The Effects of Acupuncture Treatment on Sleep Quality and on Emotional Measures among Individuals Living with Schizophrenia: A Pilot Study

Assessing a Training Program for Integrative Medicine Practitioners in the Treatment of Acute Stress Disorder

STUDY OBJECTIVE

The study examined a training program for integrative medicine (IM) providers, teaching clinical skills for treating acute stress disorder (ASD).

METHODS

A 10-h online training program, designed by IM and mental health professionals, was attended by a group of 32 IM providers working in supportive and palliative oncology care. Pre- and post-course questionnaires assessed self-perceived levels of IM and mental health ASD-related skills (from 1, very low; to 7, very high).

RESULTS

Most participants (25; 78%) completed pre- and post-study questionnaires, which showed an increase in post-course scores for the expectation that IM could reduce ASD-related pain (p = 0.004). Scores for self-assessed skill levels increased for treating gastro-intestinal symptoms and appetite (p = 0.039) and for dyspnea (p = 0.048). A borderline increase for arousal was observed (p = 0.063), with no increase with other arousal symptom cluster symptoms.

CONCLUSIONS

The ASD-focused training program for IM practitioners was associated with an increase in self-perceived levels for related clinical skills quality of life-related concerns, primarily pain, appetite and dyspnea. Further research is needed to better understand the implications of the findings, and to explore the implementation of the learned skills in clinical practice.

Cross-Cultural Patient Counseling and Communication in the Integrative Medicine Setting: Respecting the Patient's Health Belief Model of Care

PURPOSE OF REVIEW

Communicating effectively with patients having a traditional, alternative or complementary medicine-related health-belief model is challenging in today's cross-cultural society. This narrative review explores the integrative medicine setting of care, focusing on insights from the integrative oncology daily practice, while addressing the relevance to the mental health setting. The way in which healthcare providers can enhance cultural-sensitive communication with patients and informal caregivers; recognize and respect health-beliefs to bridge cultural gaps; and generate an open, non-judgmental and mindful dialogue are discussed.

RECENT FINDINGS

Identifying cross-cultural barriers to healthcare provider-patient communication is important in order to address the potential for conflict between conventional and "alternative" health beliefs; difficulties in creating a shared-decision making process; disagreement on therapeutic goals and treatment plan; and finally, the potential for non-compliance or non-adherence to the conventional oncology treatment. Acquiring intercultural competencies is needed at all stages of medical education, and should be implemented in medical and nursing curricula, as well as during specialization and sub-specialization. As with patient-centered paradigms of care, integrative medicine entails a dual patient-centered and sensitive-cultural approach, based on a comprehensive bio-psycho-social-spiritual model of care.

Anxiolytic and antidepressants' effect of Crataegus pinnatifida (Shan Zha): biochemical mechanisms

Depression and anxiety disorders are highly prevalent. Selective serotonin reuptake inhibitors (SSRIs) are the current first-line treatment for depression, but they have pronounced limitations. Traditional Chinese medicine can serve as a safe and effective alternative to conventional drugs, particularly since many herbal remedies have already been approved for human use as food additives, making the transition from bench to bedside more efficient. We previously demonstrated that a novel herbal treatment (NHT) induces anxiolytic- and antidepressant-like effects. NHT consists of four herbs: Crataegus pinnatifida (Shan Zha), Triticum aestivum (Fu Xiao Mai), Lilium brownii (Baihe), and the fruit of Ziziphus jujuba (Da Zao). In the current study, we examined the antidepressant-like and anxiolytic-like activities of each individual herb on stressed mice and compared those to the effects of NHT and escitalopram. We show here that Shan Zha is sufficient to produce an anxiolytic and antidepressant-like effect similar to NHT or the escitalopram through activation of 5-HT1A receptor and an elevation in BDNF levels in the hippocampus and Pre-frontal cortex (PFC). Chronic treatment with Shan Zha did not alter serotonin transporter levels in the PFC, as opposed to escitalopram treatment. These results were confirmed in vitro, as none of the herbs blocked SERT activity in Xenopus oocytes. Notably, Shan Zha is sold as a nutritional supplement; thus, its transition to clinical trials can be easier. Once its efficacy and safety are substantiated, Shan Zha may serve as an alternative to conventional antidepressants.

Pilot and feasibility trials in traditional Chinese medicine: a literature review of current practice

Background

The guidelines for pilot and feasibility studies were published in 2016. Little is known about the guideline adherence of TCM (traditional Chinese medicine) pilot trials or whether the guidelines can significantly enhance the quality of implementation and reporting of TCM pilot trials. We aimed to investigate the guideline adherence, assess the impact of guidelines on TCM pilot trials, and discuss potential challenges specific to TCM pilot trials, by conducting a literature review.

