Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia

Background Although millions of people with schizophrenia live in betel che wing regions, the effects of betel chewing on their symptoms are unknown. B etel nut alkaloids include potent muscarinic cholinomimetics: recent. resea rch suggests that these agents may be therapeutic in schizophrenia. Aims To compare the primary and extrapyramidal symptom profiles and substan ce-using habits of betel chewing v. non-chewing people with schizophrenia. Method Across-sectional study of 70 people with schizophrenia. Symptom rati ngs measured by the Positive and Negative Syndrome Scale (PANSS) and Extrap yramidal Symptom Rating Scale (ESRS), and demographic and substance-use dat a, were compared for 40 chewers and 30 non-chewers of betel nut. Results Betel chewers with schizophrenia scored significantly lower on the positive (P=0.001) and negative (P=0.002) sub-scales of the PANSS than did non-chewers. There were no significant differences in extrapyramidal sympto ms or tardive dyskinesia. Conclusions Betel chewing is associated with milder symptomatology and avoi dance of more harmful recreational drugs. These initial results indicate th at longitudinal research is merited. Declaration of interest Supported by grants from the University of Auckland Research Council and the New Zealand Schizophrenia Fellowship.