An unusual schizophrenic illness responsive to pyridoxine HCl (B₆) subsequent to phenothiazine and butyrophenone toxicities

This report describes the treatment of an 18-year-old male diagnosed (DSM II) as having an acute schizophrenic reaction, catatonic type (APA, 1968) in association with multiplex psychobiological findings which did not support a singular etiological diagnosis. The patient demonstrated classical psychiatric symptoms supporting the clinical diagnosis of a schizophrenic disorder. Treatment with haloperidol (butyrophenone) from 1-5 mg TID and, alternatively, trifluoperazine (phenothiazine) at 2 mg TID was unsuccessful because of the extrapyramidal side effects and the respective hepatotoxicities which occurred with both drugs. Pyridoxine HC1 (vitamin B₆) at 500 mg daily was therapeutically effective in eliminating the major schizophrenic reaction. Clinical relapse resulted with dose reduction to 250 mg daily, following full clinical recovery for 1 year, but was reinstitued again at 500 mg daily.