or without masculine features. The cause of this disorder is due to excess estrogen and male hormone, both of which are growth hormones. Estrogen stimulates more production of dopamine, a neurotransmitter thought to be responsible for schizophrenia. Minipsychosis is common in these women. Major psychosis is rarely seen in this group of patients unless another major depression co-exists with this disorder. The site of this disorder probably is in the hypothalamus and pituitary glands.

Major and Minor Unipolar Depression come from inferior orbital gyrus from studies of SPECT scanning but never have psychotic features and are treated like schizophrenia with acupuncture. Schizophrenia may exist at times in the family history of these patients.

In severe stress disorders history is very clear and possibility of schizophrenic disease must be kept in mind in this group of patients as an underlying schizophrenic process before severe stress may coexist. The major depressions, manic-depressive disorders, are associated with hypothalamic disturbances in males which cause schizophrenic symptoms. Additional acupuncture points for endocrine disturbances relieve psychosis.

Theories of Schizophrenia

Since the discovery of advanced Scanning methods it is postulated that hypofrontality seen in brain scanning (reduced size of frontal lobe with increased size of anterior parts of lateral ventricles) is highly correlated with schizophrenia, but hyperactive inhibitory input from some other areas of the brain can cause schizophrenic symptomatology. The frontal lobe inhibits the sensory output normally, and when it is disturbed in schizophrenic temporal lobe discharge, overloads cause hallucinations and other psychotic symptoms.

Other Theories

It is generally known that psychotic symptomatology is induced by the disease states following damaged brain. Secondly a single pathological process in the brain can cause a wide range of phenomena in different patients. Neurotransmitter, "Dopamine hypothesis," is that there is hyperactivity of the dopaminergic system in schizophrenia (Dopamine poisoning!) This is not well accepted as direct measurement is not possible yet.

Of the five dopaminergic tracts in the central nervous system, the mesolimbic and mesocortical tracts have received the most attention in schizophrenia. Both of these tracts have their cell bodies in the substantia nigra and ventral tegmental area. Norepinephrine and GABA may play a role in schizophrenia. Serotonin is not attributed to cause schizophrenia so far.

Location of Disease

Scanning has pointed to areas of focus. Two areas of interest are the frontal lobe and the limbic system. Involvement of the frontal lobe is supported by brain imaging studies, electrophysiology, and neurophysiological studies. Limbic involvement is supported by neuropathological and depth electrode data.

Modern Scanning Techniques for Localization of the Anatomy of the Disease

Although many studies have been performed to detect functional abnormalities in schizophrenia, the experience with PET and SPECT is limited and inconclusive as limited scanning is done due to cost of the procedure. Frontal lobe dysfunction has long been postulated as an underlying cause of many schizophrenic symptoms. A number of studies have supported this "hypofrontality" by showing decreased perfusion or metabolism in the frontal lobes (or a decreased anterior-posterior gradient), but many studies have not been able to demonstrate this. Investigators have suggested that these discrepancies may be due to differences in the study of population such as age, chronicity of disease, subtype of schizophrenia, medications or clinical state at the time of imaging. The ideal patient for demonstrating hypofrontality appears to be the older, chronic, moderate paranoid symptomatology; schizophrenic during a clinical remission. It may be possible to elicit frontal lobe dysfunction by havi ng patients undergo testing that is known to cause frontal lobe activation, such as the Wisconsin Card Sorting Task (WCST). Berman et al. for example, have repeatedly demonstrated decreased activation of the dorsolateral, prefrontal cortex during the WCST in schizophrenics versus normals. Using a non-imaging Xe inhalation technique, Devous et al. have had similar results with SPECT, but only in paranoid schizophrenics.

Left hemisphere dysfunction has also been postulated as an underlying abnormality in schizophrenia. Gur et al. found that schizophrenic patients at rest have increased perfusion and metabolism ("overactivation") in left hemisphere relative to right, with abnormal activation during cognitive (learning) tasks. They found that the severity of schizophrenic symptoms correlated with degree of left hemisphere over-reactivation ("laterality") but not the degree of hypofrontality.

