JAVIER I. ESCOBAR, M.D., M.S. Hemodialysis as a treatment for schizophrenia Dr. Escobar is associate prOfessor of psychiatry at the University of California, Los A ngeles, and director of the Veterans Administration Neighborhood Center in East Los Angeles. Reprint requests to him, 915 Bonnie Beach Place, East Los Angeles, CA 90063. ABSTRACT: The author reviews available reports on the effects of renal dialysis on schizophrenia and offers critiques of these stud- ies and their conclusions. He also addresses the possible mecha- nisms of action for hemodialysis on the psychoses, along with the risks inherent in dialysis research. The reported therapeutic action of hemodialysis on a few schizo- phrenic patients· and the finding of endorphins in their dialysates 2 have recently revitalized old theories on schizophrenic "humors." These provocative reports rapidly reached the news media and raised unrealistic hopes in the general public for this method of dealing with unremitting psychiatric syn- dromes. Consequently, hemodialy- sis is now actively sought as a pan- acea by many who have grown weary of standard treatments and their lack of results. The dialysis studies Hemodialysis is not at all a new idea as a treatment for schizophre- nia (Table). A report in 1960 claimed remission of acute cata- tonia in three of five patients after one to two IO-hour hemodialyses.) The investigators in this study tested the hypothesis of Kielholz in Basel, who believed endotoxins to be the cause of catatonia and pro- posed blood exchange transfusions as a therapy.) Some 17 years passed before we heard again of this heroic treatment modality. This time, Florida ne- phrologist Robert Cade noted symptomatic improvement of a schizophrenic patient who was un- dergoing dialysis for renal failure. He teamed up with psychiatrist Herbert Wagemaker and pursued clinical observations. The prelimi- nary results of these studies were quite optimistic concerning symp- tom relief and subsequent social adjustment of schizophrenic pa- tients dialyzed an average of 16 times. 1 Following Wagemaker and Cade's report, a number of anec- dotes and retrospective observa- tions were published.4-6 These re- ports failed to support therapeutic actions of dialysis in schizophrenia; unlike Wagemaker and Cade's ex- periment, these reports were based on schizophrenic patients in renal failure. Major problems with most pub- lished reports on hemodialysis and schizophrenia are their anecdotal quality, lack of diagnostic criteria, and absence of adequate and ob- jective measurements. Only four reports had a formal research de- sign and made attempts to measure clinical changes.6-9 Wagemaker and Cade utilized Brief Psychiatric Rating Scale (BPRS) ratings and more rigid diagnostic criteria for their later series. Analysis of BPRS total scores revealed that five of six JUNE 1980· VOL 21 • NO 6 503