Escolar Documentos
Profissional Documentos
Cultura Documentos
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O P L E W I T H S C H I ZO P H R E NI A
Extrapyramidal Symptom Rating Scale RESULTS of the women were or had been married,
(ESRS; Chouinard & Ross-Chouinard, v. 10% (5) of the men (P (P0.002);
0.002); and
1979) and a self-report questionnaire of Demographic and clinical data women averaged 2.3 (1.7 s.d.) children v.
substance-using habits. In conjunction with by chewing status 0.5 (1.1 s.d.) children per man
demographic details, the substance-use Chewers and non-chewers were signi- (P50.001). However, there were no
questionnaire asked about consumption of ficantly different in the proportions who significant differences in marital status or
betel nut, cigarettes, alcohol and marijuana. had ever married, in mean number of off- number of children in intra-gender
Self-reports were supplemented with ref- spring and mean age at first admission to comparisons (data not shown).
erence to chart histories of substance misuse hospital (Table 1). With the exception of Among chewers the average betel nut
and consultation with case workers. age at first admission, these differences are consumption was 10.6 (5.7 s.d.) whole nuts
All rating was carried out by R.J.S. To an artefact of the uneven gender (18.8 (11.1 s.d.) quids) per day. This figure
avoid rater bias, the interviewer was blind distribution in the non-chewing group is probably conservative, as an uncharacter-
to the chewing status of subjects until (87% male). The sample exhibits istic dry season, attributed popularly to El
symptom rating was completed. The test characteristic gender differences in marital Nin
NinoÄo,, resulted in a shortage of betel nut
batteries were conducted in English with status and number of children: 48% (10) over the first few months of the study
the assistance of the study participant's
case worker ± either a psychiatric nurse or
social worker. English is the language of in- Table 1 Demographic and clinical data by chewing status (n
(n70).`Chewers'
70).`Chewers' defined as 42 betel nuts per day
struction in Palauan schools and all sub-
jects spoke English with varying degrees
Non- or casual Chewers P
of fluency. The case worker helped each
participant to complete the substance-use chewers (n
(n30)
30) (n40)
40)
questionnaire and acted as interpreter
Whole nuts per day1 (mean (s.d.)) 0.5 (0.7) 10.6 (5.7) ^
when required during the PANSS interview
Chews per day1 (mean (s.d.)) 0.8 (1.3) 18.8 (11.1) ^
and ESRS assessment that followed.
Estimated chewing time, h/day2 (mean (s.d.)) 0.2 (0.3) 4.7 (2.8) ^
Background information on the parti-
cipant's social functioning required for the Age (mean (s.d.)) 40.7 (9.3) 38.0 (6.7) NS
PANSS was obtained from the participant's Males (n
(n (%)) 26 (86.7) 23 (57.5) ^
chart, case worker and family. Females (n
(n (%)) 4 (13.3) 17 (42.5) ^
Palauan case workers were consulted Ever married (n
(n (%)) 2 (6.6) 13 (32.5) 0.03
on the range of PANSS items as they related Number of children (mean (s.d.)) 0.5 (1.2) 1.4 (1.7) 0.01
to each subject, particularly delusional Years of education (mean (s.d.)) 9.8 (3.0) 11.2 (2.9) NS
content, communication and cognitive Living with family (n
(n (%)) 26 (86.7) 35 (87.5) NS
agility, and interpretation of affect. The Employed (n
(n (%)) 4 (13.3) 10 (25.0) NS
Structured Clinical Interview for the
Age at onset (mean (s.d.)) 23.1 (6.3) 21.9 (6.2) NS
PANSS (SCI-PANSS; Kay et al, al, 1992) was
Age at first admission to hospital (mean (s.d.)) 26.7 (8.7) 19.8 (12.1) 0.01
translated into Palauan, then back-
Number of admissions (mean (s.d.)) 6.1 (5.0) 4.4 (4.9) NS
translated into English to provide a
transcultural reference text for the rater Paranoid schizophrenia (n
(n (%)) 10 (33.3) 11 (27.5) NS
and case workers. The westernised Residual schizophrenia (n
(n (%)) 4 (13.3) 5 (12.5) NS
`similarities' and `proverbs' items of the Schizoaffective (mainly schizophrenia) (n
(n (%)) 3 (10) 7 (17.5) NS
`abstract thinking' section of the PANSS Undifferentiated schizophrenia (n
(n (%)) 10 (33.3) 10 (25) NS
were substituted with Palauan expressions Other schizophrenia (n
(n (%)) 3 (10) 7 (17.5) NS
and proverbs. Chlorpromazine equivalents3 (mg/day)4 (mean 917.5 (977.0) 1003.9 (993.5) NS
(s.d.))
