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Essay: Exploring Alternatives to Antipsychotics for Schizophrenia

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Introduction

About 1% of the population suffers from schizophrenia and the associated symptoms and side effects of medication (Tsuang & Faraone, 2005). Schizophrenia disorder is a complex and serious mental illness characterized by psychotic symptoms, positive symptoms, negative symptoms, and impaired cognitive functions. A brief summary of the types of symptoms: Positive symptoms are obvious phenomena, such as psychoses, people with schizophrenia often hear voices or see things that are not present; hallucination, and have strange beliefs; delusions. Negative symptoms refer to the absence or confusion of, for example, power, emotion, speech or thoughts, disturbed thinking, talking and doing. Examples of this are inconsistent speech, chaotic behavior, and strange body movements (Heaton et al., 1994; Mueser, Deavers, Penn & Cassisi, 2013). The negative symptoms have a link with decreased activity of the frontal cortex while psychotic and paranoid symptoms are associated with an enhanced activity of areas deep in the brain, like the corpus striatum (Tsuang & Faraone, 2005). About 50% of the inpatients in mental institutions are Schizophrenics (Heaton et al, 1994).

The main treatment for schizophrenia are antipsychotic drugs. These medicines often cause unpleasant side effects such as movement disorders like tardive dyskinesia and tremor. Those can so severe to stop people from taking treatment (Brenner et al., 1990). In addition, there are several alternatives described in this paper. This overview looks at these alternatives to optimize the treatment of schizophrenia, prevent or minimize side effects and treatment failure. The two most discussed alternative medications, Wendan Decoction and Cannabis, are highlighted.

Methods

The advantages and disadvantages of the alternatives and antipsychotic medication were compared. A systematic literature search was conducted across three databases; Medline, PubMed and Elsevier. Overall, N= 10 studies were included in this review. A systematic display has been chosen according to the PRISMA guidelines (Moher, Liberati, Tetzlaff & Altman, 2009). All relevant studies on alternative medications between 1990 and 2017 have been found in four online databases (Medline, PubMed and Elsevier). Search terms were: “schizophrenia, alternative, medication, medicine, treatment, Cannabis, Addiction, psychosis, Chinese Herbal, Wendan Decoction, WDD, schizophrenia-like psychosis, ETC” combined with “schizophrenia”. First, all titles and abstracts were read. If it contained useful information, the remaining part of the article was read. All studies giving a description or so about MDD or Cannabis were allowed in this overview.

Results

In total, N= 10 studies met the criteria and took place, Wandan Decoction (N= 6) en Cannabis (N= 4).

Antipsychotic drugs

First, a clarification of antipsychotic drugs. This section is kept briefly and concise, because antipsychotics are often discussed in the literature already.

The brain contains nerve cells; these cells communicate with one another through the exchange of electrical signals. Neurotransmitters enable communication between neurons and other target cells, for example, they make it possible to change activity of a neuron very quickly and for a short period of time. A known neurotransmitter is Dopamine. This is the neurotransmitter that causes us to experience happiness and joy. People with schizophrenia have to much dopamine in certain brain areas, it is still not clear how this happens (Lieberman & Tasman, 2006; Amato, Vernon & Papaleo, 2017).  

Some drugs block the receptors, affecting communication between the neurons. In this manner, the influence of the nerves can be regulated (Amato, Vernon & Papaleo, 2017).  

All antipsychotic drugs have a common belief that they block the dopamine receptors. The antipsychotics that work according to the above-described mechanism cause a certain sense of indifference, protection from stress. This is experienced as very useful by most patients. So that is the positive contribution of antipsychotic drugs: the patient can concentrate again, goes less into his own thinking world with delusions and / or hallucinations (Lieberman & Tasman, 2006). However, the good effects on psychotic phenomena are associated with more or less side effects: muscular cramps (acute dystonia), abnormal movements (dyskinesia), muscular rigidity (hypertonia), restlessness (akathisia), tardive dyskinesia, weight gain, hormonal changes (may lead to breast augmentation, including men) confused and restless patients and malignant neuroleptic syndrome (this is a rare side effect accompanied by severe muscle stiffness and high fever, it occurs almost only at very high doses) (Lieberman & Tasman, 2006; Amato, Vernon & Papaleo, 2017).

