Treatments of schizophrenia

ABSTRACT

Schizophrenia is a psychological disorder with a wide variety of treatments being used as attempts to treat it. These treatments include antipsychotic medication, cognitive behavioural therapy (CBT), and orthomolecular medicine among others. The focus of this writing is to compare both CBT and orthomolecular therapy for schizophrenia in terms of the theories behind each of these therapies. Comparisons are emphasized in the conflicting parts on the approaches used in both treatments. One research journal is chosen each for CBT and orthomolecular therapy, summarised, and compared. At the end of this paper, one of the said treatments is suggested as the better choice in treating this disorder. General suggestions are also made to therapists, patients, and patients' family members.

INTRODUCTION

Schizophrenia is a major mental illness which causes its patients to experience progressive personality changes and also a failure in their relationships with the outside world (Schizophrenia, 2006). It is prevalent to about 1% of the worldwide population, with some countries having higher incidence of this disorder and some lower (Schizophrenia, 2001). Schizophrenic patients show signs of hallucinations which are seeing or hearing something that is not really there. It is common for them to hear unreal threatening voices. Delusions, which are false beliefs or opinions of self and others, are also a symptom to this disorder. Delusions of persecution results them to experience paranoia. They would also display disorganized thought and behaviour. This includes incomprehensible speech, aggressiveness, public exhibition and so forth. Other than that, the patients might also have difficulty showing or expressing emotion including unresponsiveness, immobility, and excessive motor activity. Looking at the severity of this disorder, it does not come as a surprise that the leading cause of death among patients with schizophrenia is suicide, as argued by Schwartz and Cohen (as cited in Walker et al., 2003).

There is not a single cause of this disorder. There are, however, a number of risk factors being attributed to schizophrenia. Heredity or genetics is the most well known risk factor where the risk is increased ten times on people with immediate schizophrenic family members. Patients diagnosed with this illness are also consistently found with abnormal brain structure with decreased blood flow to the frontal lobes (Schizophrenia, 2001). The risk is also greater on those with birth trauma or complications. Besides that, it is also thought that environmental factor and stress, such as troubled relationships, do trigger the onset of this disorder.

Schizophrenia is seldom curable (Schizophrenia, 2001). In this report, we will explore two different treatments as an attempt to treat, not cure, this illness.

SECTION 1

Orthomolecular Therapy for Schizophrenia

Abram Hoffer in the 1950s was the founder of orthomolecular treatment. His therapies focused on using vitamin B3 (niacin or niacinamide), vitamin C (ascorbic acid), vitamin B6 (pyridoxine) and zinc, selenium, omega-3 essential fatty acids (docosahexaenoic acid and eicosapentaenoic acid) to treat what he diagnosed as acute schizophrenia and chronic schizophrenia. He cautions that those with chronic schizophrenia may take longer to show measurable progress by taking this therapy. Orthomolecular treatments which have been practiced in 39 countries are inexpensive, safe and effective and can be included with medication to optimize outcomes.

Hoffer's adrenochrome theory

Adrenochrome theory or, more accurately, known as aminochrome hypothesis. He stated that schizophrenic toxin was an oxidised derivative of adrenaline which is adrenochrome. Too much adrenochrome could arise from excessive oxidation of adrenaline and in turn this would increase the production of toxic metabolites of adrenochrome such as adrenolutin.His finding are shown as below.

  1. Adrenochrome and its close relatives, dopaminochrome (from dopamine) and noradrenochrome (from noradrenaline) present in the human brain
  2. Adrenochrome probably induce a combination of neurotoxic and mind-moodaltering effect
  3. Reducing adrenochrome and its close relatives is therapeutic for the treatment of schizophrenia

The adrenochrome hypothesis can be described biochemically by a series of reactions as follows:

  1. Noradrenaline + methyl ?adrenaline
  2. Adrenaline+oxygen ? adrenochrome
  3. Adrenochrome ? leukoadrenochrome / adrenolutin

We suggested that any reaction which diverted adrenochrome into adrenolutin rather than into leukoadrenochrome would cause or aggravate schizophrenia.

