Mental disorders and the use of alternative medicine: results from a national survey

The Mental Health Outcomes and Cost Estimates of Korean Medicine for Anxiety Disorder Patients

Korean medicine (KM) is used to treat anxiety disorders, but there is limited research on its effects. This study aimed to examine the associations between improved QoL and reduced clinical symptoms and KM in patients with anxiety disorders. The medical records of patients with anxiety who were treated with KM (acupuncture, psychotherapy, Chuna therapy, aromatherapy, or herbal medicine) for at least 4 weeks were retrospectively analyzed. Clinical, QoL, and cost outcomes were measured at baseline and at weeks 4 and 12 (Anxiety: State-Trait Anxiety Inventory [STAI X-1 (state), X-2 (trait)], Beck Anxiety Inventory [BAI]; anger: State-Trait Anger Expression Inventory State [STAXI-S (state), T (trait)], Anger Expression Inventory [AXI-K-I (anger-in), AXI-K-O (anger-out), AXI-K-C (anger-control); depression: Beck Depression Inventory-II [BDI II], QoL: QoL-related instruments Euro Quality of Life 5 Dimensions utility score [EQ-5D], Euro QoL Visual Analog Scale [EQ-VAS]). The total costs for each item were calculated in terms of NHIS-covered costs and patients' out-of-pocket costs from the perspective of the healthcare system. The medical records of 67 patients were evaluated. The KM treatments were found to be associated with decreased anxiety (STAI X-1; STAI X-2; BAI, p < 0.0001), depression (BDI-II, p < 0.0001), and anger (AKI-K-I; AKI-K-O, p < 0.05) and increased QoL (EQ-5D; EQ-VAS, p < 0.0001). An average of USD 1360 was paid for the KM treatments for 4 weeks. The study findings suggested that KM may improve clinical symptoms and QoL outcomes in patients with anxiety disorders.

Effect of salidroside on neuroprotection and psychiatric sequelae during the COVID-19 pandemic: A review

The coronavirus disease 2019 (COVID-19) pandemic has affected the mental health of individuals worldwide, and the risk of psychiatric sequelae and consequent mental disorders has increased among the general population, health care workers and patients with COVID-19. Achieving effective and widespread prevention of pandemic-related psychiatric sequelae to protect the mental health of the global population is a serious challenge. Salidroside, as a natural agent, has substantial pharmacological activity and health effects, exerts obvious neuroprotective effects, and may be effective in preventing and treating psychiatric sequelae and mental disorders resulting from stress stemming from the COVID-19 pandemic. Herein, we systematically summarise, analyse and discuss the therapeutic effects of salidroside in the prevention and treatment of psychiatric sequelae as well as its roles in preventing the progression of mental disorders, and fully clarify the potential of salidroside as a widely applicable agent for preventing mental disorders caused by stress; the mechanisms underlying the potential protective effects of salidroside are involved in the regulation of the oxidative stress, neuroinflammation, neural regeneration and cell apoptosis in the brain, the network homeostasis of neurotransmission, HPA axis and cholinergic system, and the improvement of synaptic plasticity. Notably, this review innovatively proposes that salidroside is a potential agent for treating stress-induced health issues during the COVID-19 pandemic and provides scientific evidence and a theoretical basis for the use of natural products to combat the current mental health crisis.

Effects of Aphrodite (an Herbal Compound) on SSRI-Induced Sexual Dysfunctions and Depression in Females with Major Depressive Disorder: Findings from a Randomized Clinical Trial