Methods

We systematically searched MEDLINE, EMBASE, and CNKI to retrieve TCM pilot trials. We randomly chose 50 pilot trials from the eligible studies for analyses. The CONSORT extension to pilot and feasibility studies was used as a framework to assess the methodology and reporting quality of the studies.

Results

The included studies had a guideline adherence level ranging from 4 to 96%, where the lowest adherence was found in the item 6c (prespecified criteria used to judge progression to future definitive trial). The guidance published in 2016 seemed to exert minimal effect on guideline adherence in TCM pilot trials. The unidentified issues related to TCM pilot trials from the guidelines included blinding, lack of standard formula of interventions, difficulty in comparison for effect assessment of interventions, and difficulty in bias control.

Conclusions

The current practice in TCM pilot trials required substantial improvement in the literature. Further endeavors are needed for training and dissemination of guideline adherence, and development of more detailed methodology in the field of TCM pilot trials.

Sleep Disturbances and Inflammatory Biomarkers in Schizophrenia: Focus on Sex Differences

OBJECTIVES

Persons with schizophrenia, and women in particular, are at high risk for sleep disturbances and inflammatory activation. The sleep-inflammation link has been reported to be stronger in women within the general population. This study sought to examine the sleep-inflammation link in persons with schizophrenia and its relationship with demographic, clinical and cognitive variables.

DESIGN

Cross-sectional case-control study.

PARTICIPANTS

Community-dwelling outpatients with schizophrenia (N=144, 46% women) and non-psychiatric comparison (NC) participants (N=134, 52% women), age 26-65 years.

MEASUREMENTS

Reported sleep disturbances (sleep quality and duration), and mental and physical health were assessed. Cognitive assessments included executive functioning (Delis-Kaplan Executive Function System) and global cognitive functioning (Telephone Interview for Cognitive Status - modified.) Inflammatory biomarkers included pro-inflammatory cytokines [high sensitivity C-Reactive Protein (hs-CRP), Interleukin (IL)-6, Tumor Necrosis Factor-α (TNF-α)] and an anti-inflammatory cytokine (IL-10).

RESULTS

The schizophrenia group had longer sleep duration, worse sleep quality, and increased levels of hs-CRP, IL-6, and TNF-α compared to NCs. Women with schizophrenia were less likely to have good sleep quality and had elevated levels of hs-CRP and IL-6 compared to men with schizophrenia. In the schizophrenia group, worse sleep quality and global cognitive functioning were associated with higher hs-CRP and IL-6 levels. Female sex and younger age were also associated with higher hs-CRP levels.

CONCLUSIONS

Sleep disturbances and increased inflammation, which were common in schizophrenia, were associated in persons with schizophrenia. Moreover, women with schizophrenia had worse sleep quality and inflammation than men. Further examination of the sleep-inflammation links, their contribution to clinical outcomes, and sex-specific factors is warranted.

Electro-acupuncture improves psychiatric symptoms, anxiety and depression in methamphetamine addicts during abstinence: A randomized controlled trial

BACKGROUND

It aimed to observe the effect of electro-acupuncture on the improvement of psychiatric symptoms, as well as anxiety and depression in methamphetamine (MA) addicts during abstinence using randomized controlled trials.

METHODS

All patients in the present study received compulsory drug detoxification in Shanghai Drug Rehabilitation Center. All patients were enrolled consecutively from June 2014 to February 2015; data collection was completed in March 2015. According to the randomized, single-blind and control principle, 68 men MA addicts were randomly divided into 2 groups: electro-acupuncture (EA) and sham electro-acupuncture (sham-EA) groups. Patients were given 20 minutes EA or sham-EA treatment every Monday, Wednesday, and Friday, with a total of 4 weeks. Positive and Negative Syndrome Scale (PANSS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) were used to evaluate the patients' psychotic symptoms, anxiety and depression before treatment and after receiving treatment with 1 to 4 weeks, respectively.

RESULTS

EA could effectively improve the symptoms of psychosis, anxiety, and depression during abstinence in patients with MA addiction. In terms of PANSS score, the scores for positive symptoms and general psychopathological symptoms in patients after receiving 1 to 4 weeks of treatment were significantly decreased compared with the control group, while the score for negative symptoms was significantly decreased after receiving 2 and 4 weeks of treatment. For the HAMA score, the psychotic anxiety scores in patients receiving 1 to 4 weeks of treatment were significant lower than the control group. In terms of HAMD score, there was a significant reduction in anxiety/somatization and sleep disturbance scores after the 4 weeks of EA treatment.

CONCLUSION

Electroacupuncture helps to improve psychiatric symptoms and anxiety and depression in MA addicts during abstinence, and promote rehabilitation of patients.

