M.P.C. Bosch

A case study on acupuncture in the treatment of schizophrenia

This report describes the use of acupuncture as an add on treatment for a patient with chronic schizophrenia. The 63-year-old woman suffered from persistent hallucinations and even physical pain as a result of the hallucination of a black bird that kept pecking her back. The patient received 12 weekly acupuncture treatments. A clinical diagnostic interview and psychological testing (on sleep quality, depression, and on positive and negative symptoms) were conducted before, immediately after and 3 months after the acupuncture treatment. The results of the diagnostic interview gave important insights into the treatment effects. The patient experienced improved daily functioning and noticed a change in hallucinations. Although the hallucinations still occurred, she felt less disturbed by them. Interestingly, pain decreased markedly. In addition, the results showed that the overall score of the positive and negative symptoms did not change immediately; however, a decrease in symptoms occurred 3 months after acupuncture treatment. Moreover, the patient described an immediate improvement in sleep; this was confirmed by a daytime sleepiness questionnaire. The patient was not able to complete a (longer) test on sleep quality beforehand but did so after the treatment period. Finally, a delayed improvement in the depression scale was found. Although larger clinical intervention studies on acupuncture and schizophrenia are needed, the results of this case study indicate that acupuncture may be beneficial as an add on treatment tool in patients with schizophrenia. Trial registration number 3132.

Schizophrenia and comorbid sleep disorders

1Research Group of Pain and Neuroscience, Kyung Hee University, Seoul 130-701, South Korea. 2Brussels Institute for Applied Linguistics, Vrije Universiteit Brussel, 1050 Brussels, Belgium. 3Psychiatric Research Institute, LVR-Klinik Bedburg-Hau, 47511 Bedburg-Hau, Germany. 4Neurology Unit, Laboratory for Cognitive and Neurological Sciences, Department of Medicine, Faculty of Science, University of Fribourg, 1700 Fribourg, Switzerland. 5Department of Acupuncture and Meridian of Oriental Medicine, Sang Ji University, Wonju 26339, South Korea. 6Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 GL Nijmegen, Gelderland, the Netherlands.

Pharmacological Treatment for Long-Term Patients with Schizophrenia and Its Effects on Sleep in Daily Clinical Practice: A Pilot Study

Background: Pharmacological treatment is still the key intervention in the disease management of long-term patients with schizophrenia; however, how it affects sleep and whether gender differences exist remains unclear. Methods: Forty-six long-term outpatients with schizophrenia entered the study. The numbers of antipsychotics, sleep medications, antidepressants, and anxiolytics were analyzed. Moreover, all patients were tested using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Correlation analyses were conducted between the medication used and the scores on the two subjective sleep inventories. Results: A large variability, ranging from 0 to 8, in the total number of psychiatric drugs per person was found between the patients. Despite ongoing pharmacological treatment, the patients scored high on the PSQI, but not on the ESS; this indicates that they report problems with sleep, but not with daytime sleepiness. A significant positive correlation between the use of antipsychotics and the ESS score, but not the PSQI score, was found; moreover, no gender differences were found. Conclusions: A large variability exists in the pharmacological treatment of long-term patients with schizophrenia. To date, patients’ sleep problems have been insufficiently treated, and gender differences have not been adequately accounted for in the pharmacological treatment of schizophrenia. More and larger international clinical studies are warranted to verify the findings of the present preliminary pilot study before any firm conclusions can be drawn and before any changes to the drug treatment of male and female patients with schizophrenia can be recommended.

Symptom severity, quality of sleep, and treatment adherence among patients suffering from schizophrenia and depression

Aim: Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression. This study investigated the possible relationships between symptom severity, quality of sleep, and treatment adherence. Methods: Thirty outpatients with schizophrenia and 58 outpatients with depression were enrolled in this study. The beck depression Inventory-II, the positive and negative syndrome scale, and the pittsburgh sleep quality index were used to assess symptom severity and quality of sleep, and sleep log data were used to measure treatment adherence. Results: The preliminary results showed no significant relationship between symptom severity and treatment adherence or between quality of sleep and treatment adherence in patients with depression. However, a significant positive relationship was found between negative symptoms and treatment adherence and a significant negative relationship between quality of sleep and treatment adherence in patients with schizophrenia. Conclusion: The present exploratory study revealed a positive relationship between symptom severity and treatment adherence and a negative relationship between quality of sleep and treatment adherence in patients with schizophrenia, but no significant relationships in patients with depression were found. Future studies are needed in order to gain a better understanding of possible risk factors related to treatment non-adherence,

