Abstract
To the Editor,
Pittosporum angustifolium (PA) commonly known as ‘Cattle Bush’ is a small tree native to Australia (Cayzer et al., 2000). It is traditionally used in bush medicine for cough, nasal congestion and also as a lactagogue for aboriginal women (Sadgrove and Jones, 2013).
We report the case of a traditional indigenous healer who has been our client for several years for treatment of chronic schizophrenia complicated by continued cannabis and alcohol abuse. Following several years of depot antipsychotics, he had developed tardive dyskinesia and nuchal dystonia to the extent that he had to be put on Botox injections for the same. After a recent increase in the dose of Paliperidone (for resistant auditory hallucinations), he developed an increase in nuchal dystonia. In an effort to relieve the distress, he reportedly drank an extract of the leaves of PA (Cattle bush). There was no apparent improvement in the symptoms, and on the contrary, he experienced an increase in dystonia. We subsequently reduced the antipsychotic dose and added anticholinergics for immediate relief.
Given its documented use in improving lactation, this ties in with the possibility of PA working as a dopamine receptor blocker and enhancing the side effects of D2 blocking agents. The recent increase in antipsychotic dose and the heavy alcohol and cannabis abuse are confounding factors in our interpretation of the finding. It is interesting to note that he did not experience any significant change in the auditory hallucinations with the extract.
Consumption of PA extracts which is a commonly prescribed aboriginal bush medicine for coughs and so on may have a role in increasing extrapyramidal side effects in susceptible individuals due to a possible role in the dopaminergic system. This has clinical significance for assessment in indigenous clients as it brings out the need for incorporating specific questions regarding the names of bush medicines consumed and their effects on symptoms. This evidence is preliminary and further research is required in the area of interaction between bush medicines and psychotropics and also traditional plant medicines with neurotropic actions.
Footnotes
Acknowledgements
The author would like to acknowledge the contribution of Dr Ernest Hunter and Dr Bruce Gynther (Consultants, Remote Mental Health, Cairns and Hinterland Health Service) for their inputs.
Declaration of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship and/or publication of this article.