What is orthomolecular therapy

Orthomolecular treatment is the treatment of diseases of the mind by providing the brain and the body with the best possible biochemical environment, especially with those substances normally found in the body such as vitamins, minerals, amino acids and other essential molecules by giving suitable doses of vitamins according to individual needs. It has been found to be very effective in the treatment of mental illness, even schizophrenia.

"Orthomolecular psychiatry, on the other hand, emphasizes a system of treatment, not any one drug or chemical. The schizophrenic is given optimal amounts of materials that are necessary for good nutrition and optimal functioning - vitamins, minerals, fats, carbohydrates, and amino acids. The orthomolecular program requires full patient participation in changing lifestyle and discontinuing faulty eating habits" (Hoffer, 1977)

The main orthomolecular strategies for schizophrenia
  1. Dietary and lifestyle adjustments
  2. All processed foods, refined sugars and stimulants such as caffeine and black tea, cigarette smoking, alcohol consumptions and the use of mind-altering substances such hashish and marijuana must be avoided to lead the schizophrenic patients to a healthy lifestyle. Bad diet, poor lifestyle and common food allergens will increase the production of adrenaline and thus oxidize it to adrenochrome in schizophrenic patients.

  3. Vitamin B3 (niacin or niacinamide)
  4. Vitamin B3 is one of the methyl acceptor. Optimum dose of niacin might decrease the amount of noadrenaline that might be converted to adrenaline. Thus, vitamin B3 reduce the quantity of adrenochrome by limiting the quantity of adrenaline because adrenochrome is oxidised from adrenaline. Vitamin B3 is a precursor to nicotinamide adenine dinucleotide(NAD), which is present in both oxidised (NAD) and reduced forms (NADH) in the body. If there are sufficient NAD and NADH, oxidised adrenaline is reconverted to adrenaline in the presence of vitamin B3 coenzymes. Without enough NAD and NADH, adrenochrome will be in much greater concentrations in patient's brain resulting from oxidised adrenaline.

    Chronic patients required vitamin B3 treatments for more years to obtain significant results. They need to be treated with vitamin B3 immediately if found to have schizophrenia.

    E.Prousky (2007) stated that the starting dose of niacin for adults is normally 1000 milligrams (mg) three times daily. In my opinion, the daily dose needs to be slowly increased to 4500-18000 mg to achieve the best possible outcome.

  5. Vitamin C
  6. It is a powerful antioxidant properties and anti-stress nutrient. It prevents the double oxidation of adrenaline to adrenochrome and also its auto-oxidation in critical brain areas. Vitamin C has upon the brain as below:

    1. protect NMDA receptors from glutamate toxicity within the brain
    2. its antagonism of the effects of amphetamines
    3. enhancement of older APDs like haloperidol
    4. prevent the auto-oxidation of dopamine to its toxic derivatives

    Acute and chronic schizophrenic patients will require more vitamin C intake. High dose of vitamin C (3000mg daily) can reduce psychological stress, decrease blood pressure, and lower cortisol levels in healthy men after 14 days taking vitamin C.

  7. Zinc and vitaminB6 (pyridoxine)
  8. Schizophrenic patients test positive in the urine for kryptopyrrote. By taking pyridoxine and zinc, kryptopyrrote combines irreversibly with pyridoxine and then zinc, thus reduce the symptoms of schizophrenia. It is free of side effects.

    250mg of pyridoxine and 50mg of zinc are suggested for daily dosages.

  9. Selenium
  10. It protects free radical damage and antagonistic to adrenaline and hence to adrenochrome, which is oxidised adrenaline. It also prevents the excessive oxidation of the fatty acids, restore glutathione peroxidise activity and produce the proper production and action of prostaglandins. Pure forms of thyroid hormone have better cure rates for schizophrenia. Triiodothyronine components achieved favourable clinical results because this hormone would reverse the toxic effects of excess adrenochrome. By taking selenium, deiodinase enzyme will convert thyroxine to triiodothyronine. 200 to 400 micrograms (mcg) of selenium is suggested for daily dosage.

