Dr Segundo Mesa Castillo
Psychiatric Hospital of Havana, Cuba
Eighteen psychotic patients meeting the DSM-IIIR criteria for schizophrenia and manic-depressive psychosis were treated with antiviral drugs-aciclovir and interferon or aciclovir alone- plus the conventional treatment for more than eight months. Before treatment was begun, a biological test (BT) was performed on blood and cerebrospinal fluid, using immunoelectromicroscopic techniques, and the test was repeated eight months later. The results obtained by comparing their evolution before and after the antiviral treatment was begun show a significant favorable outcome in 89 percent of the patients treated. This is related to a modification in the BT, with a decrease in the presence of particles that reacts to the herpes simplex hominis type I virus (HSV-1) antibody or with an increase in those patients who had a relapse.
Schizophrenia. manic-depressive psychosis. herpes simplex, interferon, aciclovir, interferon, biological test.
Schizophrenia is a disease in which a viral etiology is strongly, considered because of clinical (1), epidemiological (2), laboratory (3), experimental (4), ultrastructural (5) and immunological (6) data. among others,
Favorable results following the use of Interferons in the treatment of schizophrenia (7-11) have been obtained in previous studies. In this study, we have also applied antiviral treatment in cases of manic-depressive psychosis, on obtaining BT results that could indicate a common etiology in the two diseases (12). The favorable results, obtained in these two psychiatric disorders are set forth in this paper, as is their relationship to the BT both before and after initiating the antiviral treatment, which also includes the use of aciclovir for long periods of time.
MATERLALS AND METHODS
A total of 18 psychotic patients-15 schizophrenics and three manic-depressives, according to the DSM-IIIR criteria were treated with aciclovir or with aciclovir and interferon for more than eight months, with their consent or families’ consent. The patients were between 20 and 54 years old, nine were men, and nine, women. Each patient was given a questionnaire to obtain such data as name, age, date of birth, family members with psychosis, prevailing symptoms and the frequency and length of her/his crises among other things (Chart 1). Blood and cerebrospinal fluid samples were taken from each patient with their consent or families’ consent and a biological test (described in earlier papers) (13) was done, both before initiating treatment and eight (8) months later. A relationship was established between the clinical evolution and the BT results.
From the clinical point of view, a criterion of social evolution was established, which included the following points (Table 1): sexual relations, self-esteem, family relations, relations with neighbors, recreational activities, school and work. An outcome criterion was obtained from relatives, friends, attending physician, nurses and the own patient in a blind evaluation before and after treatment (Chart 1).
The higher the score, the less favorable the evolution. A questionnaire was answered both before treatment and three and eight months later, comparing each patient’s evolution with what it had been before and also keeping in mind the frequency, duration and intensity of crises. A blood study was made on each patient prior to treatment, and EEG and RMN studies were made in most cases. The treatment with neuroleptics or other treatment which each patient had was continued, adding the antiviral treatment. For 14 patients, this was aciclovir, as follows: one gram a day for one month, 800 mg. a day for three months, 600 mg. a day for three months, 400 mg. a day for three months, and then 200 mg. a day if the patient continued to evolve favorably. For four patients, aciclovir and Interferon were combined, as follows: 3 million IU of Alpha Interferon injected intramuscularly once a week for three months. changing to 3 million every 15 days if their evolution was favorable, combined with 200 mg. of aciclovir a day’ right from the start. Periodic blood studies were made later on in these cases, to observe leukocyte and blood platelet counts. Deposit fluphenazin was the neuroleptic used most frequently. Carbamazepin was used on four patients as another most frequently used drug.
Thirteen of the 14 patients
(93 percent of them) who were treated with high doses of aciclovir, following the plan described above, evolved favorably, with low scores on the scale of social evolution. The absence of relapses in 14 patients and the short duration and low intensity of the crises in two of the four who did have crises were other elements which were considered as favorable when the evolution of each patient was compared with his clinical evolution before the treatment was begun (Table 2). The two cases that did not evolve favorably maintained the same score in the social evolution scale that they had had prior to the beginning of treatment. Those two patient did not cooperate in the antiviral treatment. One of them got a lot better during the first six months of antiviral treatment; then the treatment was abandoned and the symptoms of the disease reappeared. In no patient was it necessary to suspend or decrease the treatment because of lack of tolerance or undesired effects. Both interferon and aciclovir were well tolerated, with the side effect on the day of the interferon injection controlled easily with antipyretics before the injection and two hours afterwards.
After an average of three months of treatment, the patients’ social conduct began to evolve very favorably, with some of them going to work or study. Those who did not at least allowed the relatives who take care of them to have a higher quality of life. In every case, there was a clear correspondence between the patient’s clinical evolution and the BT. In the cases which evolved favorably, there was an important decrease in the HSV-1 antigen or in the presence of viral like particles.
The presence of viral activity during crises was observed in the BTs (Figure 1) of patients who suffered relapses.
Every day, more elements favor a viral hypothesis of the etiology of schizophrenia, especially that of herpes sirnplex as the most probable candidate among the causative agents. The positive neurotropism of this virus to the temporal lobe (seat of the limbic system); its characteristic form of clinical evolution in outbreaks and remissions, as happens in the diseases that are the object of this paper, and its ability to remain latent in the central nervous system are some of the elements which support this hypothesis. An increase in antibodies against HSV-1 (3), which was observed in the patients and the presence of particles with the characteristic antigenic response and morphology, as seen under the electronmicroscope in patients, fetuses and inoculated animals (5,6), are other
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