Background and Objectives: Almost by default, people with major depression disorder (MDD) also report sexual health issues. This holds even more true when sexual dysfunctions are SSRI-induced. Herbal compounds may have the power to counterbalance such sexual dysfunctions, though research is still scarce. Therefore, we assessed females with diagnosed MDD treated with a standard SSRI (sertraline) and reporting SSRI-induced sexual dysfunctions, and we asked whether compared to placebo, Aphrodite (a blend of ginger, saffron, cinnamon, thistle, and Tribulus terrestris) may favorably impact on sexual dysfunctions, and on symptoms of depression, anxiety, and sleep disturbances. Materials and Methods: A total of 41 females (mean age: 35.05 years) with diagnosed MDD, treated with sertraline (a standard SSRI) at therapeutic dosages, and reporting SSRI-induced sexual dysfunction, were randomly assigned either to Aphrodite or to the placebo condition. At baseline and four and eight weeks later (study end), participants completed a series of self-rating questionnaires covering symptoms of sexual dysfunction, depression, anxiety, and sleep complaints. Results: Symptoms of sexual dysfunction, depression, and anxiety decreased over time, but more so in the Aphrodite condition, compared to the placebo condition (significant p-values and large effect sizes). Over time, sleep disturbances decreased irrespective of the study condition. Conclusions: The pattern of results suggests that compared to placebo, Aphrodite appeared to improve symptoms of sexual dysfunction, depression, and anxiety among females with diagnosed MDD and SSRI-induced sexual dysfunction. Further and similar studies should investigate the underlying psychophysiological mechanisms.

Integrative medicine approaches to chronic depression: case studies of the recovery process with a three-step path to recovery and significant cure

OBJECTIVES

The support provided by conventional treatments centered on the administration of medication for chronic or other types of depression is limited. Integrative medicine, which is based on both modern Western medicine and a range of complementary and alternative medicine practices, is patient-centered and promotes natural healing in patients to achieve significant cure. This report focuses on the indications of recovery from depression using integrative medicine, especially homeopathy.

METHODS

Thirty-one patients (9 males and 22 females) with depression underwent homeopathic treatment using various strategies over 3 months, in addition to antidepressants. All patients were diagnosed with Major Depressive Disorders, except bipolar disorders. Three steps were used to model indications of their recovery from depression: reducing difficulties in everyday life, reducing and stopping antidepressants, and reducing and stopping the homeopathic remedies. Patients were considered to have recovered when antidepressants had been stopped for 6 months or more and 3 or more months had passed since homeopathic medicines were stopped.

RESULTS

Of the 31 patients with depression, 13 recovered within 2 years of starting homeopathic treatment, and 11 completely recovered from chronic depression.

CONCLUSIONS

This study suggests that integrative medicine can be a useful strategy for depression, including the use of a three-step strategy for reducing all dependence on clinical treatment. As most patients, especially chronic patients, significantly recovered from depression through homeopathy over 2 years, this model can help understand recovery from depression through integrative medicine.

Integration of hatha yoga and evidence-based psychological treatments for common mental disorders: An evidence map

BACKGROUND

Interest in the use of yoga to enhance engagement with and augment the benefits of psychological treatment has grown. However, a systematic approach to reviewing existing research examining the use of yoga with psychological treatment is lacking.

MATERIALS AND METHODS

This mapping review identified and synthesised research trialling yoga as an integrated or adjunct therapy with evidence-based psychological interventions for the treatment of anxiety, depression, PTSD, and eating disorders.

RESULTS

Overall, the review identified ten published and three unpublished studies, representing either single group or small quasi-experimental research designs.

DISCUSSION

Limited but promising findings were shown for yoga with CBT for anxiety and depression, and the integration of yoga within intensive treatment models for PTSD.

CONCLUSIONS

Future research is encouraged to focus on controlled trials that enable examination of the component effect of yoga when applied with evidence-based psychological treatment and acceptability and feasibility data to further knowledge regarding a role for yoga in clinical practice.

