Orthomolecular psychiatry

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Orthomolecular psychiatry is the use of orthomolecular medicine for mental illness. Orthomolecular psychiatry has been rejected by evidence-based medicine and has been called quackery. The approach uses unorthodox forms of individualized testing and diagnosis to attempt to establish an etiology for each patient's specific symptoms, and claims to tailor the treatment accordingly, using a combination of nutrients, dietary changes and medications that are claimed to enhance quality of life and functionality as well as to reduce or eliminate symptoms and the use of xenobiotic drugs. Scientific studies have shown mixed results; although there are some promising results from nutritional psychiatry, some forms of orthomolecular psychiatry are ineffective.

Contents

History

Orthomolecular psychiatry began with Abram Hoffer and Humphry Osmond in the 1950s and was continued by Carl Pfeiffer, [1] although proponents of orthomolecular psychiatry say that the ideas behind their approach can be traced back to the 1920s and '30s. [2] [3] Orthomolecular psychiatry's goal of weaning patients from conventional neuroleptic drugs [4] follows "Pfeiffer's Law", "For every drug that benefits a patient, there is a natural substance that can achieve the same effect". [5] In 1968, Linus Pauling first used the term orthomolecular. [6] [7]

Hoffer's therapies focused on using niacin, among other nutrients, to treat what he diagnosed as acute schizophrenia based on an unaccepted test. In 1973, a task force of the American Psychiatric Association examined niacin monotherapy of patient populations with chronic schizophrenia and bipolar disorder and rejected the practice along with the reliability of Hoffer's diagnostic approach. [8]

The assertions by proponents of orthomolecular psychiatry were rejected in 1973 by a panel of the American Psychiatric Association. [8] [9] [10] However, the underpinning ideas of orthomolecular psychiatry have become popular in alternative medical circles as a means to explain conditions such as autism, heavy metal toxicity, and chronic inflammatory disease. After 1975, orthomolecular psychiatry research was primarily reported in Orthomolecular Psychiatry, now the Journal of Orthomolecular Medicine , a publication founded by Hoffer to counter what he considered to be a medical conspiracy against his ideas. [11]

Diagnosis

Proponents of orthomolecular psychiatry claim to have identified the causes of some psychiatric syndromes, in particular those that cause psychosis; according to orthomolecular proponents, testing for these causes guides diagnosis and treatment. Diagnostic measures and therapies commonly employed include "individual biochemical workup", fasting, identifying suggested allergies, dietary changes, megavitamin therapy, amino acids, and other so-called "pharmacologic nutrients". [4] These diagnoses have not been accepted by mainstream medicine. [12]

Specific conditions

Orthomolecularists claim that the causes of psychotic disorders include food allergy, hypoglycemia, hypothyroidism in the presence of normal thyroid values, heavy metal intoxications including those allegedly due to dental fillings, as well as several hypothesised conditions they call pyroluria, histadelia and histapenia. [4]

Pyroluria

Pyroluria (or malvaria from the term mauve factor) involves hypothetical excessive levels of pyrroles in the body resulting from improper hemoglobin synthesis. [13] Carl Pfeiffer believed that pyroluria is a form of schizophrenic porphyria, similar to acute intermittent porphyria where both pyrroles and porphyrins are excreted in the human urine to an excessive degree. [14] and orthomolecular psychiatrists have alleged that pyroluria is related to diagnoses of ADHD, alcoholism, autism, depression, down syndrome, manic-depression, schizophrenia, celiac disease, epilepsy, and psychosis. [15] Pfeiffer's methods have not been rigorously tested, [16] and pyrroles are not considered to be related to schizophrenia. Studies have either failed to detect hemopyrrole and kryptopyrrole in the urine of normal controls and schizophrenics, or found no correlation between these chemicals and mental illness. [17] [18] [19] [20] [21] [22] Few, if any, medical experts regard the condition as genuine, and few or no articles on pyroluria are found in modern medical literature; [23] the approach is described as "snake oil" by pediatrician and author Julian Haber. [16]

Histadelia

Histadelia is a condition hypothesised by Carl Pfeiffer [24] [25] to involve elevated serum levels of histamine and basophils, [4] which he says can be treated with methionine and vitamin B6 megadoses. [26] Pfeiffer claims that "histadelia" can cause depression with or without psychosis, but no published clinical trials have tested the effectiveness of this therapy. [27]

Histapenia

Histapenia in orthomolecular medicine is the condition of high serum copper with low histamine.