Acupuncture as Add-On Treatment of the Positive, Negative, and Cognitive Symptoms of Patients with Schizophrenia: A Systematic Review

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.

Acupuncture in the Treatment of a Female Patient Suffering from Chronic Schizophrenia and Sleep Disorders

Background. The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation. We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The patient was treated with manual acupuncture weekly for 12 weeks, and a psychological assessment was performed before, immediately after, and three months after the acupuncture treatment period. In addition, actiwatch data were collected for 14 days both before and after the acupuncture treatment period. Conclusion. Acupuncture treatment led to a decrease in general psychopathology, less severe sleep problems, and markedly improved cognitive functioning (working memory) in the patient; however, the positive and the negative symptoms remained stable. The actiwatch data revealed a beneficial effect of acupuncture, showing better sleep latency, a trend towards better sleep efficiency, and a decrease in the number of minutes that the patient was awake during the night after acupuncture treatment. In sum, this study showed that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized (placebo), controlled, clinical trials are needed in order to replicate the present preliminary findings.

Serum brain-derived neurotrophic factor levels associate with cognitive improvement in patients with schizophrenia treated with electroacupuncture

Accumulating evidence supports that acupuncture has been successfully used for the treatment of neurological disorders to improve cognitive function. This study was set to evaluate the efficacy of electroacupuncture (EA, using two acupoints: Baihui and Shenting) on clinical symptoms, cognitive function and brain-derived neurotrophic factor (BDNF) levels in patients with schizophrenia. Sixty-one inpatients diagnosed schizophrenia with DSM-IV criteria were recruited. The participants were randomly divided into an experimental group (n=30) and a control group (n=31). The patients were evaluated using the Positive and Negative Symptom Scale (PANSS), the Wisconsin Card Sorting Test (WCST) and Wechsler Memory Scale (WMS) at baseline and after EA treatment. There were no significant differences in the PANSS scores and serum BDNF levels between the experimental group and the control group, either at baseline or at the end of the 4-week study period. However, the EA treatment appeared to have significant benefits on memory and moderate benefits on executive functions and problem solving. Significant positive correlation was observed between the increase of BDNF levels and memory improvement after EA treatment. Our results indicated that EA treatment could improve cognitive function, and the cognitive benefits positively associate with serum BDNF levels in patients with schizophrenia.

Acupuncture for Functional Dyspepsia: A Single Blinded, Randomized, Controlled Trial

In order to investigate the therapeutic potential of acupuncture on patients with functional dyspepsia (FD), patients were randomized to receive acupuncture at classic acupoints with manipulations (treatment group) versus acupuncture at nonacupoints without manipulation (control group) once every other day, three times a week, for one month and were followed up for three months. The primary outcomes included dyspeptic symptoms, quality of life, and mental status. The secondary outcomes included the fasting serum gastrin concentration, and frequency and propagation velocity of gastric slow waves. Sixty patients with FD were included, among whom, four dropped out. After one month's treatment, patients with FD showed significant improvements in primary (in both groups) and secondary (in the eight patients of the treatment group) outcomes as compared with baseline (P = 0.0078 to <0.0001); treatment group has better outcomes in all primary outcome measures (P < 0.0001 except for SDS (P = 0.0005)). Improvements on dyspeptic symptoms persist during follow-up (better in the treatment group). Acupuncture with manual manipulation had better effects on improving dyspeptic symptoms, mental status, and quality of life in patients with FD. These effects may be related to the increased frequency and propagation speed of gastric slow waves and serum gastrin secretion.

Schizophrenia, depression, and sleep disorders: their traditional Oriental medicine equivalents

Psychiatric disorders can be described and treated from both a Western (allopathic) and an Eastern perspective, which should be taken into account when conducting research. Patients with schizophrenia or depression are likely to be undergoing Western treatment when they are referred to an acupuncturist for (add-on) treatment, and knowledge of both types of treatments is necessary to integrate them successfully. In this study, the different Traditional Oriental Medicine (TOM) diagnostic patterns in patients with a Western diagnosis of schizophrenia, depression, or sleep disorders are described from a literature and a clinical perspective. The data on 30 depression and 30 schizophrenia patients from a German study are presented. Our results show that if a psychiatric group, sorted in accordance to Western diagnostic principles, is diagnosed on the basis of TOM diagnostic patterns, it can be categorized into different groups of patients with psychiatric disorders; this finding has far-reaching consequences in scientific research on acupuncture. Moreover, we found a high prevalence of sleep disorders in patients with both schizophrenia and depression, which could be explained from the perspective of a TOM diagnostic pattern. Finally, we discuss sleep quality as a treatment objective that may play a crucial role in mediating acupuncture-induced treatment effects in patients with schizophrenia and depression.