  11. Omega-3 essential fatty acids

Fish oil, the elcosapentaenoic acid (EPA) content has proven to help positive symptoms such as hallucinations and delusions, and negative symptoms such as flat affect, depression and isolation. 2 g of EPA should be provided as optimal daily dose.

Side effects

Orthomolecular treatment is generally very safe.Vitamin dosages depend on individual's tolerance and the dosages of vitamin can change over time as prescribed by clinicians. "A small percentage of people might experience certain discomfort after taking vitamins but this can be resolved by consuming other forms of these vitamins or adjust the dose. It can be dangerous if safe doses of nutritional supplements are not observed." (Orthomolecular Medicine, 2010)

"At 3000mg vitamin B3 daily, flush and other symptoms will cease to be an issue following in the first two to three days of the treatment and will practically disappear thereafter. If patients are not consistently taking these high-milligram doses throughout the day, they will continually re-experience these cutaneous reactions." (Jonathan E.Prousky ,2007)

Conclusion

Even though there are many essential nutrients are mentioned above can help to reduce schizophrenia symptoms, but the most important are vitamin B3 and C. Those vitamins must be given to the patients initially and the others are then added over several months. The orthomolecular therapy requires a great amount of patience from clinicians since schizophrenia consumes a longer time to be cured. Similarly, patients' families need to give their support, patience and also motivation to them in order to achieve better improvement.

Cognitive Behavioural Therapy (CBT) for Schizophrenia

Psychological distress is caused by distorted thoughts from stimuli causing distressed emotions, as suggested in cognitive therapy. The task of cognitive therapy or CBT is partly to understand how emotions, behaviours, and thoughts interrelate, and how they may be influenced by external stimuli (Mulhauser, n.d). CBT is now recognized as an effective intervention for schizophrenia in clinical guidelines developed in Europe and in the U.S. (Hansen, Kingdon & Turkington, 2006) and increasingly being included in the basic training of nurses, psychologists, and psychiatrists with studies and reviews published from Malaysia, Scandinavia, Holland and North America (Turkington, Kingdon & Chadwick, 2003).

This therapy only aims to lead the patient to be aware of thought distortion which is causing psychological distress and of behaviour patterns that are reinforcing it, and to correct them. As such, the objective is not to correct each and every distortion but only those at the root of the distress.

Generally, the procedure for CBT involves the establishment of links between thoughts, feelings, and actions in a collaborative and accepting atmosphere between the patient and the therapist. The duration varies according to the needs of the patient but is generally 12 to 20 sessions and there usually is an option for booster sessions (Hansen et. al., 2006). The phases for CBT are as explained below.

The first phase involves the assessment phase. In this phase, the patient expresses his thoughts and experiences while the therapist listens actively. The therapist usually uses rating scales to monitor the progress and the results are shared with the patient.

In the engagement stage, the therapist should explain clearly what the therapy is all about. Socratic questioning is emphasized throughout the therapy. The therapist makes sure that the patient knows that he does not have all the answers but cooperation between them both could generate useful explanations. Therapeutic factors of warmth, humour, empathy, and genuineness are of great values.

Ellis and Harper's ABC model (as cited in Hansen et. al., 2006), gives patient a way of organising confusing experiences. This is to clarify the relationship between the activating events (A), the patient's belief (B), and the belief's consequences (C).

In terms of goal-setting, measurable, realistic, and achievable goals for the therapy should be discussed early with the patient. Revisitations of goals are made during and at the end of the therapy.

Besides that, normalization is decatastrophyzing for psychotic experiences. It is a fact that many people do undergo unusual experiences, such as hyperventilation, and this reduces anxiety and the sense of isolation of the patient. The possibility of recovery would seem less distant if the patient feels less stigmatised or alienated.