The use of dietary supplements for mental health among the Saudi population: A cross-sectional survey

Introduction

Methods

Results

Conclusion

Kamikihito rescued depressive-like behaviors and hippocampus neurogenesis in chronic restraint stress rats

Background and aim

Substantial evidence suggests the effectiveness of plant-based medicine in stress-related diseases. Kamikihito (KKT), a Japanese traditional herbal medicine (Kampo), has been used for anemia, insomnia, and anxiety. Recent studies revealed its ameliorating effect on cognitive and memory dysfunction in several animal models. We, therefore, determined whether daily supplementation of KKT has an antidepressant-like effect on the stress-induced behavioral and neurological changes in rats.

Experimental procedure

The effect of KKT against the stress-induced changes in anxiety- and depressive-like behaviors and hippocampal neurogenesis were determined using a rat model of chronic restraint stress (CRS). KKT was orally administered daily at 300 or 1000 mg/kg during 21 consecutive days of CRS (6 h/day). The effect of CRS and KKT on physiological parameters, including body weight gain, food/water consumptions, plasma corticosterone (CORT) levels, and percentage of adrenal gland weight to body weight, were firstly measured. Anxiety- and depressive-like behaviors in rats were assessed in the open field test (OFT), sucrose preference test (SPT), and forced swimming test (FST). Hippocampal neurogenesis was determined by immunohistochemistry.

Results and conclusion

CRS for 21 days caused a significant decrease in body weight gain and increase in plasma CORT levels and percentage of adrenal gland weight to body weight, which were rescued by KKT treatment. KKT also suppressed the CRS-induced anxiety- and depressive-like behaviors and impairment of hippocampal neurogenesis. These results suggest that daily treatment of KKT has a protective effect against physiological, neurological, and behavioral changes in a rat model of depression.

Use of Psychics for Stress and Emotional Problems: A Descriptive Survey Comparison with Conventional Providers and Informal Helpers

Conventional mental health treatments do not meet the needs of all who seek help: some consult informal and alternative providers. Researching the use and perceived benefits of these non-conventional sources of help may contribute to understanding help-seeking behavior and inform mental health policy. We explored the experiences of people consulting psychics (a type of alternative provider) for mental health needs, through comparisons with experiences of people consulting conventional and informal providers. An online survey sought feedback on help seeking for stress or emotional problems from 734 adults who had consulted a psychologist or counsellor; doctor or psychiatrist who prescribed medication; friend or family member; or psychic or similar alternative provider. Analyses included descriptive and inferential statistics and content analysis of textual responses. Problems were commonly described in symptom or disorder terminology with considerable overlap across groups. Content analysis of reasons for choice of helper identified four main categories-functional, reasoned, emotional, and passive-which differed significantly across groups (Cramer's V = 0.26), with consulting psychics predominantly a reasoned choice. Ratings of overall effectiveness of help by those consulting psychics were greater than for the three other groups (d = 0.31 to 0.42), with very few adverse outcomes in any group. Help seeking for stress or emotional problems includes consultations with psychics or similar alternative providers, with self-reported outcomes better than for conventional providers. Further research is warranted to establish whether psychic consultations may serve a useful public health function.

Ethnomedicine and neuropsychopharmacology in Mesoamerica

ETHNOPHARMACOLOGICAL RELEVANCE

The burden of disease caused by mental and neurological disorders is increasing globally, to a disproportionate degree in Latin America. In contrast to the many psychoactive plants with a use history in Mesoamerican cultures, the translation to the wider population of knowledge around numerous botanicals used contemporarily by indigenous Mesoamerican societies to treat psychological and neurological disorders did not receive the same attention.

MATERIAL AND METHODS

We used the previously published Mesoamerican Medicinal Plant Database to extract species and associated botanical drugs used as treatments for illnesses associated with the nervous system by Mesoamerican cultures in Belize, Guatemala, and Mexico. With the critical use of published pharmacological literature, the cross-culturally most salient genera are systematically reviewed.

RESULTS

From 2188 plant taxa contained in the database 1324 are used as treatments for illnesses associated with the nervous system. The ethnomedical data was critically confronted with the available biomedical literature for the 58 cross-culturally most salient genera. For a considerable proportion of the frequently used taxa, preclinical data are available, mostly validating ethnomedicinal uses.