In summary, antipsychotic treatment for people with schizophrenia has a strong number of benefits but also certain major disadvantages. Further research to alternatives need to be done to reduce, prevent or remove these adverse side effects. Two possible alternatives are Wendan Decoction and/or Cannabis.

Wendan Decoction

The first alternative option viewed is Wendan Decoction (WDD), a Chinese medicine, mostly referred to as ‘Traditional Chinese Medicine’. WDD is one of the classical Chinese herb formulas used for psychotic symptoms. It is thought to be secure, approachable and inexpensive (Deng, 2017). The last 2000 years this medicine had been used in China to treat schizophrenia-like illnesses (Veith & Barnes, 2015) and the composition of the herbal mix is different for each patient (Zhang, 1996). China, like the West, usually uses antipsychotic drugs as treatment for schizophrenia (Brenner et al., 1990). As mentioned earlier, this medicine has many side effects and, therefore, people are looking for positive alternatives worldwide. Deng (2017) claims that this method of treatment is the most commonly used ‘medication’ in China for people with schizophrenia, taking into account the large number of people living in China; 13 million people with schizophrenia; 1379 billion people in total.

Early research results from Saku (1991) and Wang (1998) show that traditional Chinese herbal medication is effective against psychosis they conducted that the combination of medication and herbs is very effective in reducing psychotic effects and shortening recovery time and side effects.

Deng (2017) also investigated the effects of WDD for schizophrenia or schizophrenia-like illness compared with placebo and antipsychotic drugs. He includes 15 randomised trails (N=1437). Unfortunately, the evidence is limited and indicates that WDD in comparison with placebo or no treatment, may have some antipsychotic effects in short-term. In addition, it had no effect on global or psychological conditions, when WDD was compared with other antipsychotics. A combination of WDD and antipsychotics results in; positive effects for global and mental condition and this combination caused less side effects. Once again, the evidence available is not from high quality. Better designed studies are needed to test WDD and the effects on schizophrenic patients (Deng, 2017; Wieland, & Santesso, 2017).

Rathbone et al. (2007) did a study taking seven trials. In the results of the studies, above all, the combination of WDD and antipsychotic drugs has advantages and is beneficial (Deng, 2017; Rathbone et al., 2007).

Despite WDD itself does not cause differences, it may be beneficial in combination with antipsychotic medication; reduced side effects.

Cannabis

  The second alternative found is Cannabis. Coulston et al (2011) claimed that patients suffering from a schizophrenia disorder can administer cannabis as a medication. They say that the cannabis causes stabilization of schizophrenic thoughts and it allows the patients to relax. The researchers found a high prevalence of cannabis use under schizophrenics. In addition, there is a so-called self-medication hypothesis: The use of cannabis provides beneficial effects with regard to the reduction of negative symptoms in a schizophrenia disorder, which is very beneficial compared to the typical medicines that do not reduce these negative symptoms.

  On the contrary Coulson and his colleagues (2011) found that Cannabis use in the schizophrenia population worsened the prognosis and increases the burden of disease. Conversely, there is evidence available for a small group of the general population that suggest that Cannabis has therapeutic effects on the negative symptoms, positive symptoms, and cognitive impairments. Although, this evidence is not final and this subject needs further research (Coulston, Perdices, Henderson & Malhi, 2011).

  Another research had been done by Babatope et al. (2016), they compared doses of antipsychotic medication with schizophrenia or schizoaffective disorder with or without concurrent cannabis use. They saw 8157 patients with schizophrenia or schizophrenia-like psychosis. An analysis showed that the ‘positive urine drug test group’ needed a lower doses of antipsychotic medication compared with the ‘negative urine drug test group’. Finally, no significant differences were found (Babatope et al., 2016).