Relationship to mainstream psychiatry

Orthomolecular psychiatry has been rejected by the mainstream medical community. [28] Critics have noted that the claims advanced by its proponents are unsubstantiated, and even false. Authoritative bodies such as the National Institute of Mental Health [12] and American Academy of Pediatrics [29] have criticized orthomolecular treatments as ineffective and toxic.

A 1973 task force of the American Psychiatric Association charged with investigating orthomolecular claims concluded:

This review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. It concludes in this regard that the credibility of the megavitamin proponents is low. Their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion. Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment," to be deplorable. [30]

Related Research Articles

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially depressive disorder, anxiety disorders, and obsessive–compulsive disorder.

<span class="mw-page-title-main">Adrenochrome</span> Chemical compound

Adrenochrome is a chemical compound produced by the oxidation of adrenaline (epinephrine). It was the subject of limited research from the 1950s through to the 1970s as a potential cause of schizophrenia. While it has no current medical application, the semicarbazide derivative, carbazochrome, is a hemostatic medication.

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

Orthomolecular medicine is a form of alternative medicine that claims to maintain human health through nutritional supplementation. It is rejected by evidence-based medicine. The concept builds on the idea of an optimal nutritional environment in the body and suggests that diseases reflect deficiencies in this environment. Treatment for disease, according to this view, involves attempts to correct "imbalances or deficiencies based on individual biochemistry" by use of substances such as vitamins, minerals, amino acids, trace elements and fatty acids. The notions behind orthomolecular medicine are not supported by sound medical evidence, and the therapy is not effective for chronic disease prevention; even the validity of calling the orthomolecular approach a form of medicine has been questioned since the 1970s.

<span class="mw-page-title-main">Ladislas J. Meduna</span> Psychiatrist and neuropathologist (1896-1964)

Ladislas Joseph Meduna was a Hungarian neuropathologist and neuropsychiatrist who initiated convulsive treatment, the repeated induction of grand mal seizures, as a treatment of psychosis. Observing the high concentration of glia in post-mortem brains of patients with epilepsy and a paucity in those with schizophrenia, he proposed that schizophrenia might be treated by inducing "epileptic" seizures. Thus, chemically induced seizures became the electroconvulsive therapy that is now in worldwide use.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

<span class="mw-page-title-main">Abram Hoffer</span> Canadian biochemist

Abram Hoffer was a Canadian biochemist, physician, and psychiatrist known for his "adrenochrome hypothesis" of schizoaffective disorders. According to Hoffer, megavitamin therapy and other nutritional interventions are potentially effective treatments for cancer and schizophrenia. Hoffer was also involved in studies of LSD as an experimental therapy for alcoholism and the discovery that high-dose niacin can be used to treat high cholesterol and other dyslipidemias. Hoffer's ideas about megavitamin therapy to treat mental illness are not accepted by the medical community.

<span class="mw-page-title-main">Insulin shock therapy</span> Psychiatric treatment

Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s.

Megavitamin therapy is the use of large doses of vitamins, often many times greater than the recommended dietary allowance (RDA) in the attempt to prevent or treat diseases. Megavitamin therapy is typically used in alternative medicine by practitioners who call their approach orthomolecular medicine. Vitamins are useful in preventing and treating illnesses specifically associated with dietary vitamin shortfalls, but the conclusions of medical research are that the broad claims of disease treatment by advocates of megavitamin therapy are unsubstantiated by the available evidence. It is generally accepted that doses of any vitamin greatly in excess of nutritional requirements will result either in toxicity or in the excess simply being metabolised; thus evidence in favour of vitamin supplementation supports only doses in the normal range. Critics have described some aspects of orthomolecular medicine as food faddism or even quackery. Research on nutrient supplementation in general suggests that some nutritional supplements might be beneficial, and that others might be harmful; several specific nutritional therapies are associated with an increased likelihood of the condition they are meant to prevent.

Irwin Stone (1907–1984) was an American biochemist, chemical engineer, and writer. He was the first to use ascorbic acid in the food processing industry as a preservative, and originated and published the hypothesis that humans require much larger amounts of Vitamin C for optimal health than is necessary to prevent scurvy.

