Suicidal, violent, and treatment-resistant
Mr. T, age 52, has a long history of schizoaffective disorder, suicide attempts, and violence. Could an underlying medical condition be contributing to his treatment resistance?
Additionally, Mr. T expresses interest in taking “natural” agents in addition to psychotropics. After reviewing the quality of available ginger root extract products, Mr. T is started on a supplement that contains 22.4 mg of gingerols and 6.7 mg of shogaols, titrated to 4 capsules twice daily.
The authors’ observations
A retrospective cross-sectional analysis reported that patients with bipolar disorder who received medications with anti-toxoplasmic activity (Table 215), specifically valproic acid, had significantly fewer lifetime depressive episodes compared with patients who received medications without anti-toxoplasmic activity.15
Alternative medicine options
Research has demonstrated the beneficial effects of Chinese herbal plants for toxoplasmosis16,17 and ginger root extract has potent anti-toxoplasmic activity. A mouse model found that ginger root extract (Zingiber officinale) reduced the number of TG-infected cells by suppressing activation of apoptotic proteins the parasite induces, which prevents programmed cell death.18
Table 3 presents a stepwise approach to identifying and treating inflammation in patients with treatment-resistant psychosis.
OUTCOME Immune response, improvement
One month after the valproic acid and ginger root extract therapy is initiated, Mr. T’s toxoplasma antibody immunoglobulin G increases by 15.2 IU/mL, indicating that his immune system is mounting an enhanced response against the parasite (Figure 2). Mr. T continues to make progress while receiving the new regimen of clozapine, minocycline, valproic acid, and ginger root extract. He no longer cycles into periods of intense anxiety, perseverative thought, and fragmented thought and speech. He participates meaningfully in weekly psychotherapy and hopes to live independently and obtain gainful employment.
The District Attorney’s office dismisses his criminal charges, and Mr. T is discharged to a less restrictive level of care.
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