COMPLEMENTARY AND ALTERNATIVE THERAPIES IN PSYCHIATRY
اسلاید 1: www.tabaye.ir
اسلاید 2: HOLISTIC HEALING FOR THE MIND: COMPLEMENTARY AND ALTERNATIVE THERAPIES IN PSYCHIATRYSudha Prathikanti, MDUniversity of California, San Franciscowww.prathikanti.com/teaching
اسلاید 3: INTEGRATIVE PSYCHIATRY tA healing approach that uses both conventional and complementary / alternative medicine to understand and treat psychiatric conditions.
اسلاید 4: NIH DEFINITION OF COMPLEMENTARY & ALTERNATIVE MEDICINE (CAM)tHealthcare systems, practices, and products not presently considered to be part of conventional medicine. Complementary: together with tconventional practiceAlternative: in place of ttttconventional practicettttttt
اسلاید 5: NIH CLASSIFICATION OF CAM Mind-Body TherapiesMeditationtBiofeedbackHypnosis and Guided ImageryBiologically-Based TherapiesBotanicals and HerbsNutritional SupplementsEnergy TherapiesReikiQi GongMagnetsManual TherapiesMassageChiropractic Alternative Medical Systems Ayurveda Traditional Chinese Medicine Homeopathy
اسلاید 6: USE OF CAM IN THE UNITED STATESGeneral public’s use of CAM: t--42% (Eisenberg 1998) t--36% when prayer excluded (Barnes et al, 2004) t--62% when prayer included (Barnes et al, 2004)Among people with self-reported anxiety or depression, CAM use exceeds conventional care (Eisenberg 2001)t--For anxiety, CAM 57% vs conventional 41%t--For depression, CAM 54% vs conventional 35%Among people with self-reported anxiety or depressionwho seek conventional caret-- 66% with anxiety also use CAM t-- 67% with depression also use CAMCAM use by patients with anxiety / depression t-- Mind-body therapies 34%t-- Spiritual healing 10%t-- Manual therapies 8% t-- Herbs / supplements 7% t
اسلاید 7: EVOLUTION OF MODERN BIOMEDICINEEuropean Enlightenment Germ Theory of DiseaseFlexner Report
اسلاید 8: THE BIOMEDICAL PARADIGMBody, mind, spirit are discrete Body can be treated independentlyBody is like machineIsolate & eradicate source of malfunctionPhysician is specialized technician Treatment is specific to illnessTreatment should pass scientific testsPhysician -patient relationship has little bearing on outcome as long as adherence to treatment prevailsEmphasis on fighting disease
اسلاید 9: LIMITATIONS OF BIOMEDICINEtttt Poorer results when conditionttttt- Chronictttttt- Non-bacterialttttt- Non-mechanicaltttttt- Autoimmunettttt- Unknown or multifactorial etiologyttttAdverse effects of biomedical therapiestRigid treatment delivery systems tLess time with physician tPossible sense of de-humanization & compartmentalization
اسلاید 10: THE “RE-DISCOVERY” OF ALTERNATIVE MEDICINEtThe more I learn of physics, the more I am drawn to metaphysics.tAlbert Einstein
اسلاید 11: THE APPEAL OF CAM THERAPIES tAcknowledge body, mind, and spirittEmphasis on preventing disease tTreatment is specific to the persontKnowing cause of illness less criticaL tPhysician activates self-healing capacityt
اسلاید 12: SOME LIMITATIONS OF CAMQuality of Care: often unregulated practiceQuality of Product: no stringent monitoringQuality of Science: often unverified efficacy
اسلاید 13: INTEGRATIVE MEDICINE: THE BEST OF BOTH WORLDStIntegrative Medicine might restore the soul to medicine…tthe soul being that part of us that is most important but the least easy to delineate.tRichard Smith tBritish Medical Journal January 2001
اسلاید 14: PSYCHIATRY AS BIOMEDICINE SPECIALITYHistorical RootsConventional medical school training Vocabulary (e.g. case history, prevalence, pathogenesis, prognosis, cure) syntonic with biomedicine Reductionism of classical Drive TheorySeparation from religionCurrent DevelopmentsInformation explosion about brain and its functionDiscovery of biochemical etiologies for mental illnessCreation of powerful psychotropic medications
اسلاید 15: PSYCHIATRY AS DEPARTURE FROM BIOMEDICINEConversion disorders & early affirmation of mind-body connectionConsultation Psychiatry & more elucidation of mind-body and body-mind syndromesPsychoanalysis as self-healing process with physician as catalystAcceptance of psychoanalysis despite lack of scientific testsDSM recognition of cultural & spiritual dimensions in diagnosis and treatment
اسلاید 16: CROSSING THE CARTESIAN DIVIDEtBut what is quackery? ttIt is commonly an attempt to cure the diseases of man by addressing the body alone.tHenry David Thoreau
اسلاید 17: Psychiatry is uniquely situated to integrate healing paradigms.
