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Comment by tominous | Hacker News Reader

I'd love to see more research about nicotine and schizophrenia. Something like 80% or schizophrenics smoke, and they do so heavily. This is 3 or 4 times the rate of the general population.

The question is: does smoking cause schizophrenia, is it self-medication, or both?

Scott Alexander has an interesting summary [1].

For what it's worth, my schizophrenic brother says smoking makes his mind feel much clearer.

I think mental hospitals should have a strategy to provide nicotine to patients (in the high dose they need) to minimise the harm of the strong cheap rubbish that schizophrenics inhale all day. Maybe e-cigs should be promoted to smoker patients.

[1] http://slatestarcodex.com/2016/01/11/schizophrenia-no-smokin...

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There is theorized to be some synergistic effects between tobacco smoking and the antipsychotic medications that people such as your brother often require. IIRC it really isn't known why that is, but it seems relatively well accepted among people who routinely work with schizophrenia.

> There is theorized to be some synergistic effects between tobacco smoking and the antipsychotic medications that people such as your brother often require.

"Antipsychotics" are palliative medications that do not address the cause of the problematic symptoms. They have repeatedly been shown to cause a very poor long-term prognosis for the unfortunate patients who are put on them.

Nicotine is somewhat similar to Vitamin B3 (Niacin), which has been shown to help schizophrenics recover. Niacinamide supplementation helps my girlfriend reduce her tobacco use.

  ... Here, we propose a model that a subset of 
  schizophrenia can respond to niacin augmentation therapy 
  better than other subsets because these patients have 
  contributions in their psychotic manifestations from the 
  neural degeneration resulting from niacin deficiency. We 
  present a short description of our case report which 
  showed rapid improvement in schizophrenic psychotic 
  symptoms subsequent to administration of niacin as an 
  augmentation therapy. We, thus, propose that niacin 
  deficiency is a contributory factor in schizophrenia 
  development in some patients and symptom alleviation in 
  these patients will benefit from niacin augmentation, 
  especially in some particular psychotic features."

- http://www.ncbi.nlm.nih.gov/pubmed/25855923

I've read your story submissions and let me first say that I admire your courage and dedication. I hope this comment is useful and not too blunt.

It sounds like you've gained two passions from your experience: (1) finding the right treatment for mental health issues, instead of long-term palliation, and (2) addressing casual abuses of power and ignorance of the law.

My advice to you is to focus on one passion at a time. You can't make progress on both fronts at once.

Regarding (1), there's a word for people who try to go around the medical establishment and run a business selling a cure-all pill. It's "quack", not "hack". Even if you're right you'll have no credibility and make zero difference to psychiatric treatment, mainstream or otherwise.

The credible approach is to write a case report plus literature review and get it published. I suggest the topic of the literature review should be "low-cost, low-risk interventions to assist in diagnosing subtypes of schizophrenia". You can't do this on your own: you'll need a friendly PhD co-author to edit it brutally and guide you through publication.

(By subtype here I mean the different etiologies, which is an emerging area of study, not the traditional grouping by symptoms)

Regarding (2), your focus should be local and specific, and honestly your best bet may be donating or raising money for existing organisations that work in this area.

Thanks for your comments - they are quite helpful.

> Regarding (1), there's a word for people who try to go around the medical establishment and run a business selling a cure-all pill. It's "quack", not "hack".

I manufactured a supplement once, then I realized it was a legal minefield. I have plans to apply for FDA approval for a claim for a device. This would provide legal protection against the status quo, while destroying their harmful business at the same time.

I gave a bottle of my supplement to a young woman who'd just been not-helped at the hospital. I called her a few days later - she said, "THAT STUFF REALLY WORKS!" I called a few months later, and her sister said she was in the state mental hospital. People need more than a supplement to become truly well.

> The credible approach is to write a case report plus literature review and get it published. I suggest the topic of the literature review should be "low-cost, low-risk interventions to assist in diagnosing subtypes of schizophrenia".

"... for the Emergency Room physician." Yeah, I like that idea. I have some ideas of people to work with.

Robert Whitaker has pointed out to the psychiatrists that their "science" is paid for by the industry whose products they use [1]. He hasn't gotten very far in the last 15 years.

[1] http://www.madinamerica.com/2016/09/confessions-of-a-trespas...

I'd just like to echo what tominous said. I'll be honest, and say that your post set off what I'd call my "Crank/Crackpot Detector". By no means is that detector anything approaching perfect, but if I had to describe why it went off, tomimous' post gets right to the heart of it.

To be clear, I don't disagree with your characterization of antipsychotics as being potentially (often) devastating in the long term. When you meet people with drastic manifestations of tardive dyskinesia from their medications for example, that fact becomes exceedingly clear.

The problem is that it becomes equally clear upon careful examination, that the only worse outcome than a lifetime of antipsychotic therapy, is psychosis. Each psychotic break is correlated with increasingly grim outcomes, such as a homelessness, permanent care, and suicide.

I see your argument as very impassioned, but fundamentally in the same vein as people who tell you to avoid chemotherapy because it's bad for you. It's true, chemotherapy is poison, but oftentimes it's the best we have to work with. The problem then, is that recognizing the limitations of current therapies doesn't imply that a better "natural" alternative exists right now.

Hi, thanks for posting and sharing your reaction to what I'd said. I'm going to respond to tominous next, so check for that comment too.

> I'll be honest, and say that your post set off what I'd call my "Crank/Crackpot Detector".

I know, right? It's usually safe to assume that conventional practices are what they are because they're the best we have, at the present time.

> Each psychotic break is correlated with increasingly grim outcomes, such as a homelessness, permanent care, and suicide.

Robert Whitaker proposes that patients did much better before the psychiatrists had drugs to put them on: people had "episodes" from which they frequently recovered. Page 7 of "The Case Against Antipsychotics" [1] begins a discussion of studies of psychotic illnesses in the pre-drug era.

[1] http://www.madinamerica.com/wp-content/uploads/2016/07/The-C...

> It's true, chemotherapy is poison, but oftentimes it's the best we have to work with.

Sometimes science takes detours before it rediscovers that which was previously unpopular. This article demonstrates that progressive oncologists are beginning to recognize the errors of their predecessors:

http://www.nytimes.com/2016/05/15/magazine/warburg-effect-an...

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