The next phase involves developing alternative explanations. It is of utmost importance to allow the patient to develop his own alternatives to previous maladaptive assumptions. The patient's own healthier explanations might just be temporarily shadowed by dysfunctional thinking patterns or external factors. If the patient is not willing to give alternative explanations, new ideas can be constructed with the collaboration of the therapist.

"Throughout this process of learning, exploring and testing, the client acquires coping strategies as well as improved skills of awareness, introspection and evaluation. This enables them to manage the process on their own in the future, reducing their reliance on the therapist and reducing the likelihood of experiencing a relapse" (Mulhauser, n.d). The effect size of the therapy is strong, with the likeliness to last long at short term follow up (Turkington, Dudley, Warman & Beck, 2006).

The treatment of schizophrenia with CBT is based on cognitive theory. Cognitive theory is based on the concept proposed by a Swiss biologist and psychologist Jean Piaget (1896-1980), who is famous for his Stage Theory of Cognitive Development, which descript cognitive development as four distinct stages in children: sensorimotor, preoperational, concrete, and formal. Cognitive theory is a learning theory of psychology that attempts to explain human behaviour by understanding the thought processes including how people think, perceive, remember and learn. The assumption is that humans are logical beings that make the choices which make the most sense to them.

Pure cognitive theory, which concerned with internal mental process, largely rejects behaviourism which focuses on observable behaviours on the basis that behaviourism reduces complex human behaviour to simple cause and effect. However, as stated by Lisa Fritscgher (2009), the trend in past decades has been towards merging the two into a comprehensive cognitive-behavioural theory. This allows therapists to use techniques from both schools of thought to help clients achieve their goals more effectively.

Contradiction between the Cognitive approach and Biopsycological approach.

CBT uses the cognitive approach. As explained by the cognitive theory, CBT focuses on the mental process and information processing, including how humans obtain perceptions, define something and remember information. The patient must understand and be aware of their distortion in thought that is causing their psychological unrest. The main focus is not to correct all thought distortions, only those that are causing the symptoms of schizophrenia including psychosis and disorganized behaviour. The patient needs to establish links between his thoughts, feelings and actions with the help of the therapist. It's obvious these links can only be constructed by the patient himself consciously, not without him knowingly. Even in Ellis and Harper's ABC model, the patient must knowingly build the actual relationships between the activating events, patient's belief and the belief's consequences. Usually, he only sees the activating event and the consequences, unknowingly skipping the belief that is causing the consequences. Here, the role of the therapist is to change the original perception of the patient that links event directly to consequences. The therapist then reason with the patient, changing this distorted thought, making him aware or be conscious that it's this distorted belief that is causing all the psychological stress.

In contrast, from the biopsychological approach, we are the consequence of our genetics and physiology. Orthomolecular treatment is an unconscious mind which the vitamins taken by the schizophrenic patients and the chemical reaction will occur in the brain and it cannot be controlled by the human themselves. The oxidation of the hormone such as tyrosine, L-dopa, dopamine, noradrenaline and adrenaline in the body to further chemical reactions which then cause the symptoms of schizophrenia can be prevented. Biopsychological approach emphasis on a physical or biological cause to psychological difficulties such as hallucination and delusion, the approach has been very influential in the use of physical therapies, or chemotherapy, as a treatment for schizophrenic patients.

Schizophrenia is understood caused by the abnormal molecules and enzyme activities in the brain. Biolopsychological influences into the study of schizophrenia. When the brain is biochemically disorganized, so is the mind. There is great inter-individual variation in the brain biochemical needs and metabolic processes. Some nutrient requirements, especially those for vitamins, may vary up to 100-fold between individuals. Persons who remain well on average levels of needed nutrients may develop problems if their diets become deficient or they are unable to absorb the nutrients. Deficiency disease can result from the lack of a particular nutrient.