Acupuncture in the treatment of a female patient suffering from chronic schizophrenia and sleep disorders

Background. The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation. We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The patient was treated with manual acupuncture weekly for 12 weeks, and a psychological assessment was performed before, immediately after, and three months after the acupuncture treatment period. In addition, actiwatch data were collected for 14 days both before and after the acupuncture treatment period. Conclusion. Acupuncture treatment led to a decrease in general psychopathology, less severe sleep problems, and markedly improved cognitive functioning (working memory) in the patient; however, the positive and the negative symptoms remained stable. The actiwatch data revealed a beneficial effect of acupuncture, showing better sleep latency, a trend towards better sleep efficiency, and a decrease in the number of minutes that the patient was awake during the night after acupuncture treatment. In sum, this study showed that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized (placebo), controlled, clinical trials are needed in order to replicate the present preliminary findings.

Transcranial magnetic stimulation for schizophrenia: Potential and risks

Recently, transcranial magnetic stimulation (TMS) has increasingly been used to investigate the neurobiology of schizophrenia. In those studies, researchers applied TMS in combination with motor evoked potentials (TMS/MEPs) and high density electroencephalograms (TMS/hd-EEG)[1]. The studies revealed significant impairments in cortical excitability, inhibition, and oscillatory activity, which are more prominent in the frontal brain areas, in patients suffering from schizophrenia compared to healthy controls[1]. Future TMS studies may help explain the underlying neurobiology of schizophrenia, and TMS may help monitor and perhaps further optimize the effectiveness of treatment interventions in patients with this disease. However, despite the potential of using TMS in the investigation of the underlying neurobiology of schizophrenia, three critical notes are essential.

On the need to unify neuroscience and physics

Neuroscience is a relatively new research field that, so far, has resulted in important progress in understanding the physiology, biochemistry, pharmacology, and structure of the vertebrate brain. Because of this progress, spectacular technological developments, i.e. positron emission tomography, functional magnetic resonance imaging, transcranial magnetic stimulation (TMS), diffusion tensor imaging, magneto-encephalography, electro-encephalography, etc., and new treatments based on them, such as high-frequency repetitive TMS (rTMS), deep brain stimulation, etc., have been of great use. However, despite those technical and clinical successes in neuroscience, in which the advances in physics have played a substantial role, one fundamental problem is still unsolved, namely, how to unify neuroscience and physics? As we will discuss in the present editorial, not only is this problem important from a purely fundamental, theoretical perspective, but it is also vital for the development of more optimal treatments in clinical neuroscience.

Ipsilateral Putamen and Insula Activation by Both Left and Right GB34 Acupuncture Stimulation: An fMRI Study on Healthy Participants

The modulatory effects on the brain during right versus left side acupuncture stimulation of the same acupuncture point have been a subject of controversy. For clarification of this important methodological issue, the present study was designed to compare the blood oxygen level-dependent responses of acupuncture stimulation on the right versus left Yanglingquan (GB34). Twenty-two healthy subjects received right or left GB34 acupuncture. Our results show that acupuncture on the left GB34 induced neural responses in the left putamen, caudate body, insula, postcentral gyrus, claustrum, right and left thalamus, right middle frontal gyrus, hypothalamus, and subthalamic nucleus. Acupuncture on the right GB34 induced neural responses in the right middle frontal gyrus, inferior parietal lobule, thalamus, putamen, lateral globus pallidus, medial globus pallidus, and insula. Interestingly, the putamen and insula were ipsilaterally activated by acupuncture on either the left or right GB34; therefore, they seem to be the main target areas affected by GB34 acupuncture. This is the first reported functional magnetic resonance imaging study directly comparing needling on the right and left GB34. Although more replication studies are needed, our preliminary results prove that acupuncture has different modulatory effects on the brain when performed on the right versus left side.