Benzatropine (mg/day)5 (mean (s.d.)) 3.0 (1.6) 2.8 (1.4) NS
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Table 4 Correlation coefficients: substance symptoms. Bodick et al (1997) report that of 24.2% cross-culturally (Yassa & Jeste,
consumption per day the selective M1 agonist xanomeline, a 1992).
thiadiazole derivative of arecoline (Moltzen
Betel Cigarettes Alcohol Marijuana
& Bjornholm, 1995), produced dose- Other substances
dependent reductions in delusions, hallu-
In accordance with findings reported
Betel 1.0 70.43* 70.04 70.17 cinations and other psychotic behaviours
elsewhere (Chong & Choo, 1996), our
Cigarettes 1.0 0.29* 0.44** in a clinical trial with patients diagnosed
results show that smokers' PANSS scores
Alcohol 1.0 0.53** with Alzheimer's disease. Shannon et al
were significantly higher than non-
Marijuana 1.0 (1998) performed preclinical rodent studies
smokers'. The possibility that the
assessing the use of xanomeline as an anti-
*P50.05, **P
**P50.01 (two-tailed). favourable association between PANSS
psychotic and produced results consistent
score and betel chewing is an artefact of
with the performance of atypical agents.
non-smoking is unlikely, because most
They conclude that ``xanomeline may pro-
vide a novel approach to the treatment of chewers consumed tobacco in their quid.
is the first study to investigate the effects of
Similarly, the finding that betel nut
betel nut directly on the symptoms of peo- psychosis with potential for a rapid onset
tends to be used to the exclusion of other
ple with schizophrenia. of action, efficacy against positive and
substances is of interest, but is unlikely to
Our results indicated that betel chewing negative symptoms, and with little or no
explain the favourable association between
is associated with less severe symptoms of liability to produce extra-pyramidal side-
betel chewing and milder symptoms of
schizophrenia as measured by the PANSS. effects'' (see also studies on other mus-
schizophrenia, as neither marijuana nor
Chewers scored significantly lower than carinic agents by Bymaster et al (1998)
alcohol consumption were significantly
non-chewers on the positive and negative and Shannon et al (1999)).
related to group PANSS scores.
symptom measures of the PANSS. The Betel nut arecoline may have similar
symptom score differences between groups effects to those of its derivatives described
were modest for the total group and above. Betel chewers hold the betel quid Social variability
balanced between positive and negative in the buccal cheek cavity, utilising an Betel chewing is a social activity in
symptoms. When only subjects not absorption route that avoids first-pass Micronesia and it may be associated with
receiving medication were considered, the metabolism and maintaining betel alkaloids milder symptomatology simply because
group difference was substantial, mainly in the blood stream for extended periods. the practice itself is indicative of, or
for negative symptoms. Among all subjects, The non-selective agonist action of marks a return to, `normal' social func-
the group total scores of chewers were sig- arecoline may exert a crude atypical-like tioning (Wilson, 1979). However, a social
nificantly lower than those of non-chewers antipsychotic effect, in conjunction with functionality explanation for group
(60.5 v. 77.3, t7 74.1, P40.001) and the parasympathetic effects routinely differences in scale scores is not supported
among unmedicated subjects the difference tolerated by habitual users. Such an action by the data, since there were no
in mean total PANSS score between may explain the favourable effect on significant chewing v. non-chewing group
chewers and non-chewers was dramatic negative symptoms and the generally mild differences in regard to demographic
(57.7 v. 84.0, t7 72.3, P0.04).
0.04). EPS and TD among betel-chewing subjects indicators of social functionality ± marital
with schizophrenia. status, number of children, living situation
or employment status. Additionally, an
Muscarinic agonists
assessment of social functioning is implicit
in schizophrenia
in the structure of the PANSS instrument
The main study hypothesis, that betel Extrapyramidal symptoms
via input from family members and case
chewing may exert a beneficial effect on and tardive dyskinesia
workers. However, a suitable social
the primary symptoms of schizophrenia, is Extrapyramidal symptoms resulting from functioning instrument is recommended
supported by these results, and the betel nut consumption have been reported in any subsequent research to more
muscarinic agonist action of the most previously (Deahl, 1989). As discussed directly clarify associations between social
abundant betel nut alkaloid, arecoline above, no significant differences emerged functioning and betel chewing.
(Farnworth, 1976), provides the most in ratings of EPS or TD between chewers
promising pharmacological explanation and non-chewers. Additionally, no signi-
for this effect. ficant differences emerged in dosages of
ACKNOWLEDGEMENTS
Despite ambiguous results in early neuroleptic or anticholinergic medication.
The authors thank the participating subjects and the
research (Davis et al,
al, 1978), a number of Despite compliant (i.e. mainly depot) many people instrumental in the completion of this
researchers propose that cholinergic agents long-term neuroleptic medication with sub- study. In New Zealand: Dr J. Collier and Dr A.
may modulate dopaminergic hyperactivity stantial dosages for many subjects, symp- Futterman-Collier, M. Harrison, Professor R. Kydd,
and prevent the emergence of positive toms of TD were fairly infrequent among Professor R. Miller, Dr G. Robinson. In Micronesia: P.
symptoms (Friedhoff & Alpert, 1973; the study participants. Unambiguous TD Aribuk, Dr G. Dever, A. Franz, Rev. F. Hezel, G.
Johanes,H.Masayos,Dr M.Myles-Worsley,
M.Myles-Worsley, H. Ngiral-
Davis et al,al, 1978; Tandon & Greden, symptoms, such as choreoathetoid or buc-
mau, A. Lyman, D. Patris, Dr A. Polloi, Senator
1989; Tandon, 1999). Research suggests co-lingual movements, were seen in only 7
Peter and Akiko Sugiyama, Minister M. Ueda and
that muscarinic agonist derivatives of of the 70 participants (10%). In com- the staff at Belau National Hospital. This research
arecoline may exert an atypical-like action, parison, a previous analysis of 76 studies was supported by grants from the New Zealand
ameliorating both negative and positive (n39
39 187) has reported a TD prevalence Schizophrenia Fellowship and The University of
17 7
S U L L I VA N E T A L
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