  A year later Rabin, Kozak, Zakzanis, Remington and George (2017) confirmed the fact that a high percentage of patients with schizophrenia use cannabis, in addition, they stated that there little concrete evidence about the possible and/or clinical effects of cannabis use in people with schizophrenia. The research groups; Cannabis addicted men with a schizophrenia disorder (N= 19) and the control group (N= 20). Participant were not allowed to use cannabis for 28 days, a urine test was used to checked their Cannabis use. Most test did not show any difference. However, patients who remained abstained showed higher scores on depression (more depressed) than patients who did not manage without cannabis. Unfortunately, this research group is very small, and the difference is not significant. Further research is needed, for example, with larger samples will provide better and causal relationships between cannabis and schizophrenia (Rabin, Kozak, Zakzanis, Remington, George, 2017).

  Finally, the research of Goodman et al. (2017) conducted a same kind of study as Rabin and colleagues (2017). The goal of their study was to find the differences between four groups: Cannabis dependent controls (N= 12), Cannabis-free schizophrenia patients (N= 11), Cannabis dependent schizophrenia patient (N= 10) and Cannabis-free controls (N= 13). The research pointed out that Cannabis addicted people with schizophrenia showed better scores compared to Cannabis-free people with schizophrenia, and that Cannabis dependent controls showed some reduces scores compared to Cannabis-free controls. So it could be, that the use of Cannabis can have different effects on different schizophrenic patients and controls. Unfortunately, in the end there were no significant differences found. It is important to continue this research and to take comorbid cannabis and schizophrenic patients into account (Goodman, Bridgman, Rabin, Blumberger, Rajji, Daskalakis, George, & Barr, 2017).

  In summary, the effect of cannabis is not consistent and the discussed researches do not give rise to any significance. However, there are schizophrenia patients whom benefit from the use of Cannabis, these benefits must also be further investigated.

Discussion

  It is important to find out what the best medication is for patients to receive the best care. As many as 1% of the population suffers from schizophrenia and the associated symptoms and side effects of medication (Tsuang & Faraone, 2005). This review sought to systematically investigate medications for patients with schizophrenia disorder. Besides the standard treatment of people with schizophrenia disorder, this review views two alternatives: Wandan Decoction and Cannabis. Research showed that a combination of Wandan Decoction and antipsychotics causes fewer side effects and this combination has positive effects for the global and mental condition (Deng, 2017; Wieland, & Santesso, 2017). Besides that, research indicates that schizophrenic patients require a less high dose of antipsychotics when using cannabis. Unfortunately, this difference is not significant (Babatope et al., 2016). Furthermore, the results regarding cannabis use in combination with schizophrenia are still far from clear. There is still a lot of information to be gained in this area.

Strongly on this paper is that it looks at medicines in a way that have not been done before. Thus, research is being conducted into something new and it is examined how the problems of side effects can be solved. Even though the pursuit of this display is completeness and perfection. Further research on these two and other alternatives is needed for more convincing conclusions and statements. For example, there is evidence that if people with schizophrenia get a lot of support from their family, then their quality of life is generally better than with other people with schizophrenia. Also, family intervention may decrease the frequency of relapse (Pharoah, Mari, Rathbone & Wong, 2014). This all can be seen in a subsequent study. An other example for further research is about the Cannabis use among schizophrenia patients. It can be investigated whether patients with schizophrenia really benefit from the use of Cannabis, or simply as an excuse.

There were several limitations in the research of Deng (2017): risks of biases in the measures and trials and overall the biases were unclear. This all results in less robust reliability (Deng, 2017). Also, limitations in the research of Coulson et al. (2011): several studies have been used to reach a conclusion. By combining of research results, outcomes are not completely reliable. The differences in the findings between neuropsychological studies that lead to different conclusions are partly due to methodological differences between the studies, as well as methodological limitations in the studies. However, given the prevalence of cannabis use and its integral role in the clinical manifestation of psychosis, this is an area for future research (Coulston, Perdices, Henderson & Malhi, 2011). At last, Babatop et al. (2016) had some limitations in this research: Through limited information on duration, amount and severity of cannabis use, as well as inability to control for other non-antipsychotic medications conclusions may be different from what it seems (Babatope et al., 2016).