Several studies have reported subcortical changes in schizophrenia. Gur et al. found an increased subcortical to cortical ratio in schizophrenics using FDG-PET. Similarly, SPECT has shown a relative increase in basal ganglia activity in schizophrenics and more specifically in patients with chronic auditory hallucinations. Using a precise localization technique with PET, Early et al. found high blood flow in the left globus pallidus. Again, however, several studies have had conflicting results.

Since the dopaminergic system is believed to play a major role in schizophrenia and its treatment, a great deal may be learned by imaging dopamine receptors with recently developed PET and SPECT agents. PET studies have demonstrated and quantified dopamine D2-receptor occupancy by various neuroleptics. Preliminary studies comparing schizophrenics to normals have found no difference in D2-receptor density in schizophrenics. With the recent development of new and improved D2-receptor agents for use in SPECT such as IBZM, many dopamine receptor imaging studies soon will be undertaken. Hopefully, these results, as well as those additional metabolic and perfusion studies, will help elucidate the neurochemical abnormalities underlying schizophrenia.

The basal ganglia are implicated by common occurrence of psychosis in movement disorders. The hypothalamus and thalamus are implicated by the disorder of sensory processing, immune and endocrine disorders, and enlarged ventricles. The limbic system is implicated as there is a connection between this and the frontal lobe of speech and socialization areas. This connection to the frontal lobe is attributed to cause classical thought disorder. Thoughts are pre-speech. Broca's area in the frontal lobe is responsible for speech. The brain stem is implicated because it contains both dopanergic and adrenergic neuronal cell bodies, as well as the reticular activating system that may be involved in the regulation of attentional (arousal) and sensory system. The cerebellum is involved primarily by degeneration of vermis seen in some CT studies. These sites for a lesion are consistent with the heterogenous model described under the etiology of schizophrenia. The neurochemical hypothesis pro bably is a protein (e.g. enzyme) deficiency in genetically-induced schizophrenia. Trauma as an etiological factor is supported by the increased incidence of prenatal (e.g., mothers having trauma, infections, and bleeding during the pregnancy), perinatal (e.g., long labor and small pelvis and big head; nobody really knows what happens during delivery as no scientific technique is available for a safe delivery of the baby), and neonatal (e.g., convulsions) complications in patients who develop schizophrenia. Epilepsy arising from the posterior part of the temporal lobe damage is more liable to cause schizophrenia than the site of epilepsy from the anterior lobe. Because of difficulty in assessing hypoxia in babies it is suggested that future delivery be done under Magnetic Resonance Imaging (M.R.I.)

The other theory is that it is an infectious process of the brain. Infection is very common and viral infection is recognized by only very experienced physicians including neurologists, but no tests are accurate for such pathology. The viral pathology of the brain is not well-accepted but highly suspected. This is not studied because of lack of technology for such studies. Degenerative disease can cause schizophrenic symptoms as seen from time to time as in Huntington's chorea.

Clinical Signs and Symptoms

From personal studies it is not possible to distinguish the symptoms but touching the three points described below would clarify if it is genetic schizophrenia or not. Another group of patients who respond to the same points are mild to major atypical depression, particularly Pericardium 6, Gall Bladder 20 and Conception Vessel 14. Pericardium 6 is a point for frontal lobe, Gall bladder 20 is a point that stabilizes neurotransmitters of adrenaline, dopamine and serotonin. Conception 14 is called the great deficiency in Chinese literature. This is a hypothalamus point as we know the hypothalamus controls fight, flight, food, fuel, fun (sex) and light. These are of great importance in the survival of animals and humans.

Mental Status Examination

The group of patients can be divided into two clinical groups with psychosis, so-called positive and negative symptoms of schizophrenia. The bizarre posture and other severe abnormalities are not seen in the genetic schizophrenia but common in the other causes of schizophrenia. Catatonia is almost always seen in manic-depressive illness with psychosis. Definite constriction of affect or face is present in almost all cases of schizophrenia.

Mood, Feelings and Affect. The two most common effective presentations of schizophrenia are reduced emotional responsiveness or even anhedonia (lack of enjoyment). The patients feel the disintegration of the soul or paralyzed anxiety about the destruction of the universe. Other feeling tones include perplexity, terror, a sense of isolation and overwhelming ambivalence. The patient may have ambivalence in feeling and emotion (like and dislike same time), thought (good and bad thoughts at the same time), action (negative and positive movement towards objects including human beings).

