Peggy Bosch, University of Bergen, Norway
On reading the title of this paper, many of you will be thinking: “What in the world do those needles have to do with schizophrenia?” This is a very good question. According to some of the (mostly Chinese) studies that have been done during the last 20 to 30 years, the needles do have an influence on these patients. As a psychologist, scientist, but also an acupuncturist, these results made me curious. You might ask yourself; why does a western psychologist who was educated at the Radboud University Nijmegen (the Netherlands), think this is even remotely interesting? I will try to explain this to you in the following paper and I invite all of you to make up your own minds as to whether we should be doing (thorough and western) research on this subject. One opinion that I would like to add is that I think that we owe it to our patients to do research on anything that might be helpful. In the last decade, there have not been many breakthroughs in the field of schizophrenia, at least not in the treatment of it. We have been concentrating on fMRI, gene-technology, neurotransmitters etc., however, apart from some small improvements in medication, no real large differences were made for our patients. As therapists we should do everything in our power to change this.
Key words: schizophrenia, acupuncture, fMRI, limbic system, ECT.
In this paper, I would like to summarize some of the results that have been found on acupuncture in fMRI studies, some acupuncture results that were found in studies that included schizophrenic patients, and last but not least I would like to include some results out of research on schizophrenia. The combination of all these results and studies, led me to believe that there is at least enough evidence to do some western research on this subject. However, I would like to invite the readers of this paper to make up their own minds on this subject.
2. ACUPUNCTURE AND FMRI
In the first place, acupuncture is now known to have a positive influence on a number of diseases and disorders (NIH, 1998), yet how this influence comes about is still unknown. One field of research, in which researchers are trying to find out how acupuncture works, is neuroimaging (mostly fMRI). In combined acupuncture and fMRI research, limited points were investigated so far, however, results on these points showed that acupuncture activated mainly pain-regulative pathways, motor-relative functional regions, the visual cortex, and other brain areas. Some parts of the brain that were activated are related to emotion (like the limbic system and amygdala). One conclusion we might come to, after reading the available literature on acupuncture (about 37 studies that were done during the past 10 years); is that the activation of multiple specific brain areas is related to its therapeutic effect on multiple systems (Bosch & Van den Noort, 2005a, 2005b; Yan & Xunchang, 2005).
3. ACUPUNCTURE AND SCHIZOPHRENIA
Several studies (mainly in China) have found positive results for acupuncture in the treatment of schizophrenic patients. I would like to give some examples here: several studies treated schizophrenic patients with electro acupuncture combined with chlorpromazine, these patients were able to use less chlorpromazine and had better results than control groups that used chlorpromazine alone (Bosch & Jørgensen, 2005; Dey, 1999; Flaws & Lake, 2001). Unfortunately, acupuncture was not found to have an effect on delusions. Specific effects, however, that were found in many studies with all kinds of modalities of acupuncture (manual acupuncture, electro acupuncture, laser acupuncture) on schizophrenic patients (see Dey, 1999 for a review) were: a decrease in auditory hallucinations, an improvement in patients with catatonic stupor and a reduction in the amount of western medicine that was required. One study on insomnia found that acupuncture was highly effective for patients who were ineffectively treated with western drugs before. The EEG waves of effectively treated patients showed lower alpha numbers, decreased alpha rate, and lowered alpha wave amplitude. There was even a gradual increase of Q waves (Dey, 1999).
4. SCHIZOPHRENIA FROM A WESTERN PERSPECTIVE
As for a western perspective on schizophrenia (Bosch & Van den Noort, 2005c), there clearly are medications that are generally effective for positive symptoms of schizophrenia. However, the positive symptoms that define a diagnosis of schizophrenia rarely represent the issues that are of greatest concern to the patients. From a patient’s perspective, a lack of a social life and problems in concentrating and learning are often much more disturbing. These problems are clearly linked to cognition. Patients also complain very often about feeling depressed, down, and demoralized. From the family’s perspective, a lack of motivation on the part of the patient is often reported. From a clinician’s perspective, both negative symptoms and affective dysregulation represent targets for long-term treatment once positive symptoms are controlled (Bosch & Van den Noort, 2005c). The use of additional agents is often necessary in the latter period of treatment because the primary antipsychotic does not appear to be fully effective as negative symptoms start to become problematic. Dealing with cognitive impairment has not yet become prominent on the clinical horizon. Still, one can come to the conclusion that schizophrenia is a complex bio-behavioral disorder that manifests itself primarily in cognition (Bosch & Van den Noort, 2005c; Heinrichs & Zakzanis, 1998).