CONCLUSION

This quantitative approach facilitates the prioritization of taxa for future pre-clinical, clinical and treatment outcome studies and gives patients, practitioners, and legislators a fundamental framework of evidence, on which to base decisions regarding phytomedicines.

Late-Life Depression: A Narrative Review on Risk Factors and Prevention

After participating in this activity, learners should be better able to:• Identify risk factors for late-life depression• Evaluate strategies to prevent late-life depression ABSTRACT: Late-life depression (LLD) is one of the major sources of morbidity and mortality in the world. Because LLD is related to increased public health burden, excess health care costs and utilization, reduced quality of life, and increased mortality, prevention is a priority. Older adults differ from younger adults with respect to key features, such as their chronicity and lifetime burden of depression and their constellation of comorbidities and risk factors. LLD likely arises from a complex interplay of risk factors, including medical, physiologic, psychosocial, behavioral, and environmental factors. Thus, a comprehensive understanding of LLD risk factors is necessary to inform prevention strategies. In this narrative literature review, we address both the risk architecture of LLD and several potential strategies for prevention. Our description of LLD risk factors and prevention approaches is informed by the framework developed by the National Academy of Medicine (formerly, Institute of Medicine), which includes indicated, selective, and universal approaches to prevention.

Individualized Homeopathic Medicines in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled, Pilot Trial

INTRODUCTION

Evidence favoring homeopathy in generalized anxiety disorder (GAD) remains scarce. The objective of this pilot trial was to test feasibility of a definitive trial in future. We also experimented whether individualized homeopathic medicines (IH) plus psychological counseling (PC) can produce significantly different effects beyond placebo plus PC in the treatment of GAD.

METHODS

A double-blind, randomized, placebo-controlled, parallel arm, pilot trial was conducted on 62 GAD patients at the National Institute of Homoeopathy, India. GAD-7 questionnaire and Hamilton Anxiety Scale (HAM-A) were used as the primary and secondary outcomes, respectively, measured at baseline and 3 months. Patients received either IH plus PC (n = 31) or identical-looking placebo plus PC (n = 31). Intention-to-treat sample was analyzed to detect group differences using unpaired t tests.

RESULTS

Recruitment and retention rates were 56 and 90%, respectively. Mean age was 31.5 years; 56.5% were male. GAD-7 reductions were non-significantly higher in IH than placebo (p = 0.122). Group differences on HAM-A favored IH significantly (p = 0.018). Effect sizes were small to medium. Calcarea carbonica was the most frequently indicated medicine. No serious adverse events happened.

CONCLUSIONS

A small but positive direction of anxiolytic effect was observed favoring homeopathy over placebo. A definitive trial appeared feasible in future.

Traditional and biomedical care pathways for mental well-being in rural Nepal

BACKGROUND

There is increasing access to mental health services in biomedical settings (e.g., primary care and specialty clinics) in low- and middle-income countries. Traditional healing continues to be widely available and used in these settings as well. Our goal was to explore how the general public, traditional healers, and biomedical clinicians perceive the different types of services and make decisions regarding using one or both types of care.

METHODS

We conducted in-depth interviews using a pilot tested semi-structured protocol around the subjects of belief, traditional healers, and seeking care. We conducted 124 interviews comprising 40 traditional healers, 79 general community members, and five physicians. We then performed qualitative analyses according to a grounded theoretical approach.

