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Schulze J, Sinke C, Neumann I, Wollmer MA, Kruger THC. Effects of glabellar botulinum toxin injections on resting-state functional connectivity in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:97-107. [PMID: 36991143 DOI: 10.1007/s00406-023-01563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 03/31/2023]
Abstract
Meta-analyses suggest a sustained alleviation of depressive symptoms through glabellar botulinum toxin (BTX) injections. This can be explained by the disruption of facial feedback loops, which may moderate and reinforce the experience of negative emotions. Borderline personality disorder (BPD) is characterized by excessive negative emotions. Here, a seed-based resting-state functional connectivity (rsFC) analysis following BTX (N = 24) or acupuncture (ACU, N = 21) treatment in BPD is presented on areas related to the motor system and emotion processing. RsFC in BPD using a seed-based approach was analyzed. MRI data were measured before and 4 weeks after treatment. Based on previous research, the rsFC focus was on limbic and motor areas as well as the salience and default mode network. Clinically, after 4 weeks both groups showed a reduction of borderline symptoms. However, the anterior cingulate cortex (ACC) and the face area in the primary motor cortex (M1) displayed aberrant rsFC after BTX compared to ACU treatment. The M1 showed higher rsFC to the ACC after BTX treatment compared to ACU treatment. In addition, the ACC displayed an increased connectivity to the M1 as well as a decrease to the right cerebellum. This study shows first evidence for BTX-specific effects in the motor face region and the ACC. The observed effects of BTX on rsFC to areas are related to motor behavior. Since symptom improvement did not differ between the two groups, a BTX-specific effect seems plausible rather than a general therapeutic effect.
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Affiliation(s)
- Jara Schulze
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christopher Sinke
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Insa Neumann
- Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Asklepios Clinic North - Ochsenzoll, Langenhorner Chaussee 560, 22419, Hamburg, Germany
- Asklepios Clinic North - Ochsenzoll, Clinic for Geriatric Psychiatry, Hamburg, Germany
| | - M Axel Wollmer
- Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Asklepios Clinic North - Ochsenzoll, Langenhorner Chaussee 560, 22419, Hamburg, Germany
- Asklepios Clinic North - Ochsenzoll, Clinic for Geriatric Psychiatry, Hamburg, Germany
| | - Tillmann H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Center for Systems Neuroscience, Bünteweg 2, 30559, Hanover, Germany.
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2
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Li J, Hui X, Yao L, Shi A, Yan P, Yao Y, Wang Q, Ma Y, Wei D, Lan L, Chen L, Yan L, Fang F, Li H, Feng X, Wu J, Qiao Y, Zhang W, Esill J, Qiao C, Yang K. The relationship of publication language, study population, risk of bias, and treatment effects in acupuncture related systematic reviews: a meta-epidemiologic study. BMC Med Res Methodol 2023; 23:96. [PMID: 37081403 PMCID: PMC10120256 DOI: 10.1186/s12874-023-01904-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND There are debates in acupuncture related systematic reviews and meta-analyses on whether searching Chinese databases to get more Chinese-language studies may increase the risk of bias and overestimate the effect size, and whether the treatment effects of acupuncture differ between Chinese and non-Chinese populations. METHODS In this meta-epidemiological study, we searched the Cochrane library from its inception until December 2021, and identified systematic reviews and meta-analyses with acupuncture as one of the interventions. Paired reviewers independently screened the reviews and extracted the information. We repeated the meta-analysis of the selected outcomes to separately pool the results of Chinese- and non-Chinese-language acupuncture studies and presented the pooled estimates as odds ratios (OR) with 95% confidence interval (CI). We calculated the Ratio of ORs (ROR) by dividing the OR of the Chinese-language trials by the OR of the non-Chinese-language trials, and the ROR by dividing the OR of trials addressing Chinese population by the OR of trials addressing non-Chinese population. We explored whether the impact of a high risk of bias on the effect size differed between studies published in Chinese- and in non-Chinese-language, and whether the treatment effects of acupuncture differed between Chinese and non-Chinese population. RESULTS We identified 84 Cochrane acupuncture reviews involving 33 Cochrane groups, of which 31 reviews (37%) searched Chinese databases. Searching versus not searching Chinese databases significantly increased the contribution of Chinese-language literature both to the total number of included trials (54% vs. 15%) and the sample size (40% vs. 15%). When compared with non-Chinese-language trials, Chinese-language trials were associated with a larger effect size (pooled ROR 0.51, 95% CI 0.29 to 0.91). We also observed a higher risk of bias in Chinese-language trials in blinding of participants and personnel (97% vs. 51%) and blinding of outcome assessment (93% vs. 47%). The higher risk of bias was associated with a larger effect estimate in both Chinese-language (allocation concealment: high/unclear risk vs. low risk, ROR 0.43, 95% CI 0.21 to 0.87) and non-Chinese-language studies (blinding of participants and personnel: high/unclear risk vs. low risk, ROR 0.41, 95% CI 0.23 to 0.74). However, we found no evidence that the higher risk of bias would increase the effect size of acupuncture in Chinese-language studies more often than in non-Chinese-language studies (the confidence intervals of all ROR in the high-risk group included 1, Table 3). We further found acupuncture appeared to be more effective in Chinese than in non-Chinese population (Table 4). CONCLUSIONS The findings of this study suggest the higher risk of bias may lead to an overestimation of the treatment effects of acupuncture but would not increase the treatment effects in Chinese-language studies more often than in other language studies. The difference in treatment effects of acupuncture was probably associated with differences in population characteristics. TRIAL REGISTRATION We registered our protocol on the Open Science Framework (OSF) ( https://doi.org/10.17605/OSF.IO/PZ6XR ).
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Affiliation(s)
- Jing Li
- Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xu Hui
- Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Health Research Methodology, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Anya Shi
- Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Peijing Yan
- West China school of public health, Sichuan university, Chengdu, China
| | - Yuan Yao
- First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Qi Wang
- Health Research Methodology, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Health Policy PhD Program and McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Yanfang Ma
- School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Center, Hong Kong Baptist University, Hong Kong, China
- Chinese EQUATOR Centre, Hong Kong, China
| | - Dang Wei
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lei Lan
- School of Acupuncture, Moxibustion and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lingxiao Chen
- Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Lijiao Yan
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fang Fang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huijuan Li
- School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Center, Hong Kong Baptist University, Hong Kong, China
| | - Xiaowen Feng
- Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jingxi Wu
- First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yifan Qiao
- Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wenhao Zhang
- First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Janne Esill
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Global Health, University of Geneva, Geneva, Sweden
| | - Chengdong Qiao
- The First Hospital of Lanzhou University, Lanzhou, China.
| | - Kehu Yang
- Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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Voss ME, Sandquist L, Otremba K, Kreitzer MJ. Integrative Nursing: A Framework for Whole-Person Mental Health Care. Creat Nurs 2023; 29:23-41. [PMID: 37551004 DOI: 10.1177/107845352202900112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The incidence of mental illness continues to increase since the start of the COVID-19 pandemic (Mental Health America, 2022). Demand for mental health services has grown, and providers report being "unable to meet the demand" or having an increase in wait times for access to care (American Psychological Association, 2022, para. 1). Due to this increase in demand, more patients are seeking mental health care from their primary care providers. Over the past decade, integrative models of care have been expanding into mental health care (Lake, 2017). Integrative Nursing is a strategy for improving the quality of care provided to patients seeking care for mental health diagnoses, as well as those with a goal of increasing mental health and wellbeing. This article proposes that Integrative Nursing can serve as a framework for providing whole-person mental health care.