Perceptual Disturbances. Hallucinations do not occur in genetically induced schizophrenia, but occur in schizophrenia with the nongenetic causes. It is common in injury to the brain, following the delivery of the child. Auditory hallucinations are more common than the other types of hallucinations.

Thought Process. The patients who were seen in a clinic setting have definite thought disorders as seen in genetic schizophrenics. Thought blocking occurs and this is introjected by the following thought disorders. Thought insertion - patient feels that someone can put thoughts into his head; thought withdrawal - patient feels that someone can take thoughts away; thought echoing - the thoughts were loud in the head; audible thought - patient can hear his own thoughts; thought broadcasting - others can hear the thoughts far away. My personal experience is that these are present in schizophrenia of genetic origin more than organic mood disorders. The passivity of soul and action controlled by someone else is seen in manic-depressive illness. Delusions of persecution, grandiosity, religiosity, or somatic and combinations thereof, were seen in schizophrenics with a history of brain damage and paranoid schizophrenia. Many other bizarre thought disorders were not seen in schizophrenia of genetic origin. Schizophrenics show looseness of associations, derailment, incoherence, tangentiality, circumstantiality, neologism, echolalia, verbigeration, word salad, and mutism. Disorders of thought include flight of ideas, thought blocking, impaired attention, paucity of thought and content of speech, poor memory, poor abstraction, idiosyncratic association (e.g. identical predicates, clang association), overinclusion, introjection of thoughts, illogical ideas, vagueness and circumstantiality. The negative (deficit) symptoms of schizophrenia are present in non-genetic schizophrenia such as: effective flattening or blunting, blocking, poor grooming, lack of motivation, anhedonia, social withdrawal, cognitive defects, and attentional deficits. The positive symptoms are present in genetic schizophrenia also with hypothalamic involvement. They are loosening of associations, hallucinations, bizarre behavior, and increased speech. It is proposed that these symptoms are produced by putamen in the frontal lobe. Lack of impulse control and suicide and homicide are seen in nongenetic schizophrenia. They have decreased social sensitivity, and behaviors are difficult to understand. The impulsive behavior includes suicidal and homicidal attempts, response to hallucinations commanding patient to act. A nongenetic schizophrenic is likely to have homicidal attempts. But this is also seen in manic-depressive disorder as shown in a small number of patients in prison. Sometimes a nongenetic schizophrenic patient is driven to homicide for unpredictable and bizarre reasons based on; hallucinations and delusions and even in hospitals with all possible restraints devised by psychiatrists. Twenty patients die every year in restraint in state hospitals.

Soft neurological signs are produced by nongenetic schizophrenics such as agraphesthesia, glabellar reflex, grasp reflex, and dysdiadochokinesia, Hoffman's sign and absent or reduced gag reflex. They are seen in groups of nongenetic schizophrenic patients more often than in normals or in patients with other psychiatric disorders. Nongenetic schizophrenic patients also have disorders of motor behavior, as evidenced by tics, snout catch, stereotypical movements, grimacing, impaired fine motor skills, and abnormal motor tone. Schizophrenics also have increased eye movements with increased eye blinking. Fifty to eighty percent of patients have this inability to follow an object through space with smooth eye movements. This is also seen in 40% of first degree relatives of schizophrenic patients and may be a neurophysiologic marker of vulnerability to schizophrenia. High numbers of mental and emotional patients have some degree of brain damage. Speech disorders, unable to carry out tasks (apraxia, a sign of frontal lobes) right-left disorientation (right parietal lobe as in Gerstmann's syndrome), lack of concern about illness as parietal lobe syndrome, psychological testing results are consistent with bilateral frontal and temporal lobe dysfunction, including impaired attention, retention time, problem solving ability, and intelligence is often present at onset and may continue to deteriorate with time. In general, the findings are comparable to those of organic brain disorders.

Course and Prognosis

The genetic schizophrenia starts at adolescence, and may have stress factors like separation from home, experience with drugs, or a death of a relative. The classical course is exacerbations and relative remissions. Sometime after recovery there is observable post-psychotic depression when tranquilizers are used. This is also true of nongenetic schizophrenia. During this period the patient denies depression but has lost interest in life and feels empty.