Conclusions

What is the best alternative medicine for people with a schizophrenia disorder diagnose; Wendan Decoction (WDD) or Cannabis?

This view shows that the combination of traditional medicine Wendan Decoction and antipsychotics is a good alternative to the commonly used treatment; antipsychotics. Besides that, it can be concluded that the use of Cannabis as a medicine against schizophrenia requires much more clarification to be able to make binding statements.

Further research will need to be done with larger samples, for example, according to the amount of dosage, other alternatives, cannabis and schizophrenia…

References

Amato, D., Vernon, A.C. & Papaleo, F. (2017). Dopamine, the antipsychotic molecule: A perspective

on mechanisms underlying antipsychotic response variability. Neuroscience and Biobehavioral Reviews. BLADZIJDE EN NUMMER! DOI: 10.1016/j.neubiorev.2017.09.027

Arseneault, L., Mary Cannon, M., Witton, J. & Murray, R.M. (2004). Causal association

between cannabis and psychosis: examination of the evidence. The British Journal of Psychiatry, 184 (2) 110-117. DOI: 10.1192/bjp.184.2.110

Babatope, T., Chotalia, J., Elkhatib, R., Mohite, S., Shah, J., Goddu, S., Patel, R.A., Aimienwanu,

O.R., Patel, D., Makanjuola, T. & Okusaga, O.O. (2016). A Study of the Impact of Cannabis on Doses of Discharge Antipsychotic Medication in Individuals with Schizophrenia or Schizoaffective Disorder. Psychiatric Quarterly. 87(4). 729-737. DOI: 10.1007/s11126-016-9426-2

Brenner, H. D., Dencker, S. J., Goldstein, M. J., Hubbard, J. W., Keegan, D. L., Kruger, G. &

Midha, K. K. (1990). Defining treatment refractoriness in schizophrenia. Schizophrenia Bulletin, 16(4), 551-561. DOI: 10.1093/schbul/16.4.551

Coulston, C.M., Perdices, M., Henderson, A.F. & Malhi G.S. (2011). Cannabinoids for the

Treatment of Schizophrenia? A Balanced Neurochemical Framework for Both Adverse and Therapeutic Effects of Cannabis Use. Schizophrenia Research and Treatment. 2011. 1-9. DOI: 10.1155/2011/501726

Degenhardt, L., Hall, W. & Lynskey, M. (2003). Testing hypotheses about the relationship

between cannabis use and psychosis. Drug and Alcohol Dependence, 71(1), 37-48. DOI: 10.1016/S0376-8716(03)00064-4

Deng, H. (2017). Wendan decoction (Traditional Chinese medicine) for schizophrenia. Cochrane

Database Systematic Review, 6. DOI: 10.1002/14651858.CD012217

Gage, S.H., Jones, H.J., Burgess, S., Bowden, J., Smith, G.D., Zammit, S. & Munafò, M.R.

(2017). Assessing causality in associations between cannabis use and schizophrenia risk: a two-sample Mendelian randomization study. Psychological Medicine, 47(5), 971-980. DOI: 10.1017/S0033291716003172

Goodman, M.S., Bridgman, A.C., Rabin, R.A., Blumberger, D.M., Rajji, T.K., Daskalakis,

Z.J., George, T.P. & Barr, M.S. (2017). Differential effects of cannabis dependence on cortical inhibition in patients with schizophrenia and non-psychiatric controls. Brain Stimulation, 10(2), 275-282. DOI: 10.1016/j.brs.2016.11.004

Hall, W. (2006). The Mental Health Risks of Adolescent Cannabis Use. PloS Med, 3(2). DOI:

10.1371/journal.pmed.0030039

Heaton, R., Paulsen, J.L., McAdams, L.A., Kuck, J., Zisook, S. et al. (1994). Neuropsychological

deficits in schizophrenics: relationship to age, chronicity, and dementia. Archieves of General Psychiatry, 51, 469-476. DOI:

Lieberman, J.A. & Tasman, A. (2006). Handbook of Psychiatric Drugs. New

Jersey: Wiley. ISBN: 978-0-470-02821-6

Moher, D., Liberati, A., Tetzlaff, J. & Altman, D.G. (2009). Preferred Reporting Items for Systematic

Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine. 6. 1-6. DOI: 10.1371/journal.pmed.1000097

Morgan, C.J.A., & Curran, H.V. (2008). Effects of cannabidiol on schizophrenia-like

symptoms in people who use cannabis. The British Journal of Psychiatry, 192(4), 306-307. DOI: 10.1192/bjp.bp.107.046649

Mueser, K.T., Deavers, F., Penn, D.L. & Cassisi, J.E. (2013). Psychosocial Treatments for

Schizophrenia. Annual Reviews Clinical Psychology. 9. 465-497. DOI: 10.1146/annurev-clinpsy-050212-185620

Os, J. van, Bak, M. & Hanssen, M. (2005). Cannabis use and psychosis: a longitudinal

population-based study. American Journal of Epidemiology, 156, 319-327

Pharoah, F., Mari, J., Rathbone, J. & Wong, W. (2014). Family intervention for schizophrenia.

Cochrane Database Systematic Review. 2010(12). DOI: 10.1002/14651858.CD000088

Sahlholm, K., Gómez-Soler, M., Valle-León, M., López-Cano, M., Taura, J.J., Ciruela, F. &

Fernández-Dueñas ,V. (2017). Antipsychotic-Like Efficacy of Dopamine D2 Receptor-Biased Ligands is Dependent on Adenosine A2A Receptor Expression. Molecular Neurobiology. 1-7. DOI: 10.1007/s12035-017-0696-y

Saku, M. (1991) The current clinical practice of herbal medicine in psychiatry in mainland

China: a review of literature. Japanese Journal of Psychiatry and Neurology, 45. 825 -832.

Tsuang, M.T. & Faraone, S.V. (2005). Schizofrenie: De feiten. Houten: Bohn Stafleu van Loghum.

ISBN10: 9031339903

Wang, B. (1998) Traditional Chinese medical treatment to invigorate blood and relieve stasis

treatment of schizophrenia: comparison with antipsychotic treatment. Psychiatry and Clinical Neuroscience, 52, 329 -330.

Wieland, L.S. & Santesso, N. (2017). Summary of a Cochrane review: Wendan decoction traditional

Chinese medicine for schizophrenia. European Journal of Integrative Medicine. 15. 81-82. DOI: 10.1016/j.eujim.2017.09.009

Veith, I. & Barnes, L.L. (2015). The Yellow Emperor’s Classic of Internal Medicine.

Oakland, California: University of California Press.

Rabin, R.A., Kozak, K., Zakzanis, K.K., Remington, G. & George, T.P. (2017) Effects of

extended cannabis abstinence on clinical symptoms in cannabis dependent schizophrenia patients versus non-psychiatric controls. Consulted at the 18th of October 2017 from https://www.ncbi.nlm.nih.gov/pubmed/28285022?dopt=Abstract

Rathbone, J., Zhang, L., Zhang, M., Xia, J., Liu, X., Yang, Y. & Adams, C.E. (2007). Chinese herbal

medicine for schizophrenia. Cochrane systematic review of randomised trials. 190(5). 379-384. DOI: 10.1192/bjp.bp.106.026880

Yang, A.C. & Tsai, S. (2017). New Targets for Schizophrenia Treatment beyond the

Dopamine Hypothesis. International Journal of Molecular Sciences, 18(8). DOI: 10.3390/ijms18081689

Zhang, J. (1996) Current status of integrated traditional and Western medicine study on schizophrenia.

Chinese Journal of Integrated Traditional and Western medicine, 16, 643 -645. DOI:

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