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<td><b><font face="Arial,Helvetica"><font size=+1>Discovery of a Urine
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<td VALIGN=TOP WIDTH="132"><font color="#FF0000">Psychosis Urine Test</font>
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<td VALIGN=TOP><font face="Arial,Helvetica"><i>Journal of Orthomolecular
Medicine</i>: The Discovery of Kryptopyrrole and its Importance. Vol. 10,
No. 1, 1995</font><font face="Arial,Helvetica"></font>
<p><b><font face="Arial,Helvetica">The Discovery of Kryptopyrrole and its
Importance in Diagnosis of Biochemical Imbalances in Schizophrenia and
in Criminal Behavior</font></b><b><font face="Arial,Helvetica"></font></b>
<p><b><font face="Arial,Helvetica">by Abram Hoffer, M.D., Ph.D.</font></b><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">In this issue (JOM, Vol 10, No 1) Dr. Richard
T. Kraus describes a notorious serial killer who is serving a 250 year
sentence for the murder of eleven women. Unfortunately, serial killers
are not a threatened species. On the contrary, they threaten society more
and more, and with modern weapons of destruction seem to be even more effective.
This case report may be the first in which four main factors which determine
human behaviour are discussed in detail. Dr. Kraus describes “...a matrix
of genetic, biochemical, neurological and psychological deficits”. I am
particularly interested because the kryptopyrrole ("kp") which was found
in this person’s urine was originally discovered in Saskatchewan about
1960 when I was Director of Psychiatric Research. The main biochemical
research was completed in Saskatchewan by Dr. D. Irvine,(1) and in New
Jersey by Dr. C. C. Pfeiffer (1) and his research group of biochemists.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">This report provides a model of how criminal
behaviour ought to be explored, with numerous references to the medical
literature for all of the four variables. I will discuss mainly the biochemical
findings and provide a brief history of its discovery. The presence of
kp in urine is a valuable diagnostic aid especially for determining more
specific treatment. It is most closely related to the schizophrenias but
cuts across all diagnostic categories. I think it could become an important
differential diagnostic test. It is simple to do, any competent medical
laboratory can do it. The laboratory in Victoria has been&nbsp;</font>
<br><font face="Arial,Helvetica">running them for me since 1976.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">By 1960 the biochemical unit of the psychiatric
research program in Saskatchewan was gearing up to investigate any possible
relationships to the schizophrenias. One of the studies involved examining
urine for several fractions and comparing the urine of patients and controls.
We were then treating many alcoholics using psychedelic therapy. D-lysergic
acid diethylamide (LSD), the hallucinogen, was well studied as a compound
which could induce a model psychosis or a psychotomimetic experience. It
occurred to me that inasmuch as LSD produced something very similar (but
not identical with) schizophrenia, perhaps it might also generate in the
body of a person (not schizophrenic) the same type of biochemical abnormality
which we thought was present in the patients. I asked Dr. N. Payza to examine
the samples of urine obtained from an alcoholic who had been given LSD
as part of his treatment.&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">The first morning specimen was obtained
and another one around noon, usually the height of the experience. My idea
was that if something appeared after LSD which was not present before,
this might give as a lead. We were fortunate because the first patient
we tested had a large amount of a substance that was not present in the
morning specimen. We soon showed that it was not a breakdown product from
the LSD itself, which meant it was created in the body by the impact of
the hallucinogenic drug upon one of the biochemical systems. After we had
improved the assay procedure we began to test patients. One day I took
into the laboratory 12 specimens of urine. Six were obtained from schizophrenic
patients, five were obtained from normal subjects and one was a blank.
The code was kept secret. I asked the biochemical team to analyze these
samples and to tell me which of the 12 were obtained from the schizophrenic
patients. They accurately spotted all the schizophrenic samples. I concluded
that schizophrenic patients, not given LSD, had the same substance in their
urine as did some alcoholics who had been given LSD, but that it was not
present in normal controls.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">We needed large amounts of material for
our chemical studies. Fortunately for us a chronic schizophrenic woman
on the ward had huge quantities of this product. For a moment we considered
calling the compound the Jensen factor. At first we called it the unknown
substance (US), and later the mauve factor because when developed on the
paper chromatogram it stained a beautiful mauve. When it was identified
we called it, more accurately, kryptopyrrole. We named the disease characterized
by large amounts of mauve factor “malvaria,” but Dr. Pfeiffer later gave
it the more appropriate term <b>pyrolleuria.</b>&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">I immediately started two lines of investigation:
(1) by Dr. Payza for short time, and then by Dr. D. Irvine who continued
the research first at the Research Laboratory at the Saskatchewan Hospital
in North Battleford, and later at University Hospital in Saskatoon. The
objective was to determine the structure of the substance and its source.