It can say that that the brain can be subdivided into many different areas and structures and biopsychological explanations often focus on which brain areas are responsible for which types of thinking or behaviour and how they connect with other functions and brain areas. It is widely believed by biopsychologists that schizophrenia, a psychological disorder involving a range of symptoms including hallucinations, delusions and disorganized thinking and speech, is at least partly the result of inheriting faulty hormones.

These hormones are thought to influence the development of the receptors in the brain, making it vulnerable to malfunctioning in certain ways that produce the symptoms of the disorder. Biopsychologists believe that chemical processes in the brain can be an important influence on behaviour. The brain relies on a large number of chemicals (called hormones). Too much or too little of any of these chemicals can result in over- or under-activity in various parts of the brain, which results in changes to thinking, feeling and behaviour.

SECTION 2

Journal title: High-dose Vitamin B6 Decreases Homocysteine Serum Levels in Patients

With Schizophrenia and Schizoaffective Disorders: A Preliminary Study.

Abstract

In this research, the author has focus on the essential role of Vitamin B6 in the normal functioning of the central nervous system. Normal homocysteine (Hcy) serum level is maintained by remethylation of Hcy to methionine by enzymes that require folic acid and vitamin B12 and by catabolism to cysteine by a vitamin B6-dependent enzyme. These findings may be consistent with the hypothesis that the vitamin B6 status may influence plasma Hcy levels. The aims of this preliminary study were:

  1. To determine whether a correlation exists between Hcy and vitamin B6 levels in patients with schizophrenia and schizoaffective disorders
  2. To investigate whether treatment with highdose vitamin B6 may reduce Hcy levels in these patients.

Subjects used and Methodology: In this preliminary study, the author enrolled 11 patients with schizophrenia or schizoaffective disorders (7 men and 4 women; mean age SD, 50 12 years). Inclusion criteria for the subjects were (a) males and females older than 18 years, (b) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder, (c) a stable psychotropic regimen for at least 1 month before entry into the study, and (d) all patients had to be hospitalized.

The subjects will receive high doses of vitamin B6 treatment (1200 mg/d) for 12 weeks. Blood samples for the assessment of pyridoxal-5-phosphate and Hcy serum levels were obtained at baseline and after 12 weeks of treatment.

Statistical Analysis.

Blood samples for assessment of pyridoxal-5-phosphate (PLP) and Hcy serum levels were obtained at baseline and following 12 weeks of treatment with vitamin B6 (1200 mg/d). Then, comparison of Hcy serum levels before and after vitamin B6 treatment were conducted. From the results obtained, Hcy serum levels has decreased significantly (before vs. after treatment, 14.2 3 vs. 11.8 2 mol/L, respectively), and this decrease was statistically significant in men compare to women.

Theoretical view.

Mattson & Shea (2003) stated that homocysteine (Hcy) is a neurotoxic amino acid generated via methionine metabolism. Increased plasma total homocysteine (tHcy) levels were reported in several neuropsychiatric disorders such as major depression and schizophrenia.

Hence, studies have been developed in order to know more about the homocysteine (tHcy) levels in human. It is found that the normal Hcy serum level is maintained by remethylation to methionine by enzymes that require folic acid and vitamin B12 and by catabolism to cysteine by the vitamin B6. This mechanism is supported by Bates CJ, Pentieva KD, Prentice A (1999) which have reported that Vitamin B6 supplementation can reduce high concentrations of Hcy seen in patients, but the role of this vitamin when administered in low to moderate doses in the commoner forms of mild hyperhomocystinemia is less clear. The study also demonstrates that supplementation with high doses of vitamin B6 leads to a reduction of Hcy serum levels in men with schizophrenia or schizoaffective disorders. More researches in a larger sample are necessary to substantiate such gender-specific effects.