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Affiliation(s)
- Megan E Voss
- Earl E. Bakken Center for Spirituality & Healing and School of Nursing at the University of Minnesota in Minneapolis, Minnesota, US
| | - Laura Sandquist
- Penny George Institute for Health and Healing at Allina Health in Minneapolis, Minnesota, US
| | - Kate Otremba
- Penny George Institute for Health and Healing at Allina Health in Minneapolis, Minnesota, US
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing and School of Nursing at the University of Minnesota in Minneapolis, Minnesota, US
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Chen H, Jann K, Li Y, Huang J, Chen Y, Kang Y, Gong Z, Huang Y, Wang H, Zhan S, Tan W. A true response of the brain network during electroacupuncture stimulation at scalp acupoints: An fMRI with simultaneous EAS study. Brain Behav 2023; 13:e2829. [PMID: 36427258 PMCID: PMC9847615 DOI: 10.1002/brb3.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/23/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore simultaneous brain network responses to electroacupuncture stimulation (EAS) at scalp acupoints by accounting for placebo effects. MATERIALS AND METHODS Sixty healthy subjects were recruited and randomly divided into two groups: Group 1 and Group 2. Functional magnetic resonance imaging (fMRI) was performed in Group 1 with sham acupuncture stimulation at acupoints Shenting (GV24) and Touwei (ST8) without EAS. Group 2 underwent verum EAS at the same acupoints during fMRI. Independent component analysis was used to analyze the fMRI data. Full-factor statistical analysis was used to compare the differences in fMRI data between the two groups and evaluate the changes in functional connectivity in brain networks after verum electrical stimulation (Group 1 [after sham electrical current stimulation - before sham electrical current stimulation] - Group 2 [after verum electrical current stimulation - before verum electrical current stimulation]) (p <.001, extent threshold k = 20 voxels). RESULTS Six brain networks were identified. Significant increased functional connectivity was observed in the right and left executive control networks, sensorimotor network, and attention network, while decreased functional connectivity was mainly found in the default mode network. There were no statistically significant differences in the salience network. CONCLUSIONS fMRI with simultaneous EAS provides a method to explore brain network responses due to EAS at scalp acupoints. The networks responsible for cognition are differentially activated by EAS in a coordinated manner.
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Affiliation(s)
- Hui Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Kay Jann
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Yijing Li
- Department of Acupuncture, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Jiling Huang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Yilei Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Yingjie Kang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Zhigang Gong
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Yanwen Huang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Hui Wang
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Songhua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Wenli Tan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
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Allen J, Mak SS, Begashaw M, Larkin J, Miake-Lye I, Beroes-Severin J, Olson J, Shekelle PG. Use of Acupuncture for Adult Health Conditions, 2013 to 2021: A Systematic Review. JAMA Netw Open 2022; 5:e2243665. [PMID: 36416820 PMCID: PMC9685495 DOI: 10.1001/jamanetworkopen.2022.43665] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Acupuncture is a popular treatment that has been advocated for dozens of adult health conditions and has a vast evidence base. OBJECTIVE To map the systematic reviews, conclusions, and certainty or quality of evidence for outcomes of acupuncture as a treatment for adult health conditions. EVIDENCE REVIEW Computerized search of PubMed and 4 other databases from 2013 to 2021. Systematic reviews of acupuncture (whole body, auricular, or electroacupuncture) for adult health conditions that formally rated the certainty, quality, or strength of evidence for conclusions. Studies of acupressure, fire acupuncture, laser acupuncture, or traditional Chinese medicine without mention of acupuncture were excluded. Health condition, number of included studies, type of acupuncture, type of comparison group, conclusions, and certainty or quality of evidence. Reviews with at least 1 conclusion rated as high-certainty evidence, reviews with at least 1 conclusion rated as moderate-certainty evidence, and reviews with all conclusions rated as low- or very low-certainty evidence; full list of all conclusions and certainty of evidence. FINDINGS A total of 434 systematic reviews of acupuncture for adult health conditions were found; of these, 127 reviews used a formal method to rate certainty or quality of evidence of their conclusions, and 82 reviews were mapped, covering 56 health conditions. Across these, there were 4 conclusions that were rated as high-certainty evidence, and 31 conclusions that were rated as moderate-certainty evidence. All remaining conclusions (>60) were rated as low- or very low-certainty evidence. Approximately 10% of conclusions rated as high or moderate-certainty were that acupuncture was no better than the comparator treatment, and approximately 75% of high- or moderate-certainty evidence conclusions were about acupuncture compared with a sham or no treatment. CONCLUSIONS AND RELEVANCE Despite a vast number of randomized trials, systematic reviews of acupuncture for adult health conditions have rated only a minority of conclusions as high- or moderate-certainty evidence, and most of these were about comparisons with sham treatment or had conclusions of no benefit of acupuncture. Conclusions with moderate or high-certainty evidence that acupuncture is superior to other active therapies were rare.
