Add-on effect of Brahmi in the management of schizophrenia
Mr. A, a 34-year-old single graduate male, presented with suspiciousness and fearfulness, wandering behavior, muttering to self, unprovoked aggression and disorganized behavior for the past 15 years. Mental status examination revealed delusion of persecution and grandiosity, third-person auditory hallucinations, irritable effect and grade I insight. He was diagnosed as having paranoid schizophrenia according to ICD-10 diagnostic criteria for research. On positive and negative syndrome scale (PANSS), the total score was 108 (positive 59, negative 21 and general psychopathology 28) and on brief psychiatric rating scale (BPRS) the total score was 48. He was started on olanzapine tablets 10 mg/day, which was increased gradually up to 20 mg/day over a period of two weeks. Although there was initial improvement in psychopathology, it did not sustain after three-week trial on the same dose of olanzapine. His rating on PANSS was 92 (positive 43, negative 21 and general psychopathology 28) and on BPRS was 38. Subsequently, after obtaining written informed consent, after five weeks on olanzapine tablets, he was given an add-on trial of Ayurvedic drug Brahmi (each tablet containing 250 mg of Brahmi extract, a pure herb extract by Himalaya Herbal Healthcare) at a dose of two tablets, a day for a period of one month, as prescribed by a qualified Ayurvedic physician on the basis of research reports and not on Ayurvedic parameters. Weekly rating was done for four weeks on PANSS, BPRS and Udvalg for Kliniske Undersogelser (UKU) side effect rating scale. The dose of olanzapine was kept constant, and no other drugs were added during this period. At the end of four weeks there was a reduction in psychotic symptoms and on PANSS, his score was 67 (positive 29, negative 18 and general psychopathology 20) and BPRS totals score was 27. The changes in psychopathology scores over time are summarized in . There were no side effects as assessed on the UKU scale.