High level of Hcy has recently been suggested to be an independent risk factor for schizophrenia. In this regard, Levine et al(2002) and Appelbaum et al(2004) reported high Hcy levels in patients with schizophrenia appearing mainly in young men. Based on a meta-analysis of 8 retrospective studies (812 cases and 2113 control subjects) conducted to examine the association between Hcy and schizophrenia, a 5-mol/L higher Hcy level was associated with a higher risk of schizophrenia (about 70% higher; Muntjewerff et al, 2006). Levine et al(2006) has performed a studied on 42 schizophrenic patients with plasma Hcy levels greater than 15 mol/L who were treated for a 3-month period with folate (2 mg/d), vitamin B12 (400 g/d) and B6 (25 mg/d) in a doubleblind, placebo-controlled, cross-over, add-on design. The active treatment compared with the placebo has led to a decline of Hcy plasma level coupled with an improvement in clinical symptoms of schizophrenia as measured by the Positive and Negative Syndrome Scale.

Based on the data above, it can be suggested that a subgroup of schizophrenic patients with hyperhomocystinemia might benefit from the simple addition of B vitamins.

Journal title: Effectiveness of a brief cognitive behavioral therapy intervention in the treatment of schizophrenia

Aim: to assess the effectiveness of CBT intervention in a sample of patients with schizophrenia in secondary care setting.

  • Methodology and sampling method: a pragmatic randomized trial involving 422 patients and careers is performed to compare the brief CBT intervention against treatment as usual. All the patients are within the age range of 18 to 65 years and they receive secondary care services at six sites of UK which are Belfast, Glasgow, Hackney, Newcastle, Southampton and Swansea. Any patient who was deteriorating, needed intensive home treatment, and with a primary diagnosis of drug or alcohol dependence, organic brain disease or learning disability severe enough to interfere with the rating is excluded from the research. Randomization was conducted by computer- generated blocks of six random numbers and stratified by site. The ratio of active intervention to treatment as usual (TAU) was 2:1.
  • Assessment: Standardized measures were used to assess the primary outcomes of the study at baseline and at the end of therapy (20 weeks). The primary outcome measures were of overall symtomatology (Comprehensive Psychopathilogical Rating Scale, Asberg et al. 1978), insight (Insight Rating Scale, David, 1990) and career burden (Burden of Care Questionnaire, Mueser et al, 1996). Secondary outcome measures included change in schizophrenic symptoms (Schizophrenia Change Scale, Montgomery et al, 1978) and depression (Montgomery- Asberg Rating Scale, Mongomery & Asberg, 1979). Details of medication are converted to chlorpromazine equivalents using the WTO's Anatomical Therapeutic Chemical Classification System (WTO, 1993). In the case of typical neuroleptics, along with the number of atypical neurolectics and pre-study hospitalization, were taken from the medical case notes. All of these measures were then rechecked at the end of the study period to check for differences between the groups. Further assessments of primary outcome scales and of rehospitalization were carried out 9 months after the end of therapy to ascertain the whether the effects of treatment are durable.
  • Result: CBT intervention group has a mean of 4.71 previous admissions for schizophrenia with a mean number of previous days in hospital for schizophrenia of 48.53. In contrast, the TAU group has a mean of 5.18 admissions and 52.01 days in hospital. The CBT intervention group has a mean figure for chlorpromazine equivalence of 746.88mg and the TAU group of 886.58mg. Of those on atypical neuroleptics, 55 were in the CBT intervention group and 25 in the TAU group. Statistically significant improvements were seen in the CBT intervention group compared with the TAU group in overall symptoms, insight and depression. The score mean difference between two groups for overall symptomatology is 2.29 (P 0.015), insight 1.30 (P<0.001), depression 0.87 (P 0.003), symptoms of schizophrenia 0.35 (P 0.258), and burden of care 4.25 (P 0.126). There was one suicide occur in the TAU group during the treatment period. There was significantly more drop-out in the TAU group than in the intervention group.
  • Discussion: The research shows that a brief CBT intervention, along with psychoeducational materials, can be delivered by community psychiatric nurses (CPN) in the community with the help of careers to achieve symptomatic improvement without increasing suicidality. Patients from CBT intervention group who exposed to psychoeducation have a better understanding on their mental illness. The improvement in insight for CBT group suggest that patients receiving CBT may show a potential for improved adherence, better use of coping skills and in longer term, reduced length of time in hospital. This is consensus with the theoretical view as discussed previously, in which patients who receive CBT have fewer and less intense hallucinations and delusions, and recover their functioning to a greater extent than patients who do not receive CBT. Furthermore, it can be strengthen by Debbie M. Warman and Aaron T. Beck (2002), who summarize that patients who received CBT did significantly better than patients who received routine care only. The treatment has successful to promote positive change in CBT group by addressing their thought patterns, feelings and behavioral issues.