The limited patients treated in my practice have shown marked changes altering the poor prognosis observed in the past. The nongenetic group takes time to improve but a good prognosis is expected most of the time.

Subtypes

These are to be noted here for patients who are presenting themselves with particular symptoms. ( 1) Disorganized Type (hebephrenic): This is characterized by a marked regression to primitive, uninhibited, and unorganized behavior. Onset is before puberty. These patients are usually active but aimless, nonconstructive. Thought disorders are present. Contact with reality is very poor. Their personal and social appearance are less than desirable. This is seen in the genetic type schizophrenic most of the time. ( 2) Catatonic Type: This type is due to manic-depressive disorder with psychosis and are treatable with acupuncture. There is marked psychomotor retardation involving stupor, negativism, rigidity, excitement or posturing.( 3) ( 3) Although the paranoid type is included in subtyping of schizophrenia, this is not so. It is either due to excess growth hormone from hypothalamus, or due to damage to the brain during perinatal period. These patients are tense, suspicious, guarded, and reserved. The patient is often hostile and aggressive. The site of the disease is in the thalamus, detectable in functional SPECT scanning. They remain intelligent and usually tall. ( 4) Undifferentiated type does not fit in any criteria. They belong in either genetic or nongenetic schizophrenia, and are late presentations of hebephrenia. ( 5) Residual types are nongenetic schizophrenia in my personal experience. These patients are without overt psychosis and with presentation of social withdrawal, eccentric behavior, illogical thinking, mild loosening of association. The delusions and hallucinations are not prominent. These are manic-depressive illness. ( 6) Paraphrenia: This is a late onset of the disease due to infarction of periventricular areas of the brain seen in functional SPECT scanning. In this condition patients have well-preserved personality with well-systemized delusions. Therefore this should not be included in schizophrenia. ( 7) Simple schizophrenia (int ellectually speaking) is again due to nongenetic mood disorder. The patient withdraws from contact with other people and often stops working. (8) Latent schizophrenia is a personality disorder called schizoid or schizotypal personality, considered personally due to organic mood disorder. Moderate hypofrontality is present in this condition in SPECT Scanning. (9) Childhood schizophrenia exists and is treated with acupuncture, or as in nonorganic mood disorders. (10) Process schizophrenia is with deteriorating condition, are paranoid schizophrenic or manic-depressive with passivity of thought and action. No longer do they carry a poor prognosis in my personal practice. (11) Acute delusional psychosis is due to organic mood disorder. (12) Oneiroid type is a nongenetic psychosis, feels life is a dream state and is deeply perplexed, not oriented to time and space. He knows everyday realities but gives priority to hallucinatory experiences. This is an organic mood disorder. (13) Pseudoneur otic is an organic mood disorder. This is characterized by pananxiety, panphobia, panambivalence and chaotic sexuality. The anxiety never subsides. Overt psychosis is very rare. They may have intermittent paralysis of parts of the body and functional epilepsy. This condition is amenable to treatment by intravenous pentothal (truth serum) to get proper history of stresses in life and severe personal reactions. These patients are usually not preferred to be seen in private practice or in state hospitals as they constantly cause behavioral problems.

Differential Diagnosis

Drug induced - amphetamine, hallucinogens, belladonna alkaloids, alcohol hallucinosis, barbiturate withdrawal, cocaine, PCP. Epilepsy - especially temporal lobe epilepsy, neoplasm, stroke, trauma, abscess (especially frontal or limbic and temporal conditions), vitamin B12 deficiency, herpes encephalitis, heavy metal poisoning, systemic lupus erythematosus, Wernicke-Korsakoff syndrome, normal pressure hydrocephalus, neurosyphilis, acute intermittent porphyria, cerebral lipoidosis, Huntington's disease, homocystinurea (one patient with homocystinurea seen recently responded to acupuncture treatment of manic depressive treatment), Wilson's disease, pellagra, Creuzfeldt-Jacob disease, Fabry disease, Fahr's syndrome, Havervorden-Spatz disease, metachromatic leukodystrophy. Psychiatric - atypical psychosis, brief reactive psychosis, normal adolescence, obsessive compulsive disorders, malingering with psychological symptoms, infantile autism, personality disorders schizotypal, schizoid , borderline mood disorders, paranoid, schizoaffective disorder, or schizophreniform disorders.

