Hemodialysis in schizophrenia: psychiatric aspects of treatment failure in a pilot study

In order to examine the reported curative effects of hemodialysis in patients with chronic schizophrenia a pilot study approved by the Committee of Ethics at the University of Lund was initiated in September 1977. 13 patients, 10 men and 3 women, 21--44 years old, were treated. All but one were diagnosed as chronic schizophrenia. The duration of illness was 4--20 years. All the patients functioned defectively psychosocially, and conventional therapy had failed. Our goal was to give at least one dialysis treatment a week during 13 weeks. 10 patients completed the treatment series. The patients were scored according to the Brief Psychiatric Rating Scale and the Rockland and Pollin scale before, during and after the treatment. Conventional therapy was given throughout. Analysis of hemofiltrates for endorphins did not reveal any abnormal levels. 1 patient reported a distinct and hitherto lasting improvement. Marginal and temporary improvements were noted in 3 patients. Therefore placebo effects or spontaneous remission seemed probable. The ratings showed no significant changes in any patient during the treatment period. All patients including those who showed improvement remained seriously incapacitated by their psychiatric illness. Different psychiatric aspects of our failure to reproduce the American findings including cultural discrepancies in diagnostic criteria are discussed.