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Affiliation(s)
- Jennifer Allen
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | - Selene S. Mak
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | - Meron Begashaw
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Isomi Miake-Lye
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
- UCLA School of Public Health, Los Angeles, California
| | - Jessica Beroes-Severin
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
| | - Juli Olson
- Veterans Health Administration, Central Iowa Heathcare System, Des Moines
| | - Paul G. Shekelle
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California
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Kruger THC, Schulze J, Bechinie A, Neumann I, Jung S, Sperling C, Engel J, Müller A, Kneer J, Kahl KG, Karst M, Herrmann J, Fournier-Kaiser L, Peters L, Jürgensen F, Nagel M, Prager W, Dulz B, Wohlmuth P, Heßelmann V, Sinke C, Wollmer MA. Neuronal effects of glabellar botulinum toxin injections using a valenced inhibition task in borderline personality disorder. Sci Rep 2022; 12:14197. [PMID: 35987909 PMCID: PMC9392726 DOI: 10.1038/s41598-022-17509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Previous studies have indicated that glabellar botulinum toxin (BTX) injections may lead to a sustained alleviation of depression. This may be accomplished by the disruption of a facial feedback loop, which potentially mitigates the experience of negative emotions. Accordingly, glabellar BTX injection can attenuate amygdala activity in response to emotional stimuli. A prototypic condition with an excess of negative emotionality and impulsivity accompanied by elevated amygdala reactivity to emotional stimuli is borderline personality disorder (BPD). In order to improve the understanding of how glabellar BTX may affect the processing of emotional stimuli and impulsivity, we conducted a functional magnetic resonance imaging (fMRI) study. Our hypotheses were (1) glabellar BTX leads to increased activation in prefrontal areas during inhibition performance and (2) BTX decreases amygdala activity during the processing of emotional stimuli in general. Using an emotional go-/no-go paradigm during fMRI, the interference of emotion processing and impulsivity in a sample of n = 45 women with BPD was assessed. Subjects were randomly assigned to BTX treatment or serial acupuncture (ACU) of the head. After 4 weeks, both treatments led to a reduction in the symptoms of BPD. However, BTX treatment was specifically associated with improved inhibition performance and increased activity in the motor cortex. In addition, the processing of negative emotional faces was accompanied by a reduction in right amygdala activity. This study provides the first evidence that glabellar BTX injections may modify central neurobiological and behavioural aspects of BPD. Since the control treatment produced similar clinical effects, these neurobiological findings may be specific to BTX and not a general correlate of symptomatic improvement.
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7
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Dai Z, Liao X, Wieland LS, Hu J, Wang Y, Kim TH, Liu JP, Zhan S, Robinson N. Cochrane systematic reviews on traditional Chinese medicine: What matters-the quantity or quality of evidence? PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 98:153921. [PMID: 35104758 PMCID: PMC9741948 DOI: 10.1016/j.phymed.2021.153921] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Systematic reviews on traditional Chinese medicine (TCM) are constantly increasing. However, if these reviews are to be of practical value, the evidence needs to be relevant, valid, and adequately reported. Cochrane Systematic Reviews (CSRs) are considered as high-quality systematic reviews that can inform health care decision making. Our aim was to provide an overview of the scope, findings, quality and impact of CSRs on the benefits and harms associated with TCM interventions for the treatment and prevention of disease to provide new information for clinical practice and future research. METHODS The Cochrane Database of Systematic Reviews was searched up to May 2021, and descriptive characteristics were extracted. The correspondence between the questions asked in the CSRs and the available evidence, conclusions and certainty of findings (according to GRADE assessment), methodological quality (AMSTAR 2), and impact (Altmetric Attention Score [AAS], total citations by guideline, and total citations in Web of Science [WoS]) of CSRs were extracted. Tabular and graphical summaries of these descriptive characteristics were constructed. RESULTS Of 104 CSRs on TCM identified, 70 diseases belonged to 16 disease systems and contained 1642 primary studies with 157,943 participants. Interventions included Chinese herbal medicine (n = 70), acupuncture (n = 28), TCM exercises (n = 4), and moxibustion (n = 2). Among 1642 primary studies, 662 studies included an intervention group treated with at least one TCM therapy and 980 studies included a combination of therapies. Promising outcomes from the 104 CSRs were divided into endpoint outcomes (34 diseases), doctor- or patient-reported outcomes (27 diseases), and surrogate outcomes (37 diseases). Despite the presence of promising outcomes, only 5/104 CSRs drew overall positive conclusions, 42 CSRs concluded the evidence was insufficient, and 54 failed to draw firm conclusions. GRADE assessments were reported in 41.3% of the CSRs, and the ratings were mostly low or very low. Comparing the questions asked and results obtained, there was frequently a lack of information about specific outcomes. Only 16 CSRs obtained results for all outcomes listed in the methods section. According to AMSTAR 2, 51 CSRs (49.0%) were of low quality. The total number of citations in the WoS was 2135 (mean ± SD: 20.8 ± 21.2), and 38.5% of the CSRs had been cited in guidelines 95 times. CONCLUSION Although TCM is commonly used, evidence of its effectiveness remains largely inconclusive. Rigorous high-quality trials are needed to support the performance of high-quality reviews and to increase the evidence base. It is critical to emphasize quality over quantity in future TCM research.
