The Effects of an Indigenous Muscarinic Drug, Betel Nut (<i>Areca catechu</i>), on the Symptoms of Schizophrenia: A Longitudinal Study in Palau, Micronesia

Sullivan, Roger J.; Andres, Sylvia; Otto, Carsten; Miles, Wayne; Kydd, Robert R.

doi:10.1176/ajp.2007.164.4.670

Cited by 27 publications

(19 citation statements)

References 14 publications

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“…Finally, they used clinical diagnoses, which we know maybe accurate with regard to “presence of psychosis” but not necessarily with regard to type of psychosis. The highest risk estimate was the study in Myles-Worsley et al60 However, there is substantial use of betel nut (a muscarinic agonist) chewing in the healthy population as well as in patients with schizophrenia, particularly high in women,74,75 which may contribute to the substantially high rate of psychosis in the high-risk offspring, a hypothesis that warrants investigation.…”

Section: Commentmentioning

confidence: 99%

Specificity of Familial Transmission of Schizophrenia Psychosis Spectrum and Affective Psychoses in the New England Family Study’s High-Risk Design

Goldstein¹,

Buka²,

Seidman³

et al. 2010

Arch Gen Psychiatry

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Context There is a long history of research on the familial transmission of schizophrenia and other psychoses. However, few studies have investigated the specificity of the transmission of schizophrenia-psychosis spectrum (SPS) disorders and affective psychoses (APs) or observed high-risk offspring into mid-adulthood. Objectives To investigate the transmission of psychoses from parents to their offspring and the specificity of transmission across psychosis subtypes. Design High-risk follow-up study. Setting New England Family Study’s High-Risk Study, with population-based community sampling from Boston, Massachusetts, and Providence, Rhode Island. Participants A total of 203 high-risk offspring of 159 parents with diagnoses of psychoses (SPS and AP) and 147 control offspring of 114 control parents. Main Outcome Measures Systematically assessed research DSM-IV psychiatric diagnoses for adult offspring. Results Compared with those of control parents, offspring of parents with SPS had a significant, almost 6-fold elevated risk of SPS disorders and a nonsignificant doubling of risk for AP. Offspring of parents with AP had a significant 14-fold elevated risk for AP compared with offspring of controls; for SPS disorders, the risk doubled but was not significant. Conclusion Having a parent with psychosis significantly increased the risk for psychosis among offspring and demonstrated specificity for the transmission of SPS disorders and APs within families.

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Section: Commentmentioning

confidence: 99%

Specificity of Familial Transmission of Schizophrenia Psychosis Spectrum and Affective Psychoses in the New England Family Study’s High-Risk Design

Goldstein¹,

Buka²,

Seidman³

et al. 2010

Arch Gen Psychiatry

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“…Older evidence shows that anticholinesterases, or cholinomimetics may be helpful in psychotic states [67,120]. New data, based on the traditional practice in many Pacific islands of betel-nut chewing, suggest that actions of cholinergic alkaloids in betel nuts may also be antipsychotic [146]. Exactly which cholinergic receptor is implicated in cholinergic actions against psychosis, and whether any presently-available antipsychotic drugs (including the atypical ones and the unique drug clozapine) act in this way, is discussed below.…”

Section: Theory: the Indirect Mode Of Therapeutic Action Of D2-blockimentioning

confidence: 99%

Mechanisms of Action of Antipsychotic Drugs of Different Classes, Refractoriness to Therapeutic Effects of Classical Neuroleptics, and Individual Variation in Sensitivity to their Actions: PART I

Miller

2009

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Many issues remain unresolved about antipsychotic drugs. Their therapeutic potency scales with affinity for dopamine D2 receptors, but there are indications that they act indirectly, with dopamine D1 receptors (and others) as possible ultimate targets. Classical neuroleptic drugs disinhibit striatal cholinergic interneurones and increase acetyl choline release. Their effects may then depend on stimulation of muscarinic receptors on principle striatal neurones (M4 receptors, with reduction of cAMP formation, for therapeutic effects; M1 receptors for motor side effects). Many psychotic patients do not benefit from neuroleptic drugs, or develop resistance to them during prolonged treatment, but respond well to clozapine. For patients who do respond, there is a wide (>ten-fold) range in optimal doses. Refractoriness or low sensitivity to antipsychotic effects (and other pathologies) could then arise from low density of cholinergic interneurones. Clozapine probably owes its special actions to direct stimulation of M4 receptors, a mechanism available when indirect action is lost.

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“…methamphetamine in Hawai‘i). Of interest, betel nut, chewed commonly in several Pacific Island nations, may have protective effects on the manifestations of schizophrenia (Sullivan et al ., ). As described in Tables and , certain agents such as pesticides or toxic medications may be used as agents for self‐harm in suicide attempts.…”

Section: Resultsmentioning

confidence: 97%

Care for the seafarers: A review of mental health in Austronesia

Guerrero

Fung

Suaalii‐Sauni

et al. 2013

Asia-Pacific Psychiatry

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The Effects of an Indigenous Muscarinic Drug, Betel Nut (Areca catechu), on the Symptoms of Schizophrenia: A Longitudinal Study in Palau, Micronesia

Abstract: These findings have clinical significance in betel-chewing regions and broader implications for theory of muscarinic neurophysiology in schizophrenia.

Cited by 27 publications

References 14 publications

Specificity of Familial Transmission of Schizophrenia Psychosis Spectrum and Affective Psychoses in the New England Family Study’s High-Risk Design

Specificity of Familial Transmission of Schizophrenia Psychosis Spectrum and Affective Psychoses in the New England Family Study’s High-Risk Design

Mechanisms of Action of Antipsychotic Drugs of Different Classes, Refractoriness to Therapeutic Effects of Classical Neuroleptics, and Individual Variation in Sensitivity to their Actions: PART I

Care for the seafarers: A review of mental health in Austronesia

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