There is a set of neural circuits that underlie cognitive impairments, making them brain-relevant phenomena, which have an effect on functional status. Some results that were found in the brains of schizophrenic patients are cortical-subcortical. Furthermore, it was found that many, but not all schizophrenic patients have larger than normal ventricles (Zipursky, Lim, Sullivan, Brown, & Pfefferbaum, 1992). Schizophrenic brains have fewer neurons in the cerebral cortex (Benes, Davidson, & Bird, 1986), the dorso-medial thalamus (Pakkenberg, 1990), the amygdale, and the hippocampus (Altshuler, Casanova, Goldberg, & Kleinman, 1990). Schizophrenic people, including those who have never been medicated, also have lower than average levels of brain metabolism, especially in the hippocampus and the temporal and frontal areas of the cortex (Andreasen et al., 1992; Buchsbaum et al., 1992; Tamminga et al., 1992). The general trend of data suggests greater posterior than anterior metabolic rate (Kalat, 1995). In addition to having fewer and less active neurons than normal, many people with schizophrenia also show signs of disorganization among their neurons. During an early stage of brain maturation, certain developing neurons migrate through layers of white matter to reach their normal destination in the cerebral cortex. In some people with schizophrenia, many of those neurons apparently failed to complete the journey; they remain throughout life somewhere in the midst of the white matter (Akbarian et al., 1993a; Akbarian, Vi?uela, Kim, Potkin, Bunney, & Jones, 1993b). Even neurons that do approximately reach their normal locations, fail to arrange themselves in the neat, orderly manner typical of non-schizophrenic brains (Benes & Bird, 1987). People with schizophrenia also show signs of impaired transfer of information across the corpus callosum. They also show deficits implying a left-hemisphere impairment, such as being slow to shift their attention from an object on their left to an object on their right (Posner, Early, Reiman, Pardo, & Dhawan, 1988). These results suggest that the lateralization of function between the two hemispheres fails to take place properly in the brains of people, who eventually become schizophrenic.
Now it is not said that these brain findings can be influenced by acupuncture, it was, however, found that acupuncture has an influence on at least some of these brain areas.
My personal belief is not that acupuncture can cure schizophrenia, as some (but certainly not all) of the Chinese studies seem to imply. However, after seeing the promising results of these studies, and after talking to some of the experts that are working on schizophrenia and acupuncture, my curiosity is raised. From what I have heard and seen it is probable that some side effects of western drugs may be diminished by the use of acupuncture. If so, patients might be more easily persuaded to keep taking their western medicine, thereby reducing the chance of having a recurrent psychotic episode. Speaking of recurrent episode; some symptoms that predict a recurrent psychotic episode might be successfully treated as well. If we look at the western research results, a lot has been found that is different in the schizophrenic brain. How acupuncture might influence this, is unclear. Is that a reason not to do more research on acupuncture? In my opinion it is not. If we look at electro convulsive therapy (ECT), for example, we see that we do not have a clue why one of the oldest forms of treatment within psychiatry is effective, yet still we use it. A comparison between ECT and electro acupuncture by the way, has been made before. In China, it was found that when ECT is performed on acupuncture points on the head, the electric currency can be less, resulting in the same results, but less side effects (Van den Noort & Bosch, 2005). To conclude, my opinion is that we need more (thorough and western) research on the combination of acupuncture and western medicine in the treatment of schizophrenia. I invite everybody who is interested and who might be willing to cooperate, to contact me. (Comments are, of course, also welcome).
Email address: Pbosch@online.no
For more information: http://peggybosch.blogspot.com/
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