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Affiliation(s)
- Zeqi Dai
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China; China Center for Evidence Based Traditional Chinese Medicine, Beijing 100700, China
| | - Xing Liao
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - L Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore MD 21201, USA
| | - Jing Hu
- Evidence-based Medicine Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China
| | - Yongyan Wang
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, #23 Kyungheedae-ro, Dondaemun-gu, Seoul 02447, South Korea
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China.
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.5 Yiheyuan Road, Haidian District, Beijing 100191, China.
| | - Nicola Robinson
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China; Institute of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK.
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8
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Dong H, Qin YQ, Sun YC, Yao HJ, Cheng XK, Yu Y, Lu SS. Electroacupuncture Ameliorates Depressive-Like Behaviors in Poststroke Rats via Activating the tPA/BDNF/TrkB Pathway. Neuropsychiatr Dis Treat 2021; 17:1057-1067. [PMID: 33880028 PMCID: PMC8053498 DOI: 10.2147/ndt.s298540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/22/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Electroacupuncture (EA) is a form of physical therapy that has been widely used in clinical practice in China. Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke. EA has been shown to have beneficial effects on PSD patients. However, the potential mechanism underlying the protective effects of EA on PSD remains unclear. Here, we investigated whether tissue plasminogen activator (tPA)/brain-derived neurotrophic factor (BDNF)/tyrosine kinase receptor B (TrkB) signaling pathway participates in the therapeutic effects of EA in a rat PSD model. METHODS Experimental PSD was induced by combining middle cerebral artery occlusion (MCAO) with chronic unpredictable mild stimulation (CUMS) in adult male rats. Bodyweight gain, neurological score, sucrose preference, and open field test were determined at 0, 7, 14, and 35 days after completing MCAO. The protein expressions of tPA, precursor BDNF (proBDNF), mature BDNF (mBDNF), and TrkB were measured by immunofluorescence and Western blot analysis. The tPA inhibitor plasminogen inhibitor-1 (PAI-1) was used to explore whether tPA plays a crucial role in the protective effects of EA on PSD. RESULTS Compared with the sham rats, the PSD rats showed decreased bodyweight, deteriorated neurological score, and significant depressive-like behaviors. EA remarkably reversed bodyweight loss, neurological deficit, and depressive-like behaviors in PSD rats. Immunofluorescence staining and Western blot analysis showed that PSD-induced decreased expression of tPA, mBDNF, and TrkB were prevented by EA. Furthermore, we found that the effects of EA against PSD-induced depressive-like behaviors were abolished by PAI-1, the specific inhibitor of tPA. CONCLUSION Our results suggest that the improvement in depressive-like behaviors induced by EA is likely achieved via activation of the tPA/BDNF/TrkB pathway.
