Acetylcholine And Schizophrenia
ironjustice
Acetylcholinesterase Inhibitors (AChEI's) for the
treatment of visual hallucinations in schizophrenia:
a review of the literature.
BMC Psychiatry. 2010; 10: 69
Patel SS, Attard A, Jacobsen P, Shergill S
BACKGROUND:
Visual hallucinations occur in various
neurological diseases, but are most prominent in
Lewy body dementia, Parkinson's disease and
schizophrenia.
The lifetime prevalence of visual hallucinations
in patients with schizophrenia is much more common
than conventionally thought and ranges from 24% to 72%.
Cortical acetylcholine (ACh) depletion has been
associated with visual hallucinations; the level of
depletion being related directly to the severity of
the symptoms.
Current understanding of neurobiological visual
processing and research in diseases with reduced
cholinergic function, suggests that AChEI's may prove
beneficial in treating visual hallucinations.
This offers the potential for targeted drug therapy of
clinically symptomatic visual hallucinations in patients
with schizophrenia using acetylcholinesterase inhibition.
METHODS:
A systematic review was carried out investigating the
evidence for the effects of AChEI's in treating visual
hallucinations in Schizophrenia.
RESULTS: No evidence was found relating to the specific
role of AChEI's in treating visual hallucinations in
this patient group.
DISCUSSION:
Given the use of AChEI's in targeted, symptom specific
treatment in other neuropsychiatric disorders, it is
surprising to find no related literature in schizophrenia
patients.
The use of AChEI's in schizophrenia has investigated
effects on cognition primarily with non cognitive effects
measured more broadly.
CONCLUSIONS:
We would suggest that more focused research into the effects
of AChEI's on positive symptoms of schizophrenia, specifically
visual hallucinations, is needed.
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Acetylcholinesterase Inhibitors (AChEI's) for the
treatment of visual hallucinations in schizophrenia:
a case report.
BMC Psychiatry. 2010; 10: 68
Patel SS, Attard A, Jacobsen P, Shergill S
BACKGROUND:
Visual hallucinations are commonly seen in various neurological
and psychiatric disorders including schizophrenia.
Current models of visual processing and studies in diseases
including Parkinsons Disease and Lewy Body Dementia propose
that Acetylcholine (Ach) plays a pivotal role in our ability
to accurately interpret visual stimuli.
Depletion of Ach is thought to be associated with visual
hallucination generation.
AchEI's have been used in the targeted treatment of visual
hallucinations in dementia and Parkinson's Disease patients.
In Schizophrenia, it is thought that a similar Ach depletion
leads to visual hallucinations and may provide a target for
drug treatment
CASE PRESENTATION:
We present a case of a patient with Schizophrenia presenting
with treatment resistant and significantly distressing visual
hallucinations.
After optimising treatment for schizophrenia we used Rivastigmine,
an AchEI, as an adjunct to treat her symptoms successfully.
CONCLUSIONS: This case is the first to illustrate this novel use
of an AchEI in the targeted treatment of visual hallucinations in
a patient with Schizophrenia.
Targeted therapy of this kind can be considered in challenging
cases although more evidence is required in this field.
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"AChEI increase the concentration of extracellular acetylcholine"
Anti-inflammatory properties of cholinergic up-regulation: A new role
for acetylcholinesterase inhibitors.
Nizri E, Hamra-Amitay Y, Sicsic C, Lavon I, Brenner T.
Laboratory of Neuroimmunology, Department of Neurology, The Agnes
Ginges
Center for Human Neurogenetics, Hadassah-Hebrew University Medical
Center, P.O. Box 12000, Jerusalem 91120, Israel.
We investigated the anti-inflammatory effects of acetylcholinesterase
inhibitors (AChEI) at the cellular and molecular levels.
AChEI suppressed lymphocyte proliferation and pro-inflammatory
cytokine
production, as well as extracellular esterase activity.
Anti-inflammatory activity was mediated by the alpha7 nicotinic
acetylcholine receptor (neuronal); the muscarinic receptor had the
opposite effect.
Treatment of the central nervous system (CNS)inflammatory disease,
experimental autoimmune encephalomyelitis (EAE),with EN101, an
anti-sense oligodeoxynucleotide, targeted to AChE mRNA,
reduced the clinical severity of the disease and CNS inflammation
intensity.
The results of our experiments suggest that AChEI increase
the concentration of extracellular acetylcholine (ACh), rendering it
available for interaction with a nicotinic receptor expressed on
lymphocytes.
Our findings point to a novel role for AChEI which may be
relevant in CNS inflammatory diseases such as EAE and multiple
sclerosis.
They also emphasize the importance of cholinergic balance in
neurological disorders, such as Alzheimer's disease and
myasthenia gravis, in which these drugs are used.
PMID: 16336980
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"Lecithin may therefore be the method of choice for
accelerating acetylcholine synthesis"
Lecithin consumption raises serum-free-choline levels.
Lancet. 1977 Jul 9;2(8028):68-9.
Wurtman RJ, Hirsch MJ, Growdon JH.
Consumption of choline by rats sequentially increases serum-choline,
brain-choline, and brain-acetylcholine concentrations. In man
consumption of choline increases in levels in the serum and
cerebrospinal fluid; its administration is an effective way of
treating
tardive dyskinesia. We found that oral lecithin is considerably more
effective in raising human serum-choline levels than an equivalent
quantity of choline chloride. 30 minutes after ingestion of choline
chloride (2-3 g free base), serum-choline levels rose by 86% and
returned to normal values within 4 hours; 1 hour after lecithin
ingestion, these levels rose by 265% and remained significantly raised
for 12 hours. Lecithin may therefore be the method of choice for
accelerating acetylcholine synthesis by increasing the availability of
choline, its precursor in the blood.
PMID: 69151 [PubMed - indexed for MEDLINE]
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