(2) To study its clinical correlates, i.e. could it be used to assist in
diagnosis, could it have therapeutic significance, and could it be used
to follow patients both to determine if they were improving, and to determine
if they were getting worse.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Dr. Irvine showed that it was a pyrrole,
later identified as kryptopyrrole. We began to cooperate with Dr. C. C.
Pfeiffer at Princeton, New Jersey. Dr. H. Osmond, my colleague in the earlier
Saskatchewan research, was then Director of Research for the state. The
two laboratories did the basic work. Dr. Pfeiffer and his team discovered
how to measure the amount of this substance in the urine using a fairly
simple test, and they showed that this substance bound with pyridoxine
and zinc and when present in large amounts produced a double deficiency
of this vitamin and the mineral. On the clinical side he described the
syndrome pyrolleuria, a form of schizophrenia with clearly marked out symptoms
and signs which could be diagnosed by the present of kp in the urine.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Several years later we had examined thousands
of patients at three hospitals for the mauve factor.(2) It was present
mostly in schizophrenic patients but was also present in one-quarter of
other non schizophrenic patients including depressions, alcoholics, anxiety
states, and in children with learning and behavioral disorders. It was
rarely present in normal subjects, and was present in ten percent of a
non psychiatric stressed population drawn from the surgical wards of the
hospital. To my surprise it was found in most cases of lung cancer.(3)
I found the following relationships:</font><font face="Arial,Helvetica"></font>
<p><i><font face="Arial,Helvetica">1) Relationship to diagnosis</font></i><font face="Arial,Helvetica">
- The mauve factor was found in the following categories of patients:</font><font face="Arial,Helvetica"></font>
<p><i><font face="Arial,Helvetica">Diagnosis; percent with the diagnosis
mauve factor</font></i><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica"><b>Normal subjects&nbsp;&nbsp;</b>&nbsp;&nbsp;&nbsp;
0</font><b><font face="Arial,Helvetica"></font></b>
<p><b><font face="Arial,Helvetica">Physically ill</font></b>
<br><font face="Arial,Helvetica">Adults&nbsp;
10</font>
<br><font face="Arial,Helvetica">Children&nbsp;
10</font>
<br><font face="Arial,Helvetica">Mood disorders&nbsp;&nbsp;&nbsp; 20</font>
<br><font face="Arial,Helvetica">Alcoholics&nbsp;
20</font><b><font face="Arial,Helvetica"></font></b>
<p><b><font face="Arial,Helvetica">Schizophrenics</font></b>
<br><font face="Arial,Helvetica">Early, not treated&nbsp; 75</font>
<br><font face="Arial,Helvetica">Recovered&nbsp;
0</font>
<br><font face="Arial,Helvetica">Not recovered&nbsp;
50</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Thus it was clear that although it was
most closely related to the schizophrenic&nbsp;</font>
<br><font face="Arial,Helvetica">population, it could not be considered
a test for schizophrenia. Probably there will never be such a test since
the clinical diagnosis is subjective and there is wide disagreement among
clinicians about the diagnosis. I therefore compared the results of testing
for this compound with the results obtained on the HOD (Hoffer-Osmond Diagnostic)
test.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica"><i>2) Relationship to HOD Test</i>.(4)
This is a card sort test similar in principle to the MMPI but containing
entirely different questions. Perceptual symptoms including hallucinations
and illusions are specifically covered. The HOD test can be described as
a perceptual test. Patients sorted 145 cards into true and false piles
and these were recorded and scores obtained. We standardized this test
on thousands of subjects and have reported the results widely.&nbsp; We
found that there was a better relationship between the presence of high
scores in the test and the presence of kp in the urine than there was between
kp and clinical diagnosis. Schizophrenics had much higher scores than did
any other group of psychiatric patients, with the exception of patients
with delirium tremens and normal subjects undergoing the LSD experience.
In one study in New York, the investigating team found that the admission
HOD test results were more closely correlated to the final discharge diagnosis
than they were to the admitting diagnosis, even though none of the clinicians
were able to see the results of the HOD test.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica"><i>3) As an indicator for treatment</i>.
By 1960 we had completed four double blind controlled prospective studies
on schizophrenic patients comparing niacin, niacinamide and placebo.(5)
Based upon these studies and upon open clinical studies going back to 1951,
I had concluded that schizophrenic patients responded better to any treatment
when they were given adequate doses of vitamin B3. Forty years later this
is still my conclusion, as it is of every physician who uses the same treatment.