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Affiliation(s)
- Hao Dong
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, Beijing, People's Republic of China
| | - Yan-Qiang Qin
- Treatment Center of TCM, Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Ying-Chun Sun
- Treatment Center of TCM, Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Hai-Jiang Yao
- Treatment Center of TCM, Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Xian-Kuan Cheng
- Treatment Center of TCM, Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Yan Yu
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, Beijing, People's Republic of China
| | - Shou-Si Lu
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, Beijing, People's Republic of China
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9
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Ji Z, Zhang J, Menniti-Ippolito F, Massari M, Fauci AJ, Li N, Yang F, Zhang M. The quality of Cochrane systematic reviews of acupuncture: an overview. BMC Complement Med Ther 2020; 20:307. [PMID: 33054785 PMCID: PMC7556594 DOI: 10.1186/s12906-020-03099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background Many systematic reviews of clinical trials on acupuncture were performed within the Cochrane Collaboration, the evidence-based medicine (EBM) most recognized organization. Objective of the article was to systematically collect and identify systematic reviews of acupuncture published in the Cochrane Library and assess their quality from a methodological perspective. Methods A comprehensive literature search was performed in the Cochrane Database of Systematic Reviews to identify the reviews of acupuncture conducted until June 2019. The methodological quality of the included reviews was assessed using the AMSTAR 2 checklist, an evaluation tool for systematic reviews. Results Out of a total of 126 eligible reviews, 50 systematic reviews were included. According to the AMSTAR 2, 52% of Cochrane Systematic Reviews (CSRs) were of low quality, due to the presence of one or more weaknesses in at least one of the domains defined as critical for the methodological quality assessment. The less satisfied critical domain was inadequate investigation and discussion of publication bias. Declaration of potential sources of conflict of interest, and funding of the authors of the review and of the included studies were other important weaknesses. Conclusions The main methodological flaws in the included CSRs were related to topics of relatively new concern in the conduction of systematic reviews of the literature. However, both, lack of attention about retrieval of negative studies, and statements about conflict of interests are crucial point for the evaluation of therapeutic interventions according to EBM methodology.
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Affiliation(s)
- Zhaochen Ji
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | | | | | | | - Na Li
- School of Social and Political Sciences, Institute of health and wellbeing, University of Glasgow, Glasgow, UK
| | - Fengwen Yang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mingyan Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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10
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Jia J, Shen J, Liu FH, Wong HK, Yang XJ, Wu QJ, Zhang H, Wang HN, Tan QR, Zhang ZJ. Effectiveness of Electroacupuncture and Electroconvulsive Therapy as Additional Treatment in Hospitalized Patients With Schizophrenia: A Retrospective Controlled Study. Front Psychol 2019; 10:2306. [PMID: 31681100 PMCID: PMC6804524 DOI: 10.3389/fpsyg.2019.02306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/27/2019] [Indexed: 12/18/2022] Open
Abstract
Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA + ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per week, respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA + ECT groups had markedly greater clinical response rate than controls on SAPS [72.7 and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3 and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% vs. 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia. Clinical Trial Registration: http://www.chictr.org.cn/showprojen.aspx?proj=38901, identifier ChiCTR1900023563.
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Affiliation(s)
- Jie Jia
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Jun Shen
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Fei-Hu Liu
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Hei Kiu Wong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xin-Jing Yang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Qiang-Ju Wu
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Hui Zhang
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Qing-Rong Tan
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhang-Jin Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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11
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van den Noort M, Yeo S, Lim S, Lee SH, Staudte H, Bosch P. Acupuncture as Add-On Treatment of the Positive, Negative, and Cognitive Symptoms of Patients with Schizophrenia: A Systematic Review. MEDICINES (BASEL, SWITZERLAND) 2018; 5:E29. [PMID: 29601477 PMCID: PMC6023351 DOI: 10.3390/medicines5020029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/01/2023]
Abstract
Background: Schizophrenia is a severe psychiatric disorder that has a large impact on patients' lives. In addition to Western medicine, the use of additional treatments, such as acupuncture, in treating the positive, negative, and cognitive symptoms is increasing. Methods: We conducted a systematic review on the use of acupuncture as an add-on treatment for patients with schizophrenia that are in regular care, with a special focus on the treatment of the often accompanying sleep disorders. In this study, we searched the Medline, ScienceDirect, Cochrane Library, Scopus, and ERIC databases with a cut-off date of 31 December 2017, thereby following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. Results: Our search resulted in 26 eligible studies with 1181 patients with schizophrenia who received acupuncture treatment. Most studies showed limited evidence for the use of acupuncture as add-on therapy in the treatment of the positive, negative, and cognitive symptoms, but beneficial effects have been reported in the treatment of the accompanying sleep disorders. Conclusions: Limited evidence was found for the use of acupuncture as add-on therapy in the treatment of patients with schizophrenia; however, positive results were found in the treatment of sleep disorders, but this result needs to be confirmed in large, randomized, controlled trials.
