Orthomolecular psychiatry began with Abram Ho�er and Humphry Osmond in the 1950s and was continued by Carl Pfei�er of the Pfei�er Treatment Center,[2] although proponents of orthomolecular psychiatry say that the ideas behind their approach can be traced back to the 1920s and '30s.[3][4] Orthomolecular psychiatry's goal of weaning patients from conventional neuroleptic drugs[5] follows "Pfei�er's Law", "For every drug that bene�ts a patient, there is a natural substance that can achieve the same e�ect".[6] In 1968, Linus Pauling used the term "orthomolecular".[7][8]The assertions by proponents of orthomolecular psychiatry were rejected in 1973 by a panel of the American Psychiatric Association.[1][9][10] Orthomolecular psychiatry has subsequently found little support in mainstream psychiatry[11] and is currently considered to be unproven and potentially harmful. After 1975, orthomolecular psychiatry research was primarily reported in Orthomolecular Psychiatry, now the Journal of Orthomolecular Medicine, a fringe publication founded by Abram Ho�er to counter what he considered to be a medical conspiracy against his ideas.[12][edit]Diagnosis

Proponents of orthomolecular psychiatry claim to have identi�ed the causes of some psychiatric syndromes, in particular those that cause psychosis; according to orthomolecular proponents, testing for these causes guides diagnosis and treatment. Diagnostic measures and therapies commonly employed include "individual biochemical workup", fasting, identifying suggested allergies, dietary changes, megavitamin therapy, amino acids, and other so-called "pharmacologic nutrients".[5] These diagnoses have not been accepted by mainstream medicine.[11][edit]Speci�c conditions

Orthomolecularists claim that the causes of psychotic disorders include food allergy, hypoglycemia, hypothyroidism in the presence of normal thyroid values, heavy metal intoxications including those allegedly due to dental �llings, as well as several hypothesised conditions they call pyroluria, histade-lia and histapenia.[5] These conditions are not recognized by the medical community.[edit]PyroluriaPyroluria (or malvaria from the term mauve factor) involves hypothetical excessive levels of pyrroles in the body resulting from improper hemoglobin synthesis.[13] Carl Pfei�er believed that pyroluria is a form of schizophrenic porphyria, similar to acute intermittent porphyria where both pyrroles and porphyrins are excreted in the human urine to an excessive degree.[14] and orthomolecular psychia-trists have alleged that pyroluria is related to diagnoses of ADHD, alcoholism, autism, depression, down syndrome, manic-depression, schizophrenia, celiac disease, epilepsy, and psychosis.[15] Pfei�er's methods have not been rigorously tested,[16] and pyrroles are not considered related to schizophrenia. Studies have either failed to detect hemopyrrole and kryptopyrrole in the urine of normal controls and schizophrenics, or found no correlation between these chemicals and mental illness.[17][18][19][20][21][22] Few, if any, medical experts regard the condition as genuine, and few or no articles on pyroluria are found in modern medical literature;[23] the approach is described as "snake oil" by pediatrician and author Julian Haber.[16][edit]HistadeliaHistadelia is a condition hypothesised by Carl Pfei�er[24][25] to involve elevated serum levels of histamine and basophils,[5] which he says can be treated with methionine and vitamin B6 megadoses.[26] Pfei�er claims that "histadelia" can cause depression with or without psychosis, but no published clinical trials have tested the e�ectiveness of this therapy.[27][edit]HistapeniaHistapenia in orthomolecular medicine is the condition of high serum copper with low histamine.[edit]Bipolar disorderA 1999 review study found that a "substantial body of direct and indirect evidence" supports the use of omega-3 fatty acids in treating bipolar disorder.[28][29][edit]Relationship to mainstream psychiatry

Orthomolecular psychiatry has been rejected by the mainstream medical community.[30] Critics have noted that the claims advanced by its proponents are unsubstantiated, and even false. Authoritative bodies such as the National Institute of Mental Health[11] and American Academy of Pediatrics[31] have criticized orthomolecular treatments as ine�ective and toxic.A 1973 task force of the American Psychiatric Association charged with investigating orthomolecular claims unanimously concluded:This review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. It concludes in this regard that the credibility of the megavitamin proponents is low. Their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scienti�cally acceptable fashion. Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment," to be deplorable.[32][edit]References

Carl Curt Pfei�er, M.D., Ph.D. (1908–1988) was a physician and biochemist who researched schizophrenia, allergies and other diseases. He was Chair of the Pharmacology Department at Emory University and considered himself a founder of what he called "orthomolecular psychiatry".[1]Pfei�er was interested in trace element and mineral metabolism in schizophrenia and what is now known as bipolar disorder[2] and investi-gated the therapeutic uses of amino acids in various illnesses.[3] Pfei�er and co-workers reported that about a third of all the patients they examined had very high basophil counts, very high blood histamine levels and anomalies in their trace metal levels.[4][5] Pfei�er collaborated with Abram Ho�er.[6] For many years Dr. Pfei�er helped run the Princeton Brain-Bio Center, now known as the Earth House, which is dedicated to the orthomolecular treatment of psychiatric ailments.[1]The Pfei�er Treatment Center in Warrenville, Illinois treats patients with psychiatric ailments according to Pfei�er's megadose therapy ideas.