The only physicians who disagree are those who have never used the treatment
and who have even refused to examine earlier studies. There is no patent
on vitamin B3, and without a patent there is no financial incentive for
any company to promote this treatment. Since schizophrenic patients, most
of whom had the factor in their urine, responded better when treated with
vitamin B3, I concluded that any psychiatric disease, no matter what they
were diagnosed clinically, might also do better with this vitamin. This
was confirmed by a large series of open clinical studies. I will not term
these studies anecdotal, which has become the politically correct term
for denigrating any studies that are not double blind, since all clinical
studies depend upon the history or herstory of patients and how they respond,
i.e. upon anecdotes. The only difference is that in double blind studies
the anecdotes are collected by physicians or others who are blinded by
not knowing what treatment is being given. At least this is the theory
of this type of procedure. In fact, the vast majority of these studies
are so imperfectly blinded that few clinician or nurses have much difficulty
deciding whether the patient was on placebo or something more active.&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Worshippers of the double blind remind
me of the emperor whose nakedness was seen only by a child not yet blinded
by tradition. This report by Kraus is an excellent example of the type
of anecdotal history which has contributed so much to medicine.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">The presence of the mauve factor in urine
became a valuable indicator to use vitamin B3. Later, when Dr. C. C. Pfeiffer
showed that kp bound pyridoxine and zinc and described the syndrome pyrolleuria,
this became another important indicator that vitamin B6 and zinc must be
used. It is especially valuable for children, who are very difficult to
diagnose because they vary so much one from the other.&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">4) Response to treatment. Patients who
responded to treatment invariably became mauve factor or kp factor negative.
However, there were many patients who no longer excreted this factor but
who had not recovered. I have not examined whether these patients might
have responded to longer treatment. In my recent report (6) on chronic
patients it is evident that many chronic patients need five to seven years
of treatment. Perhaps some of the negative excretors after having been
positive might have fallen into this group. Patients who were well and
were kp free were followed for months or years. If they became positive
at any time they also became clinically ill within a matter of weeks or
months.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Generally, the presence of kp is associated
with clinical conditions characterized by a high degree of perceptual disorganization.
These are chiefly the schizophrenic patients, but also includes a substantial
proportion of other psychiatric diseases also characterized by perceptual
changes. Unfortunately psychiatrists do not search their patients’ mental
state adequately and miss many of these changes. They can be readily detected
using perceptual tests such as the HOD test. (7) In other words, the presence
of kp correlates strongly with high scores on these perceptual tests. Perhaps
Dr. Kraus’s detailed report will arouse interest in this test, sadly neglected
for so many years.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">In 1960 I examined a seven year old boy
who had been diagnosed retarded and preparations were being made to send
him to a special school. His parents were very concerned and asked me whether
I would examine him. For over a year he had difficulty in school, could
not read, and avoided going to school as much as he could, often staying
away from home all day but not at school. His mother, a teacher, had been
spending a lot of time giving him special instruction without improvement.
He was also developing behavioral problems at home. I examined him early
in 1960 and could not locate any particular problem, perhaps because I
had not had much experience treating children. I then had his urine analyzed
for mauve factor, kp, and to my surprise found a large amount. I called
his father, a friend of mine, and said in jest “You are in luck, your son
has schizophrenia.” He answered, “Why does that make me so lucky?” I then
told him I was kidding him, and added seriously he was certainly not schizophrenic,
but since he had the same biochemical factor in his urine we had found
in schizophrenics, and since they had responded well to vitamin therapy,
this suggested that his son might respond in a similarly beneficial way.&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">I started him on niacinamide 1,000 milligrams
after each meal. In the fall his father asked me would I like to know what
had happened to his son. He then told me that two months after his son
had started on the vitamin he had begun to read, that he had spent a few
months reading voraciously and that he was no longer concerned about his
behaviour. His son was normal and remained well. He took his niacinamide
regularly until he was about 14. One day he asked his mother why he was
taking the pills. She brought him to see me and I explained why I thought
he should remain on the vitamin until at least age 18 at which time he
could determine how well he could do without it. He is still well, happily
married with children, and is fully employed in a responsible job.&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">This illustrates the use of the kp urine
test for pyrolleuria, and the use of niacinamide in large doses to treat
this condition successfully. I did not use vitamin B6 nor zinc in 1960.