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Affiliation(s)
- Maurits van den Noort
- Research Group of Pain and Neuroscience, Kyung Hee University, Seoul 130-701, Korea.
- Brussels Institute for Applied Linguistics, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
| | - Sujung Yeo
- College of Oriental Medicine, Sang Ji University, Wonju 26339, Korea.
| | - Sabina Lim
- Research Group of Pain and Neuroscience, Kyung Hee University, Seoul 130-701, Korea.
| | - Sook-Hyun Lee
- Research Group of Pain and Neuroscience, Kyung Hee University, Seoul 130-701, Korea.
| | - Heike Staudte
- Psychiatric Research Group, LVR-Klinik Bedburg-Hau, 47511 Bedburg-Hau, Germany.
| | - Peggy Bosch
- Psychiatric Research Group, LVR-Klinik Bedburg-Hau, 47511 Bedburg-Hau, Germany.
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 Nijmegen, The Netherlands.
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12
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Fang JF, Du JY, Shao XM, Fang JQ, Liu Z. Effect of Electroacupuncture on the NTS is modulated primarily by acupuncture point selection and stimulation frequency in normal rats. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:182. [PMID: 28359336 PMCID: PMC5374564 DOI: 10.1186/s12906-017-1690-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/15/2017] [Indexed: 12/16/2022]
Abstract
Background The effect of electroacupuncture (EA) is affected by both the acupuncture point selection and the frequency of stimulation. However, little is known regarding acupuncture point and simulation frequency selection. Neuronal activation of the nucleus of the solitary tract (NTS) is one of the important targets of EA for modulating gastrointestinal function. This study investigated the effects of various combinations of EA frequencies and acupuncture points on NTS neurons. Methods Rats were randomly divided into normal, 2 Hz EA, 100 Hz EA and the alternate 2/100 Hz EA groups. Then rats in each group were randomly divided into the following two subgroups according to the acupuncture point: ST 36 group and ST 25 group. All the rats underwent electrode implantation surgery. Rats in all EA groups received one treatment with EA (a constant square wave at, 2 Hz,100 Hz or 2/100 Hz frequencies with intensities ranging from 1 to 2 mA), and NTS neuronal activation was recorded before and after EA treatment. Finally, to confirm the effect of EA on the NTS, minimal acupuncture was administered and its effect on NTS was detected. Results ST 36 stimulated with 2 Hz EA significantly increased the population of excited NTS neurons and spike frequency. However, ST 36 stimulated with 100 Hz or 2/100 Hz EA produced only a transient effect on the activity of NTS neurons and did not induce any effect on the spike frequency. Furthermore, the excitatory effect of 100 Hz or 2/100 Hz EA on NTS neurons in the ST 36 group was lower than 2 Hz EA at the same point. When applied to ST 25, 2 Hz EA had no significant excitatory effect on NTS neurons or spike frequency. However, 100 Hz EA or 2/100 Hz EA at ST 25 decreased both NTS neuronal excitability and spike frequency. By comparing the effects of different EA combinations, it was shown 2 Hz EA applied to ST 36 had the strongest excitatory effect on NTS neurons, while 100 Hz EA applied to ST 25 had the greatest inhibitory effect. Minimal acupuncture stimulation produced no effect on NTS neurons. Conclusion EA’s effects on NTS were mainly affected by the acupuncture point selection, but the frequency of EA also played a role. Different combinations of acupuncture points and frequency selection may lead to different EA effects on NTS neuronal excitability.