اسلاید 18: SOME UNIVERSITY-BASED INTEGRATIVE MEDICINE CENTERS IN THE UNITED STATES ColumbiaCornellDukeGeorge WashingtonHarvardStanfordThomas JeffersonTuftsUniversity of ArizonaUniversity of MarylandUniversity of MiamiUniversity of MichiganUniversity of PittsburgUniversity of TexasUniversity of WashingtonUniversity of California,San Francisco
اسلاید 19: EVIDENCE BASE FOR CAM REMEDIES IN PSYCHIATRYtMEDITATIONttHATHA YOGAttACUPUNCTUREtHERBS & SUPPLEMENTS
اسلاید 20: MEDITATIONChronic anxiety Chronic pain Chronic insomnia Recurrent depression Overall emotional well-being Less anxiety and depressionIncreased sense of controlIncreased empathy
اسلاید 21: HATHA YOGAtRandomized controlled trialsDepressionAnxietyOpiate DependencettNon-randomized controlled trialsMood benefits equivalent to swimming Mood benefits superior to muscle relaxation and visualization Higher life satisfaction, better overall mood, better coping with stress
اسلاید 22: ACUPUNCTUREPrimary therapy in acute musculoskeletal painAdjuvant therapy in chronic musculoskeletal painPerhaps some efficacy in depression Scant data in anxiety disordersNo convincing data re: efficacy in smoking cessation or drug detox/rehab
اسلاید 23: HERBAL REMEDIEStSt. John’s WorttEquivalent to low-dose tricyclic in mild-mod depressionTwo large negative studies compared to SSRI’sTypical dose 900-1800 mg/day (in three divided doses)Watch for photoxicity and herb-drug interactionsNIH Minor Depression study pendingHypericum perforatum
اسلاید 24: HERBAL REMEDIEStGingkoMore than 30 double-blind trials show tpromise in slowing dementia symptomsMay delay Alzheimer progression tby 6-12 monthsMost effective in Alzheimer’s , tnot vascular dementia Full effect may require one year t at 120-240 mg/dayNo head-to-head comparison with anti-cholinesterasesSome prelim positive results in t young, healthy subjectsWatch for seizure in epileptics, themorrhage in patients on anti-coags Gingko Biloba
اسلاید 25: HERBAL REMEDIESRhodiolaMany classified Russian studies during Cold warEnhances cognitive performance under stressReduces mental fatigueImproves sexual functionImproves overall well-being300-900 mg/day for depressionCaution with bipolar and post-MI patientsRhodiola Rosea
اسلاید 26: HERBAL REMEDIEStValerian RootUsed for hundreds of years for anxiety / insomniaSeven placebo-controlled trials (400-900 mg/day)6 of 7 studies found statistically significant, dose-related sedative effectsNot benzodiazapine, so little abuse potentialAvoid if liver dysfunctionValeriana officinalis
اسلاید 27: HERBAL REMEDIES FROM AYURVEDABacopa MonnieraWithania somniferaValeriana jatamansiConvolvulus pluricaulisRauwolfia serpentinaCentella asiaticaMandukparniJatamansiSarpagandhaAshwagandhaShankpushpiBrahmiAntipsychotic Effect -- Rauwolfia * -- Centella (in polyherbal) Anxiolytic Effect -- Valeriana -- Centella -- Withania -- Convolvulus -- Bacopa *Antidepressant Effect --- Withania --- ConvolvulusSoporific Effect -- Valeriana * -- Centella (in polyherbal)Cognitive Enhancement -- Centella -- Withania * -- Convolvulus -- Bacopa *
اسلاید 28: DIETARY SUPPLEMENTSttttOmega-3 Fatty AcidstWorldwide, lower serum omega-3 fatty acids significantly correlate with depression Double-blind, placebo-controlled studies show efficacy of omega 3 (from fish oil) in unipolar and bipolar depressionEicosapentanoic acid (EPA) more critical omega-3 fatty acid than docosahexanoic acid (DHA)Typical EPA dose 2.5 gm/day Flaxseed oil also source for omega-3 fatty acids, tbut no controlled studies to date on tuse in psych conditionsFood increases omega-3 absorptionDo not heat fish oilVitamin E may help in vivo potency Caution with anti-coagulants and hi-dose NSAIDS
اسلاید 29: DIETARY SUPPLEMENTStS-Adenosyl-Methionine (SAMe)Several placebo-controlled trials tfor use in depressionMeta-analysis shows SAMe t(400mg-1600 mg by mouth) may be equivalent to tricyclics No data on comparison to SSRI’s Risk of mania, serotonin syndrome
اسلاید 30: DIETARY SUPPLEMENTStttt Folic AcidFolate deficiency appears significantly correlated with t higher rates of depression Data suggest low serum folate may hinder antidepressant responseFolate (0.5 mg/day) may be important adjuvant in treating woment (but not men) with resistant depressionFolate may help prevent relapse during & after depression txWatch for reduced efficacy of concurrent phenobarb/phenytoin
اسلاید 31: DUTY TO PROTECTProven danger with specific CAM useNo proven benefit with CAM use and clear benefit with conventional treatment
اسلاید 32: DUTY TO PROMOTELikely benefit with specific CAM useLow risk of harm
اسلاید 33: DUTY TO PARTNERBenefit / harm of CAM unknown per scientific studiesConventional diagnosis / treatment inadequate Symptoms fit CAM healing paradigm Competent CAM practitioner / product availableOptimistic patient / healer expectation Joint monitoring of CAM therapeutic trial
اسلاید 34: RESOURCES FOR CAM EDUCATION
اسلاید 35: Websites CAM on PubMed Cochrane Collaboration NCCAM Website Herb Research Foundation American Botanical Council Consumer Lab NIH Office of Dietary SupplementsJournals Alternative Therapies in Health and Medicine Journal of Alternative and Complementary Medicine Integrative Medicine Evidence Based Complementary and Alternative MedicineRESOURCES FOR CAM EDUCATION
نقد و بررسی ها
هیچ نظری برای این پاورپوینت نوشته نشده است.