Based on the data above, it can be said that CBT intervention is an effective way to reduce the symptoms of schizophrenia and reduce suicide rate in schizophrenia patients.

SECTION 3

Schizophrenia can be considered as a serious mental illness in the field of psychology. After examining and analyzing both of the treatments, we are in view that orthomolecular therapy is a better treatment if compared to cognitive behavioural therapy (CBT) and it has a greater potential in the coming days. At the North Nassau Mental Health Center, in Manhasset, New York (one of the world's largest psychiatric clinics, employing 15 psychiatrists as well as psychologists, social workers, and research technicians), Director Dr. David R. Hawkins has demonstrated what he feels is the proof that orthomolecular techniques are much more effective than conventional methods in treating schizophrenia.

First, the main reason is that orthomolecular therapy is more effective in terms of improving schizophrenia symptoms. This is because orthomolecular therapy treats the illness from the internal biological aspect, in which the conditions of patients are improved just by taking vitamins so that the oxidation of hormones such as tyrosine, L-dopa, dopamine, noradrenaline and adrenaline in the body, which is the cause of schizophrenia, will be decreased. The schizophrenia symptoms will improve naturally after taking the vitamins as suggested by clinicians. In contrast, CBT, which is focused more on the internal mental process and observable behaviours, uses external ways to treat the illness. In other words, the illness is treated somehow by giving counselling sessions to patients. To strengthen our point of view, (Vonnegut, 1975, pg 272) described his experience with schizophrenic delusions. Standard psychotherapy was unable to help him, and most of his doctors said his case was hopeless. Then Vonnegut went to the Brain Bio Center and the biochemists said otherwise. He was successfully treated with inexpensive, simple, non-prescription pills - vitamins, mostly.

Besides, in most cases, CBT is only used as an adjunct to psychotic medications because it is not strong enough to be used alone as the main course of treatment. Furthermore, people who are not able to attend subsequent CBT sessions and have less cognitive capacity to follow the thought process in CBT show lower progress and may ultimately require more hospitalizations and have lower quality of lifestyle. Gottlieb and Cather (2007) state that the effects of the antipsychotic medication tend to make CBT more productive because the medications generally provide at least some relief from voices and having confused thinking which are a major distraction if not treated. The drug treatments lower the effect of psychosis, allowing the patients to concentrate more on the skills and strategies as laid out by CBT. Meanwhile, orthomolecular therapy can definitely be used as a main treatment course for schizophrenia. According to a research by Hoffer (as cited in Prousky, 2007), the patients who had taken vitamin B3 fared much better than patients who were not given the vitamin. Schizophrenic patients who had taken vitamin B3 will have less hospitalization admission, required hospitalization for fewer days and even no suicides.

Other than that, CBT will require more attention from clinicians and family members if compared to orthomolecular therapy, in which patients only need to consume vitamins daily at the doses prescribed by the clinicians. Furthermore, orthomolecular therapy has a better recovery rate than CBT. As proven by North Nassau Mental Health Center, which has switched to the orthomolecular approach, schizophrenic patients require only about one-tenth the attention they previously required, approximately 15 visits a year, and show a dramatically improved recovery rate (over 75% as compared with less than 40% previously) with fewer relapses.