Pyridoxine is essential for the conversion of tryptophan to nicotinamide
adenine dinucleotide, the vitamin B3 coenzyme. With a deficiency of pyridoxine,
the synthesis of NAD in the body is reduced. A pyridoxine deficiency will
produce a form of pellagra not distinguishable clinically from the pellagra
caused by a deficiency of vitamin B3.</font><font face="Arial,Helvetica"></font>
<p><b><font face="Arial,Helvetica">References</font></b>
<br><font face="Arial,Helvetica">Hoffer A: The Presence of Malvaria in
Some Mentally Retarded Children. Amer J&nbsp;&nbsp; Ment Def 67:730-732,
1963. Hoffer A: Malvaria and the Law. Psychoso-matics,&nbsp;&nbsp; 7:303-310,
1966.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: A Program for the Treatment of
Alcoholism: LSD, Malvaria and Nicotinic Acid. In, The Use of LSD in Psychotherapy
and Alcoholism. Ed. HA Abramson.Bobbs-Merril, New York, 343-402, 1967.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Mahon M: The Presence of
Unidentified Substances in the Urine of&nbsp;&nbsp; Psychiatric Patients
2:331-362, 1961</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: The Relationship
Between an Unknown Factor (US) in the Urine of Subjects and HOD Test Results.
J Neuropsychiatry 2:363-368, 1961.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: Malvaria: A New
Psychiatric Disease. Acta Psychiat Scand&nbsp;&nbsp; 39:335-366, 1963.&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: The Psychophysiology of Cancer.
J Asthma Research 8:61-76, 1970.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: A Card Sorting
Test Helpful in Making Psychiatric Diagnosis. J Neuropsychiatry 2:306-330,
1961.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: A Card Sorting
Test Helpful in Establishing Prognosis. Am&nbsp; J Psychiatry 118:840-841,
1962.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: The Relationship
Between an Unknown Factor (US) in the Urine of Subjects and HOD Test Results.
J Neuropsychiatry 2:363-368, 1961.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: The Association
Between Schizophrenia and Two Objective Tests. Can Med Ass J 87:641-646,
1962.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A, Kelm H &amp; Osmond H: The Hoffer-Osmond
Diagnostic Test. RE Krieger Pub&nbsp;&nbsp; Co. Huntington, New York, 1975.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A, Osmond H, Callbeck MJ &amp; Kahan
I: Treatment of Schizophrenia with Nicotinic Acid and Nicotinamide. J Clin
Exper Psychopathol 18:131-158, 1957.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Niacin Therapy in Psychiatry.
C.C.Thomas, Springfield, IL, 1962.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: Treatment of Schizophrenia
with Nicotinic Acid - A Ten Year Follow-Up. Acta Psychiat Scand 40:171-189,
1964.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Treatment of Schizophrenia with
a Therapeutic Program Based Upon Nicotinic Acid as the Main Variable. Molecular
Basis of Some Aspects of Mental Activity, Vol II. Ed. O Walaas, Academic
Press, New York, 1967.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Megavitamin B-3 Therapy for Schizophrenia.
Can Psychiatric Assoc J&nbsp;&nbsp; 16:499-504, 1971.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Treatment of Hyperkinetic Children
with Nicotinamide and Pyridoxine.&nbsp; Can Med Assoc J 107:111-112, 1972.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Natural History and Treatment
of Thirteen Pairs of Identical Twins,&nbsp; Schizophrenic and Schizophrenic-Spectrum
Condi-tions. J Orthomolecular Psychiatry 5:101-122, 1976.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Orthomolecular Medicine for Physicians.
Keats Pub, New Canaan, CT, 1989.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Orthomolecular Medicine. In,
Molecules In Natural Science and Medicine, An Encomium for Linus Pauling.
Ed Z.B. Maksic &amp; M. Eckert-Maksic, Ellis Horwood Ltd, Chichester, West
Sussex, England, 1991.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Vitamin B3 and Schizophrenia:
Discovery, Recovery, Controversy. Quarry Press, Kingston, Ontario, 1994.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A: Chronic Schizophrenic Patients
Treated Ten Years Or More. J. Orthomolecular Medicine, 9:7-37, 1994.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: How To Live With
Schizophrenia. University Books, New York, NY, 1966. Also published by
Johnson, London, 1966. New and Revised Ed. Citadel Press, New York, N.Y.
1992</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Hoffer A &amp; Osmond H: The Hallucinogens.
Academic Press, New York, 1967.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Orthomolecular Psychiatry, Eds. D. Hawkins
and Linus Pauling. W.H. Freeman and Co., San Francisco, 1973.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">(Also see References in Dr. Richard T.
Kraus' paper.)&nbsp;</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">Reprinted with permission of the author.</font><font face="Arial,Helvetica"></font>
<p><font face="Arial,Helvetica">A. Hoffer, M.D., Ph.D.</font>

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