Clinical Management

In genetic schizophrenia hospitalization is not necessary unless patient is suicidal, homicidal, or grossly disorganized, including inability to take care of basic needs (e.g., food, clothing, and shelter). The genetic schizophrenics are tested by the acupuncture points described in this article by pressing a spring tension pen about 20 times. Always there is response with a calming down effect, usually a minimum of 50% relaxation is achieved. The calming effect is seen in their speech (volume increase or decrease with good flow of thought), attention improved as patient looks at the surroundings more intensively, eye contact gets better. The face is more enlightened, and eventually the patient smiles with less tense lips. When acupuncture needles are applied, improvement is seen immediately. These are acupuncture points P6, CV14, GB20.( 4) It is preferable to suture these points in subsequent visits with long-lasting sterile nylon. Patients who do not like sutures may be encoura ged to take surgical staples for 3 months. I have seen no patient who has recurrences after the treatment with acupuncture. Many patients who came back had different types of stress-related anxiety and depression. Initially the patient may be given antipsychotic medications to control the unacceptable behavior.

In schizophrenia with hallucination and psychosis, these above points with additional points are given. These points for psychosis were rediscovered during my psychiatric practice. The points are K24, (heavenly storehouse for soul), CV15 (heavenly palace), St.25 (heavenly pivot), GV14 (Ghost pillow on the leg), GV13a (below the second thoracic vertebra), GV13 (below the third dorsal), Bl13 (on the side of third thoracic vertebra), Ghost side table, mine), K7a (between K7 and K8, follicular stimulating point), and B160 (spring point). The improvement is gradual and definite in genetic schizophrenia with thought disorders and psychosis. Two thousand years of review of acupuncture in psychosis did not show these points. None of these points are the so-called devil's point.

Antipsychotic Medications

These medicines are necessary in acute psychosis and the first 4 to 6 months for the psychotic behavior of organic psychosis as patients may arrive at a point of extremely unpredictable behavior and are uncooperative. After this the antipsychotic drugs are decreased gradually with the improvement of symptoms and finally discontinued.

Very rarely Electroconvulsive therapy is given for immediate recovery in severe behavioral disturbances and when a patient is unable to eat, sleep, or extremely suicidal, and immobilized by psychosis.

This treatment plan gives relief to the patients and family and ends the disease. The reliability is to be tested in larger settings as correlative findings are expected to confirm this author's last 17 years of private practice of psychiatry. Teaching of these methods are available to licensed physicians.

References
(1.) Bleuler, E (1911) Dementia Praecox or Group of Schizophrenia, Vienna (Trans J. Zinkin, 1950), New York: Inter. Unv. Press.

(2.) Bleuer, E. (1916) Text of Psychiatry: Berlin: Springer, 548.

(3.) Jackson, DD, editor, The Etiology of Schizophrenia. Basic Books, New York, 1960.

(4.) Das, Arabinda (1980) Acupuncture Found Major Importance in Depressive Syndromes. American Journal of Acupuncture, Vol., No. 4, Oct/Dec 1980.

(5.) Flyberg Sonic Therapy, Kindt Flyberg, Flyberg Therapy, Markidevej 6, DK 3200 Helsinge, Denmark, or contact: Exclusive Distributor, M.E.D. Servi-System Canada Ltd. Sweetnam Drive, Stittsville, Ontario Canada K2S 1 G2, 1-613-836-3004

(6.) Fichtner, NMF. Therapy Equipment and Operating Practice. Elec; Wisbaden, Germany or SINUS S.A. C.V. Agua Calienta, 4558, C2 Local, T.J. B.C. Mexico, 22420. Tel from U.S.A. 01-52-66-81-69-93. Tijuana, B.C. Mexico, 81-69-93.

(7.) Heel, Biolosche Heilmittel Heel GmbH, Baden Baden, Germany. Represented in USA by B.H.I. 1-600-621-7644.

Townsend Letter for Doctors & Patients.

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By Arabinda Das

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