Recommendations for therapies

  1. Therapist should pay tremendous amount of patience since the results take long time to materialize.
  2. Therapists should make sure the patients' families understand the importance of taking the vitamins on time so that family members could play their part by making sure the patients take the vitamins at the correct time.
  3. Therapists should advise patients not to stop taking the vitamins even if they are experiencing red flush and other symptoms such as nausea in the first few days after taking the vitamins. These side effects are only present during the initial introduction of the high dosage vitamin intake. Failure to consistently adhere to the prescription will only cause the side effects to remain.
  4. Therapists should encourage the patients not to give up easily in continuously taking the vitamins and also have patience since this therapy requires a longer time to obtain the desired results.

Recommendations for patients/clients

  1. Clients must have a balanced diet and a healthy lifestyle including regular exercises, do not smoke and avoid alcohol consumption.
  2. Clients should avoid taking allergens such as milk, dairy, wheat, corns and eggs and also stimulants such as caffeine and black tea.
  3. Clients have to give commitment to the treatment given by their therapists and take initiative to consume the vitamins punctually.
  4. Family members should accept the fact that their loved ones have mental disorder and therefore should give them support, love and care.
  5. Patients and their family members need to have the necessary patience and motivation to continue in the therapy as this mental illness will take a long time to recover.

References.

  1. Abram Hoffer (1977). Orthomolecular Psychiatry in Theory and Practice. Retrieved March 25, 2010, from http://www.lightparty.com/Health/ORTHO.html
  2. Douglas Turkington, David Kingdon and Trevor Turner. 2002. Effectiveness of a brief cognitive-behavioral therapy intervention in the treatment of schizophrenia. Retrieved March 23, 2010, from http://bjp.rcpsych.org/cgi/content/full/180/6/523
  3. Hansen, L., Kingdon, D., Turkington, D. (2006). The ABCs of Cognitive-Behavioral Therapy for Schizophrenia. Psychiatric Times, 23(7). Retrieved 24 March, 2010, from http://www.psychiatrictimes.com/display/article/10168/51321
  4. Jonathan E.Prousky (2007). The Orthomolecular Treatment of Schizophrenia: A primer for Clinicians. Retrieved March 25, 2010, from The Canadian College of Naturopathic Medicine, , ND, FRSH
  5. Lisa Fritscher. 2009. Cognitive Theory. Retrieved March 22, 2010, from http://phobias.about.com/od/glossary/g/cognitivethedef.htm
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  8. Mulhauser, G. (n.d.). An Introduction to Rational Emotive Behaviour Therapy. Retrieved 24 March, 2010, from http://counsellingresource.com/types/rational-emotive/index.html
  9. Mulhauser, G. (n.d.). Schizophrenia Symptoms. Retrieved March 24, 2010, from http://counsellingresource.com/distress/schizophrenia/dsm/schizophrenia.html
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  11. Richard Warner (2000), The Environment of Schizophrenia, Innovations in practice, policy and communications, London: Brunner- Routledge.
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  14. Stage Theory of Cognitive Development (Piaget). Retrieved March 22, 2010, from http://www.learning-theories.com/piagets-stage-theory-of-cognitive-development.html
  15. The National Institute of Mental Health. Cognitive-Behavioral Psychotherapy. Retrieved March 22, 2010, from http://www.psychologyinfo.com/schizophrenia/cognitive.htm
  16. Turkington, D., Dudley, R., Warman, D. M., Beck, A. T. (2006). Cognitive-Behavioral Therapy for Schizophrenia: A Review. Focus, 4(2), 223-33. Retrieved 24 March, 2010, from http://focus.psychiatryonline.org/cgi/content/full/4/2/223
  17. Turkington, D., Kingdon, D., Chadwick, P. (2003). Cognitive behavioural therapy for schizophrenia: filling the therapeutic vacuum. The British Journal of Psychiatry (2003), 183, 98-99. Retrieved 24 March, 2010, from http://bjp.rcpsych.org/cgi/content/full/183/2/98
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  19. Walker, E., Kestler, L., Bollini, A., Hochman, K. M. (2004). SCHIZOPHRENIA: Etiology and Course. Annu. Rev. Psychol. 2004, 55, 401-430.

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