The Journal of Orthomolecular Medicine was established in 1967 by Abram Hoffer. It publishes studies in nutritional and orthomolecular medicine. There is controversy surrounding the journal, as the validity of the field of orthomolecular medicine is not widely accepted by mainstream medicine. The journal is ranked in the bottom 10 percent of all journals about complementary and alternative medicine that are indexed in the bibliographic database Scopus.

<span class="mw-page-title-main">Primary polydipsia</span> Medical condition

Primary polydipsia and psychogenic polydipsia are forms of polydipsia characterised by excessive fluid intake in the absence of physiological stimuli to drink. Psychogenic polydipsia caused by psychiatric disorders—oftentimes schizophrenia—is frequently accompanied by the sensation of dry mouth. Some conditions with polydipsia as a symptom are non-psychogenic. Primary polydipsia is a diagnosis of exclusion.

Carl Curt Pfeiffer was a physician and biochemist who researched schizophrenia, allergies and other diseases. He was Chair of the Pharmacology Department at Emory University and considered himself a founder of what two-time Nobel prize winner, [Pauling, PhD.], named orthomolecular psychiatry and published in the Journal Science. 1968 Apr 19;160(3825):265-71.

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<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

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Allen J. Frances is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as chair of the American Psychiatric Association task force overseeing the development and revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Frances is the founding editor of two well-known psychiatric journals: the Journal of Personality Disorders and the Journal of Psychiatric Practice.

Thaddeus Eugene Weckowicz was a Polish-Canadian social scientist, Professor Emeritus of Psychiatry, Psychology, and Theoretical Psychology at the University of Alberta, and Research Associate, Center for Systems Research, University of Alberta, known for his research in chronic schizophrenics since the 1950s.

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.

