The role of traditional health practitioners and the effects of Salix mucronata on the treatment of negative symptoms of Schizophrenia in KwaZulu-Natal, South Africa.

Abstract

Introduction: The negative symptoms of schizophrenia overlap with the symptoms presented in conditions associated with witchcraft, evil spirits and ancestors in the African healing setting. The cornerstone biomedical treatment for schizophrenia is antipsychotics which are associated with adverse side effects. Traditional healing employs a holistic approach when managing physical and mental ailments, and encompasses cultural and spiritual beliefs. Hence, its preferability in African communities. Thus, this study aimed to investigate the role of Traditional Health Practitioners (THPs) and traditional medicine in the treatment of negative symptoms of schizophrenia by investigating the THPs’ methods of diagnosis and treatment. The herbal plants used by THPs were investigated for phytochemistry and cytotoxicity, and S. mucronata was further investigated for its antipsychotic activity which was compared to the activity of the currently used antipsychotic drug, risperidone. Methodology: Self-developed questionnaires were administered to 100 randomly selected THPs from the Harry Gwala District Municipality and focus group discussions were conducted with 31 of the THPs with experience in treating mental illness. Phytochemistry and cytotoxicity of herbal plants recommended by the THPs were investigated using GC-MS and the MTT assay, respectively. S. mucronata, was further tested for antipsychotic potential on ketamine-induced Sprague-Dawley rats. The animal component of the study consisted of a total of 66 male adult rats (n=21 formed the experimental groups and n=45 formed the experimental groups which received 30 mg/kg of ketamine). During the treatment phase, the animals received either saline, risperidone (6 mg/kg) or the herbal extract of S. mucronata (5 mg/kg). This plant was selected since there is a paucity of studies reporting on its potential for the treatment of this disorder. Three-chambered sociability and sucrose preference tests were used to examine asociality and anhedonia, respectively. The concentrations of dopamine and acetylcholine were measured using ELISA as the dysfunction of these neurotransmitters is linked with the pathophysiology of schizophrenia. Results: Consultation with ancestors and the administration of a medicinal concoction were the common methods employed by the THPs to diagnose and treat schizophrenia. A variety of bioactive compounds were identified from herbal plants recommended by the THPs for treatment of schizophrenia and these plants showed no cytotoxic effects. S. mucronata reversed social withdrawal and promoted social novelty in ketamine-induced rats. Conclusion: THPs play a significant role in the treatment of schizophrenia and traditional medicine (TM) had a positive effect in the treatment of this disorder. The herbal plants used by THPs to treat mental disorders in KwaZulu-Natal can be considered safe for use as they have indicated non-cytotoxicity and may have a number of benefits as they possess a variety of beneficial bioactive compounds. S. mucronata showed antipsychotic activity similar to the effects of risperidone.