Orthomolecular Treatment for Schizophrenia (Good Health Guides)
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One study found no effect of the Chinese herb sarsasapogenin compared with placebo when added to risperidone on positive, negative, and cognitive symptoms or general psychopathology in 90 patients during 8 weeks Xiao et al. Many different nonsevere adverse effects were reported e. B1 showed some positive effect on general psychopathology when combined with B6 and B12 in one study Joshi, and on positive and negative symptoms in another Sacks et al.
B3 showed improved general psychopathology in three from nine studies Ananth et al. B6 improved general psychopathology in four from five studies Ananth et al. In one study, general psychopathology improved after the administration of methylfolate Godfrey et al. One study reported no effect of B9 folic acid Hill et al. Another study showed a positive effect of combined B6, B9, and B12 on positive, negative, and cognitive symptoms Levine et al.
Yet, another study showed improved negative symptoms by adding B9 folic acid and B12 to antipsychotics, but only in those with a specific genotype Roffman et al. B6 improved extrapyramidal adverse effects of antipsychotics TD and neuroleptic induced akathisia in four from four studies Lerner et al.
In one study on B3 in 57 children without antipsychotics, cognition and general psychopathology had not improved after 6 months Greenbaum, Most B vitamins induced modest adverse effects, especially skin flushing and abnormal liver function induced by vitamin B3 and B6. One reported improved general psychopathology and reduced adverse effects reduced serum malondialdehyde; a lipid peroxidation product when added to olanzapine 10 mg , quetiapine mg , or ziprasidone 40 mg after 8 weeks Dakhale et al. One study without antipsychotics found no effect on cognition or motor functioning after 10 days Bhavani et al.
Both studies reported no adverse effects of vitamin C. Four studies on ginkgo biloba were found Zhang et al. Three from four studies found improved positive symptoms Zhang et al. In all four studies, adverse effects of antipsychotics improved behavioral toxicity, symtoms of nervous system, and TD. No adverse effects of ginkgo were reported. Thirteen studies of vitamin E were found Adler et al.
Five from five reported no effect on general psychopathology Adler et al.
Agents that did not fit in the five aforementioned categories were classified in this residual category. A total of 16 high-quality RCTs have been performed on multivitamins Altman et al. Two from five studies on DHEA added to antipsychotics showed improvement of negative symptoms Ritsner et al. Three from four improved adverse effects of drugs Nachshoni et al. Three from three studies on estradiol showed improvement of general psychopathology Akhondzadeh et al. Two from two studies on GHB found no improvement of general psychopathology Levy et al.
No serious adverse effects of these agents were reported. One study of two on artemisinin a natural medicine against malaria found a significant effect on negative symptoms and clinical global impression, but no effect on positive or cognitive symptoms or on general psychopathology in first-episode treatment-naive patients that were treated with risperidone Dickerson et al.
The study of Dickerson et al.
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This review describes the effects of natural agents in the treatment of psychotic disorders and of undesired effects of antipsychotics. Some studies suggest that glycine, sarcosine, NAC, several Chinese and ayurvedic herbs, ginkgo biloba, estradiol, and vitamin B6 may be effective for psychotic symptoms when added to antipsychotics glycine not when added to clozapine. Reserpine without antipsychotics seemed effective in one old study but was poorly tolerated. Ayurvedic herbs seemed equally effective as olanzapine in only one study.
Other agents as monotherapy vitamin B3, vitamin C, sarcosine, glycine, and protilerin were not effective or had only been tested in single or small trials. For alleviation of adverse effects, ginkgo and vitamin B6 seemed effective for TD and neuroleptic induced akathisia NIA.
The evidence for reducing some adverse effects of antipsychotics by omega-3 fatty acids, melatonin, and DHEA was inconclusive. Apart from reserpine, all natural compounds studied caused no or mild undesired adverse effects. There is inconclusive evidence for improved outcome by combining omega-3 fatty acids with antipsychotics in schizophrenia. Earlier reviews reported similar conclusions Boskovic et al. A meta-analysis of randomized placebo controlled trails showed a modest, nonsignificant, beneficial effect of fatty acids in schizophrenia Fusar-Poli and Berger, Glycine and sarcosine combined with antipsychotics may reduce negative symptoms, but not when combined with clozapine and neither as monotherapy.
Inconclusive evidence was found for d -cycloserine and d -serine on clinical improvement. Our results concur with two reviews Singh and Singh, ; Tsai and Lin, and are in line with a Cochrane review Tiihonen and Wahlbeck, By adding Chinese or ayurvedic herbs to antipsychotics, general psychopathology may improve.
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One study of two on artemisinin a natural medicine against malaria found a significant effect on negative symptoms and clinical global impression, but no effect on positive or cognitive symptoms or on general psychopathology in first-episode treatment-naive patients who were treated with risperidone Wang et al. Rathbone et al. The combined approach using knowledge from both conventional and Chinese medicine seems promising, as it may lead to innovation Van der Greef, and possibly to improved outcomes Zhang et al.
One review concluded that no adequate support for the efficacy of B vitamins in schizophrenia can be identified Kleijnen and Knipschild, Most studies with positive effects in our review, however, were published after the aforementioned review was published. Most convincing evidence was found for vitamin B6 added to antipsychotics, shown to be effective in diminishing general psychopathology and TD.
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The findings on the efficacy of vitamin C for schizophrenia in only two RCTs were inconsistent, hindering definite conclusions. The efficacy of vitamin E on TD remains inconclusive, as only half of the included studies found some positive results. Even so, a meta-analysis by Boskovic et al. A Cochrane review in Soares et al. There is no evidence that vitamin E improves symptoms of this problematic and disfiguring condition once established. Ginkgo biloba seems to benefit patients with schizophrenia in several ways when added to antipsychotics.
Several studies suggested evidence for improving symptoms in various domains, especially an effect on positive symptoms and the reduction of adverse effects of antipsychotics. On melatonin, one study provided preliminary evidence for diminishing TD Shamir et al. As TD is difficult to investigate because of the fluctuating symptom severity, this study needs replication. Some inconsistent evidence was found on improved outcomes by several hormones DHEA, PREG, and testosterone in schizophrenia, not allowing final conclusions. For estradiol, a Cochrane review reported no convincing evidence over placebo Chua et al.
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Since then, two studies found that estradiol improves positive but not negative symptoms and general psychopathology in schizophrenia when added to antipsychotics Kulkarni et al. Therefore, using estradiol in schizophrenia warrants further study. There are several methodological limitations. First, the wide scope of this review allows only general descriptions of included studies in six domains. Second, it is unclear to which extent our findings are influenced by publication bias, in favor of publication of studies with positive results. Third, we used the Jadad score to select only RCTs of high quality with a score of three or higher, as is in accordance with other reviews [ e.
However, the Jadad score is not a perfect tool because it does not judge the selection of subjects, the sample size and power, and the quality of the data analyses. Therefore, RCTs with a Jadad score of 3 or higher might still have methodological weaknesses, which hamper drawing firm conclusions.
Fourth, some studies e. Fifth, in most of the studies included, effect sizes were not provided nor was it possible to calculate them, which makes it difficult to compare the results or to estimate the clinical relevance of some of the findings. Sixth, it cannot be ruled out that some of the studies were underpowered, which might have hampered finding a significant effect. Clinicians need to be aware that patients often use natural medicines without medical prescription, whereas some patients assume that natural is better than chemical and causes fewer adverse effects.
Although beneficial effects may occur, this is certainly not always true.
Some natural agents that may be suggested for treatment of psychotic disorders are toxic to humans Topliss et al. From a medical perspective, it is therefore important to know what patients buy and try.