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Schizophrenia, sleep, and acupuncture
  1. Colin Lewis
  1. Correspondence to aim{at}bmjgroup.com

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Peggy Bosch, Maurits van den Noort. 348 pages Hogrefe & Huber Publishers 2008 Hardcover, £31.00 978-0-88937-355-8

Schizophrenia is a complicated mental illness, which I feel is best left to the psychiatrists. Patients hate the side effects of medication. I don’t treat patients with schizophrenia with acupuncture: would this book change my mind?

A large collection of international experts have been drawn together to give their views on the diagnosis and medical treatment of the condition with a dedicated chapter on neuroimaging, which concludes only that schizophrenia is associated with frontal and temporal brain dysfunction. One quarter of the book is taken up with scientific discussion of the disease, which is covered well, but you have to ask yourself whether you would prefer to read this in a conventional medical textbook rather than a book on acupuncture.

The next two chapters look at sleep disturbance because “insomnia is associated with almost all psychiatric disorders” and a poor quality of life. An increase in total sleep with anti-psychotic medication, with an increase in REM (rapid eye movement) sleep latency, was associated with improvement of the schizophrenic state. Reduction in activity of the prefrontal cortex could “explain the hallucinatory, fantasy-rich nature of both dreams and the positive symptoms of schizophrenia”. There is evidence to suggest that melatonin affects dopamine systems and improves the quality of REM sleep and schizophrenia, and that acupuncture treatment can increase melatonin levels.

Next is the introduction to Traditional Chinese Medicine (TCM), its history, philosophy, the inevitable “medical acupuncture is rubbish” and that Western medical practitioners do not understand the concepts of TCM and holism. Then the usual comments about how acupuncture cannot lend itself to strict research protocols and “it is an impossible task to condense several thousands of years of accumulated knowledge and wisdom on the topic into a single chapter”. In an attempt to resolve TCM’s antipathy to Western medicine, neuroimaging is brought out again in a chapter authored by the editors of the book which lists all 33 imaging studies between 1998 and 2007. The research does not tell us much apart from the limbic system may be fired up by acupuncture. This chapter was delightfully TCM free.

We know that the neurotransmitter dopamine is involved in the pathophysiology of schizophrenia and that the positive symptoms may be attributable to an excess of dopaminergic transmission within the central nervous system. Is it possible to control the level of dopamine by acupuncture? Eleven acupuncture on schizophrenia studies were analysed and five showed a positive response to one or more aspects of the illness. Extra Point 1 (Yintang) and GV20 were mostly used, and HT7, GV20, PC6, SP6, BL62 were used in 18 trials for insomnia with good results (but small sample numbers). No study on sleep disorders caused by schizophrenia was identified. Experiments on animals did not find acupuncture research on the levels of dopamine related to schizophrenia. Having found very little research to support TCM principles and in particular the Yin and Yang Heel Vessels, a salient chapter considers: Can acupuncture be used in the treatment of insomnia and schizophrenia? Well, sort of.

Next comes a very heavy chapter on TCM and the treatment of psychological disorders but I’m afraid that the effect of invisible phlegm, congealed blood, the concept of syndrome differentiation, and the relationship between body and mind, simply alienate me from TCM. I have no doubt that acupuncture helps anxiety, depression, and improves sleep and wellbeing as symptoms of schizophrenia, but not the illness itself. TCM protagonists may revel in the identification of phlegm-fire harassing internally or the effulgent yin-vacuity fire but you might as well choose two or four points from ST40, SP6, TE6, GV20, HT7, GB20, KI1 and BL15, 18 and 20. Many point selections are given in the book.

The final chapter details one case history that responded well to acupuncture explained in TCM reasoning. The therapist thought that a formal diagnosis of schizophrenia was not important as treatment was directed to the disharmony of the organ systems. It was not known whether the acupuncture had simply reduced the side effects of medication or worked as a catalyst for a change in lifestyle.

The authors conclude that they hope to have brought together a bridge between Eastern and Western medicine (maybe for TCM practitioners) and that acupuncture works by a normalising effect on brain neurotransmitters. I’m glad to note that they do not claim that schizophrenia can be cured by acupuncture, but perhaps enhance the effect of medication and reduce side-effects, as well as improving sleep. Of course, more research is needed….

The book contains a wealth of material and the early chapters provided useful summaries. I must admit that I found the book heavy going and disappointed that concepts of medical acupuncture were not included. I remain very wary of using acupuncture in schizophrenia.

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Footnotes

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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