MindCheck is the Weekly Wednesday Kids Mental Health series with Dr. Ray Pataracchia N.D. MindCheck provides in depth information on the orthomolecular approach to coping with mood, behavior and psychotic disorders. The MindCheck Health Series is endorsed by the Mindful Network - ‘A Better Future for Children’s Mental Health’.
If I had a time machine I could go anywhere anytime, what a high that would be …
Perception of Time in Psychosis: Early Orthomolecular Intervention
Distorted Perception of Time in Psychotic Disorders
Time distortion in patients with psychosis is a common phenomenon. Many first time sufferers experience such symptoms early in life. Orthomolecular treatment for psychosis can alleviate time distortion symptoms.
Time Distortion in the Schizophrenic Patient
I constantly see schizophrenic patients answering yes to either of these two questions — “I find that past, present and future seem all muddled up” and “I can no longer tell how much time has gone by”. When I inquire further on why they answered yes on these questions they relate to perceived déjà vu experiences (not based on previous experience), being time warped, or feeling that they are in a different season of the year.
Not all psychotic patients have time distortions but it is common enough to consider as a red flag symptom that can alert us to investigate further, to determine if the patient has other characteristic psychotic symptoms.
Time Distortion in the ‘Pre-Schizophrenic’ Patient
Similarly, time distortion seems to emerge in the ‘pre-schizophrenic’ prodromal phase of schizophrenia.
Other characteristic behaviors in the ‘pre-schizophrenic’ prodromal phase of schizophrenia include “early symptoms of depression and anxiety, irritability, insomnia, eccentric behavior, negative symptoms like apathy, social withdrawal, cognitive changes like inattention, impaired concentration and late symptoms like suspiciousness, ideas of reference, and perceptual abnormalities” (Kulhara, P, Banerjee, A, & Dutt, A. Early intervention in schizophrenia. Indian J Psychiatry. 2008(Apr-Jun); 50(2): 128–134).
Time Distortion Assessment: Hoffer-Osmond Diagnostic (HOD) Testing
A highly reliable and valid HOD Test is a 145 question true/false questionnaire that can be done at home in 15 minutes. In clinical practice this test often alerts me to cases of psychosis that might otherwise not have been noticed.
The HOD test is not a diagnostic test but it is a useful assessment tool for the severity of symptoms. Time distortion alone is not sufficient for defining psychosis which requires evidence of both hallucinations (sensory distortions of the five senses – e.g. hearing voices or seeing/feeling/smelling/tasting things that are not real) and delusions (thought distortion not based on reality).
Time distortions are however exhibited in the thinking of psychotic patients and to some medical professionals may be considered a thought disorder component of schizophrenia.
Psychotic versus Mood Dominant Conditions
The HOD Tests’ Ratio Score (RS) can give medical professionals some indication of the need to treat psychotic symptoms if they are more dominant than mood symptoms. A high RS indicates the need to consider treatment for psychosis.
Cases with Higher Risk for Becoming Schizophrenic
There is a push to treat psychotic patients early before they have exhibited consistent psychotic symptoms for 6 months, which qualifies a diagnosis of schizophrenia, first-episode. If symptom are moderate to severe and have existed consistently for at least 3 months, there is a momentum that it is hoped can be curtained with treatment. Genetic predisposition is a risk factor but not all cases with high genetic risk will become psychotic.
Early Detection with HOD Testing
In conventional medicine there is a movement to detect patients at risk for or suffering with psychotic symptoms early. The aim is to alleviate suffering early. At this stage, patients and parents can decide to start neuroleptic/sedative medications in an attempt to palliate symptoms, decide to start orthomolecular therapy in an attempt to address underlying metabolic imbalances, or do both. There is substantial indication that less chronic cases respond better to orthomolecular tretament especially in unmedicated cohorts (see Abram Hoffer archives available via Journal of Orthomolecular medicine and the ISF website).
The Naturopathic Medical Research Clinic has an advanced niacin therapy approach for consideration; we treat cases on or off medication.
In cases that are not on sedative medication we can do a PANSS assessment before and after treatment. The PANSS is the gold standard severity assessment tool for psychosis.