CLINICAL NOTES

(The Clinical Notes report the jndings of the authors and

do not necessarily represent the opinion of the Journal.)

A PILOT STUDY OF THE KETOGENIC DIET

IN SCHIZOPHRENIA1

ABEL PACHECO, M.D.,2 W. S. EASTERLING, M.D.,3 D

MARGARET W. PRYER4

Recently, one of the authors (A.P.) ob- al.(5), found that after giving electric shock
served that some schizophrenic patients (ECT) to a group of 7 schizophrenic pa-
seemed to crave carbohydrates shortly be- tients, brain metabolism decreased and a
fore an exacerbation of their illness. Con- fall was produced in arterial blood pH and
comitantly, and before they showed other Co2. According to Altschule(6) both ECT
clinical symptoms, there was a loss in and insulin coma (ICT) decrease initially
weight. Others have observed similar man- the glucose tolerance and later increase it,
ifestations(1-2). It then occurred to the and the effects persist for several weeks.
same author that schizophrenics might have According to Himwich and Sullivan(7) the
difficultyin utilizing carbohydrates and that drop in blood glucose accompanying ICT
perhaps a carbohydrate-free diet would be is faced by the brain tissue by using ac-
beneficial. The ketogenic diet is a low CHO cumulated glycogen and apparently the
diet and has been known for years to pro- brain is able to utilize non-carbohydrate
duce favorable effects in certain epileptics, sources of energy. Recent investigations in-
both in terms of seizures and behavior(3). dicate various changes in CHO metabolism
In view of this, it has been surprising to the with the use of psychotropic drugs(8).
authors that in our limited survey of the We speculated that the beneficial effects
literature we have found no reference to of the above mentioned treatments might
the specific use of the ketogenic diet in be, in part, due to their effects upon CHO
schizophrenia. metabolism. Further, we speculated that a
However, many authors have reported relative degree of acidosis might be an im-
variations and/or abnormalities in the car- portant concomitant of these effects. Since
bohydrate metabolism of schizophrenics. the ketogenic diet would to some extent
Bellak provides a good summary of these simulate these effects and since it could
studies and also gives an extensive bibliog- easily be given without risk to the patients,
raphy(4). Also, variations in CHO metab- we started this pilot study.
olism have been reported in conjunction The diet was given to 10 female patients
with various types of treatment. Kety, et whose ages ranged from 19 to 63. All were
diagnosed as chronic schizophrenics, 9 un-
1 This study was done at Central Louisiana State differentiated type, 1 paranoid type. All
Hospital (CLSH), Pineville, La., and was partially were considered to have a poor prognosis
supported by the Research & Training Fund of the and all had been given previous treatment
State Department of Hospitals, Baton Rouge, La. of various types without lasting results.
The authors gratefully acknowledge the assistance
of Dr. A. L. Seale, Superintendent, CLSH, and of
While the diet was given, they continued to
the Psychology Department, particularly Mr. Zed receive their current treatment, which con-
Van Buren, Miss Olga Vegas, and Dr. Roland Frye. sisted of drugs and ECT.
2AJD Fellow, Louisiana State University, and Three rating instruments were used to
presently staff psychiatrist at Hospital Psiqui#{225}trico measure behavioral changes in the patients
Chapul, San Jos#{233}, Costa Rica.
during and after administration of the keto-
Director of Training and Research, CLSH,
genic diet. A nursing check list for ward
Pineville, La., and Clinical Assistant Professor of
Psychiatry, LSU School of Medicine, New Orleans, behavior ratings was used. This scale was
La. devised at this hospital and has been used
‘ Psychology Department, CLSH, Pineville, La. previously with demonstrated validity. This

1110
19651 CLINICAL NOTES 1111

was not done as systematically as desired symptoms were not found to be significant
and its validity in this particular study was in the present study.
questioned. The Minimal Social Behavior The authors are well aware that this was
Scale(9) was used but was found to be a small, poorly controlled study. We were
inappropriate for this group of patients be- conscious of the difficulty in producing a
cause their initial scores were too high. true acidosis in adult patients, and we sus-
The Beckomberga Rating Scale for the pect that most of the patients were at times
S-Factor( 10), which was especially con- given carbohydrate foods by other patients.
structed to determine clinical change in Because of limited time and facilitiesonly
schizophrenic patients was considered by 10 patients were involved, no control group
the authors to be the most promising of was used, and no control was exercised
the three measures used. This scale was over other treatment.
administered to all patients 3 times: dur- While the present results are certainly
ing the first 2 days of the study, after 2 not conclusive, it is felt that they do indi-
weeks on the diet, and one week after dis- cate some beneficial effects of the ketogenic
continuing the diet. During an interview diet. Our purpose in reporting this is not
with the patient, ratings were made inde- based upon the results of this study, but
pendently by one of the authors (A.P.) and rather upon our opinion that a more defini-
by a Clinical Psychology Intern. After the tive investigation of this type is warranted.
interview the two raters discussed each
item and then made a joint rating. These BIBLIOGRAPHY
joint ratings were considered to be reliable 1. Krypsin-Exner, W.: Wien. Kiln. Wschr.,
since high statistical agreement was 59: 531, 1947.
obtained between the independent ratings 2. Kalinowsky, L. B.: J. Nerv. Ment. Dis.,
of the psychiatrist and psychologist at each 108: 423, 1948.
of the 3 rating periods. 3. Livingston, S.: Living With Epileptic
Seizures. Springfield, Ill.:C. C Thomas, 1963.
Rather than tabulate the various scores,
4. Bellak, L.: Schizophrenia: A Review of
the results on the Beckomberga scale can
the Syndrome. New York: Logos Press, 1958.
be summarized as follows: The average of 5. Kety, S. S., et al.: Am. J. Psychiat., 104:
the scores showed a statisticallysignificant 765, 1948.
decrease in symptomatology after 2 weeks 6. Altschule, M. D.: Bodily Physiology in
on the ketogenic diet. The third rating, ta- Mental and Emotional Disorders. New York:
ken one week after discontinuing the diet, Grune & Stratton, 1953.
showed that in 7 of the 10 patients there 7. Himwich, lit E.: Brain Metabolism and
was a slight to fairly large increase in symp- Cerebral Disorders. Baltimore: Williams &
tomatology. Although these changes were Wilkins, 1951.
8. Arneson, C. A.: J. Neuropsychiat., 5:
not significantly different from the second
181, 1964.
rating, they were still significantly better
9. Farina, A., Arenberg, D., and Guskin,
than the initial rating. S.: J.Consult. Psychol., 21: 265, 1957.
The ratings on the Beckomberga Scale 10. Martens, S.: Evaluation of Clinical
were also examined in terms of the four Change in Schizophrenia. In R. Heath (Ed.):
factors discussed by Martens. Differen- Serological Fractions in Schizophrenia. New
tialchanges on these factors or “clusters” of York: Harper and Row, 1963.

A SCHEMA FOR THE USE OF ANTIDEPRESSANT DRUGS

HARVEY J. WIDROE, M.D.’

In choosing an antidepressant drug the is the time necessary for a given drug to exert
psychiatrist must take certain factors into a therapeutic effect? Should a drug prove
account. Which drugs are effective P What ineffective and a change in medication be
indicated, what is the medication-free inter-
1 Head, Inpatient Service, Department of Pry-
chiatry, Ernest V. Cowell Memorial Hospital, Uni- val necessary to avoid dangerous potentiat-
versity of California, Berkeley, California. ing effects?