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13
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Deng H, Adams CE. Traditional Chinese medicine for schizophrenia: A survey of randomized trials. Asia Pac Psychiatry 2017; 9. [PMID: 27734592 DOI: 10.1111/appy.12265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To survey the reports of randomized trials of traditional Chinese medicine (TCM) interventions for schizophrenia and produce a broad overview of this type of research activity in this area. METHOD We searched the Cochrane Schizophrenia Group's comprehensive Trials Register (January 2016), selected all relevant randomized trials, and extracted the data within each study. Finally, we sought relevant reviews on the Cochrane Library. RESULTS We initially screened 423 articles from which we identified 378 relevant studies randomizing 35 341 participants (average study size 94, SD 60). There were 7 herbs used as single medicine, 4 compositions or extractions, more than 144 herbal mixes, and 7 TCM principles reported for schizophrenia. Nonpharmacological interventions of TCM included acupuncture and exercise. The most commonly evaluated treatments are Ginkgo biloba, acupuncture, Wendan decoction, and Shugan Jieyu Capsule. There are 3 directly relevant Cochrane reviews. CONCLUSIONS Most treatment approaches-and some in common use-have only one or two relevant small trials. Some coordination of effort would help ensure that further well-designed appropriately sized randomized trials are conducted. Systematic reviews should be performed in this field but with titles that take into account the complexity of TCM.
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Affiliation(s)
- Hongyong Deng
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Clive E Adams
- Cochrane Schizophrenia Group, Institute of Mental Health, University of Nottingham, Nottingham, UK
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14
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The Relationship between Body Weight Change and Body Constitutions of Traditional Chinese Medicine in Patients with Schizophrenia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:9585968. [PMID: 27818703 PMCID: PMC5081436 DOI: 10.1155/2016/9585968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/16/2016] [Accepted: 09/21/2016] [Indexed: 01/09/2023]
Abstract
Objective. To explore the relationship between body constitution (BC) types and weight change in patients with schizophrenia and who underwent second-generation antipsychotics (SGAs) treatment. Method. Body weight and waist circumference of eighty-five participants were measured for 6 consecutive weeks. Constitutions of Yin-Xu, Yang-Xu, and Stasis were assessed using the Body Constitution Questionnaire (BCQ). Results. Participants with body constitutions Yin-Xu (50.6%), Yang-Xu (49.4%), or Stasis (38.8%) exhibited worse physical condition and unhealthy daily habits, particularly in Stasis constitution. Moreover, Stasis constitution was significantly associated with several factors, including BMI, body weight, waist circumference, perception of stress, perception of health, staying up late, and less physical exercise. However, perception of stress showed significant difference in Yin-Xu, Yang-Xu, and Stasis. Generalized estimating equation (GEE) analysis revealed that significant time effects in body weight increase in the imbalanced BC types and gentleness BC type. SGAs induced weight gain in imbalanced BC type as well as gentleness BC type, especially treated with olanzapine. Conclusions. This is the first study to explore the longitudinal relationship between BC and weight gain in schizophrenia patients undergoing SGAs treatment. Health care providers should focus on weight gain problems in schizophrenia patients who underwent SGAs treatment.
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15
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Abstract
BACKGROUND Acupuncture, with many categories such as traditional acupuncture, electroacupuncture, laser acupuncture, and acupoint injection, has been shown to be relatively safe with few adverse effects. It is accessible and inexpensive, at least in China, and is likely to be widely used there for psychotic symptoms. OBJECTIVES To review the effects of acupuncture, alone or in combination treatments compared with placebo (or no treatment) or any other treatments for people with schizophrenia or related psychoses. Search Methods We searched the Cochrane Schizophrenia Group Trials Register (February 2012) and inspected references of all identified studies. We contacted relevant authors for additional information. SELECTION CRITERIA We included all relevant randomized controlled trials involving people with schizophrenia-like illnesses, comparing acupuncture added to standard dose antipsychotics with standard dose antipsychotics alone, acupuncture added to low dose antipsychotics with standard dose antipsychotics, acupuncture with antipsychotics, acupuncture added to traditional chinese medicine (TCM) drug with TCM drug, acupuncture with TCM drug, electric acupuncture convulsive therapy with electroconvulsive therapy.
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Affiliation(s)
- Xiaohong Shen
- Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Xia
- Systematic Review Solutions Ltd, Nottingham, UK;
| | - Clive Adams
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
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