References

  1. ↑ Saul, AW; Jolliffe M; Hoffer A. "Bibliography of the Publications of Carl Pfeiffer, MD, PhD". doctoryourself.com. Retrieved 2007-04-19.
  2. ↑ Reiter, PJ (1927). "Behandlung von Dementia Praecox mit metallsalzen. Mangan. Z". Neur. 108: 464–80. doi:10.1007/bf02863975. as cited in Pfeiffer, C; LaMola, S (1983). "Zinc and Manganese in the Schizophrenias". Journal of Orthomolecular Psychiatry. 12 (3).
  3. ↑ Kay Lily E (1993). The molecular vision of life: Caltech, the Rockefeller Foundation, and the rise of the new biology. Oxford: Oxford University Press. ISBN   978-0-19-511143-9.
  4. 1 2 3 4 Edelman Eva (2001). Natural Healing for Schizophrenia: And Other Common Mental Disorders. Borage Books. ISBN   978-0-9650976-7-3.
  5. ↑ Barney, Paul (1998). Doctor's guide to natural medicine. Pleasant Grove, Utah: Woodland. ISBN   978-1-885670-84-7.
  6. ↑ Pauling L (1968). "Orthomolecular psychiatry. Varying the concentrations of substances normally present in the human body may control mental disease" (PDF). Science . 160 (3825): 265–71. Bibcode:1968Sci...160..265P. doi:10.1126/science.160.3825.265. PMID   5641253. S2CID   20153555.
  7. ↑ Pauling, Linus; Hawkins, D (1973). Orthomolecular psychiatry: treatment of schizophrenia. San Francisco: W.H. Freeman. p. 697. ISBN   978-0-7167-0898-8.
  8. 1 2 Menolascino FJ, Donaldson JY, Gallagher TF, Golden CJ, Wilson JE (1988). "Orthomolecular therapy: its history and applicability to psychiatric disorders". Child Psychiatry Hum Dev. 18 (3): 133–50. doi:10.1007/BF00709727. PMID   2898324. S2CID   38354755.
  9. ↑ Pauling L, Wyatt RJ, Klein DF, Lipton MA (1974). "On the orthomolecular environment of the mind: orthomolecular theory". American Journal of Psychiatry. 131 (11): 1251–67. doi:10.1176/ajp.131.11.1251. PMID   4608217.
  10. ↑ Lerner, V (2005-08-31). "Treatment of acute schizophrenia with vitamin therapy". Clinicaltrials.gov. Retrieved 2008-01-15.
  11. ↑ Hoffer, Abram. "The History of the Journal of Orthomolecular Medicine". J Orthomol Med. Archived from the original on 2011-05-20. Retrieved 2011-06-18.
  12. 1 2 Barrett MD, Stephen (2000-07-12). "Orthomolecular Therapy". Quackwatch . Retrieved 2008-01-02.
  13. ↑ Laperchia, P. (1987). "Behavioral disorders, learning disabilities and megavitamin therapy". Adolescence. 22 (87): 729–738. PMID   2963502.
  14. ↑ "Pyroluria". nutritional-healing.com. Archived from the original on 2008-02-26. Retrieved 2008-02-17.
  15. ↑ Jackson James A; Riordan Hugh D; Neathery Sharon; Riordan Neil H (1997). "Urinary pyrrole in health and disease" (PDF). The Journal of Orthomolecular Medicine. 12 (2nd Quarter): 96–8. Retrieved 2008-02-17.
  16. 1 2 Skertic, Mark (April 21, 2002). "For some, a question of balancing nutrients". SunTimes.com. Available at the internet archive. Retrieved on 2008-02-17
  17. ↑ Holman, Paul (July 1995). "Pyridoxine - Vitamin B-6" (PDF). Journal of Australian College of Nutritional & Environmental Medicine. 14 (1): 5–16. Archived from the original (PDF) on 2007-05-08. Retrieved 2007-04-19.
  18. ↑ Cruz, R; Vogel, WH (1978). "Pyroluria: a poor marker in chronic schizophrenia". The American Journal of Psychiatry. 135 (10): 1239–40. doi:10.1176/ajp.135.10.1239. PMID   696910.
  19. ↑ Gendler, PL; Duhan, HA; Rapoport, H (1978). "Hemopyrrole and kryptopyrrole are absent from the urine of schizophrenics and normal persons". Clinical Chemistry. 24 (2): 230–3. doi:10.1093/clinchem/24.2.230. PMID   627053.
  20. ↑ Jacobson, SJ; Rapoport, H; Ellman, GL (1975). "The nonoccurrence of hemo- and kryptopyrrole in urine of schizophrenics". Biological Psychiatry. 10 (1): 91–3. PMID   1120177.
  21. ↑ Gorchein, A (1980). "Urine concentration of 3-ethyl-5-hydroxy-4,5-dimethyl-delta 3-pyrrolin-2-one ('mauve factor') is not causally related to schizophrenia or to acute intermittent porphyria". Clinical Science. 58 (6): 469–76. doi:10.1042/cs0580469. PMID   7428279.
  22. ↑ Vaughan, K.; McConaghy, N. (1999). "Megavitamin and dietary treatment in schizophrenia: a randomised, controlled trial". The Australian and New Zealand Journal of Psychiatry. 33 (1): 84–88. doi:10.1046/j.1440-1614.1999.00527.x. PMID   10197889. S2CID   38857700.
  23. ↑ National Library for Health (2005-10-05). "What is pyroluria, is it an accepted clinical entity and what are the treatment?". Archived from the original on 2007-02-11.
  24. ↑ Pfeiffer Carl C, et al. (July 1971). "Blood histamine levels, basophil counts, and trace metals in the schizophrenias". Psychopharmacol Bull. 7 (3): 37. PMID   5117854.
  25. ↑ Pfeiffer Carl C; Smyrl, EG; Iliev, V (July 1972). "Extreme basophil counts and blood histamine levels in schizophrenic outpatients as compared to normals". Res Commun Chem Pathol Pharmacol. 4 (1): 51–9. PMID   4671910.
  26. ↑ Pfeiffer Carl C (1988). Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry. Healing Arts Press. ISBN   978-0-89281-226-4.
  27. ↑ Pfeiffer, Carl C (1987). Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry. Healing Art Press. ISBN   978-0-89281-226-4.
  28. ↑ Miller M (1996). "Diet and psychological health". Altern Ther Health Med. 2 (5): 40–8. PMID   8795935.
  29. ↑ Bennett, Forrest C (November 1983). "Vitamin and mineral supplementation in Down's syndrome". Pediatrics. 72 (5): 707–713. doi:10.1542/peds.72.5.707. PMID   6226926. S2CID   1888682.
  30. ↑ Lipton M, et al. (1973). Task force report on megavitamin and orthomolecular Therapy in psychiatry. Washington DC: American Psychiatric Association.; as cited in Barrett MD, Stephen (2000-07-12). "Orthomolecular Therapy". Quackwatch . Retrieved 2008-01-02.

Bibliography

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