RESULTS

A majority of the participants endorsed belief in both supernatural and medical causes of illness and sought care exclusively from healers, medical practitioners, and/or both. Our findings also revealed several pathways and barriers to care that were contingent upon patient-, traditional healer-, and medical practitioner-specific attitudes. Notably, a subset of community members duplicated care across multiple, equally-qualified medical providers before seeing a traditional healer and vice versa. In view of this, the majority of our participants stressed the importance of an efficient, medically plural society. Though participants desired a more collaborative model, no consistent proposal emerged on how to bridge traditional and biomedical practices. Instead, participants offered suggestions which comprised three broad categories: (1) biomedical training of traditional healers, (2) two-way referrals between traditional and biomedical providers, and (3) open-dialogue to foster mutual understanding among traditional and biomedical providers.

CONCLUSION

Participants offered several approaches to collaboration between medical providers and traditional healers, however if we compare it to the history of previous attempts, education and understanding between both fields may be the most viable option in low- and middle-income contexts such as Nepal. Further research should expand and investigate opportunities for collaborative learning and/or care across not only Nepal, but other countries with a history of traditional and complimentary medicine.

Complementary and alternative medicine recommendations for depression: a systematic review and assessment of clinical practice guidelines

BACKGROUND

Up to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). The aim of this study was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines for the treatment and/or management of depression in adults using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.

METHODS

A systematic review was conducted to identify depression guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines published by non-profit agencies on treatment of depression for adults were assessed with the AGREE II instrument twice, once for the overall guideline and once for the CAM sections.

RESULTS

From 931 unique search results, 19 guidelines mentioned CAM, of which 16 made CAM recommendations. Scaled domain percentages from highest to lowest were as follows (overall, CAM section): clarity of presentation (87.0, 66.1%), scope and purpose (80.9, 77.6%), stakeholder involvement (62.0, 44.3%), editorial independence (61.6, 61.6%), rigour of development (58.0, 52.0%), and applicability (42.2, 25.4%). Quality varied within and across guidelines. Only 1 of 16 guidelines was recommended without modifications for both its overall and CAM sections by both appraisers.

CONCLUSIONS

There are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression. The quality of guidelines varied within and across guidelines and the quality of CAM recommendations was generally lower than the overall recommendations in the guidelines for all domains except editorial independence. Generally, characteristics of guidelines, including the year of publication and region of development varied across the guidelines irrespective of quality. Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide.

Complementary and alternative therapies for post-traumatic stress disorder: A protocol for systematic review and network meta-analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a psychiatric disorder. While bringing psychologic pain to patients, it also damages their social function, which is a great threat to people's life and health. Complementary and alternative medicine (CAM) therapies have been used clinically to treat PTSD; however, the selection strategies of different CAM interventions in clinical practice is still uncertain, and the purpose of this study is to evaluate the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis.

METHODS

According to the strategy, the authors will retrieve a total of 7 electronic databases by June 2020. After a series of screening, the 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from randomized controlled trials of CAM therapies for the PTSD. Finally, the evidence grade of the results will be evaluated.

RESULTS

This study will provide a reliable evidence for the selection of CAM therapies for PTSD.

CONCLUSION

The results of this study will provide references for evaluating the influence of different CAM therapies for PTSD, and provide decision-making references for clinical research.

The global use of diverse medical systems

In 1969, anthropologist Irwin Press introduced the concept of dual use in an attempt to lay to rest the idea that individuals in the real world must choose between allopathic and alternative systems. While providers of medical traditions have a vested interest in seeing the public use one system exclusively, individuals do not. Yet, utilization research generally follows a bifurcated research agenda. thwarting our understanding of how the population uses health care resources. Here, we frame a global analysis of individuals' yearly use of different medical systems. Using the Network Episode Model (NEM), we shift the focus to patterns of care and lay out seven hypotheses, testing whether socio-demographic, cultural, access and health factors are associated with use of one, another, or both system. Data from the 2011 International Social Survey Program's Health Module, reveals that the use of alternative systems alone has virtually disappeared as a pattern of care while dual use remains relevant. Using multilevel models to take into account country differences, we find that being older or younger (i.e., curvilinear effect), female, out-group member, employed, unsatisfied with last allopathic visit; or, reporting barriers to allopathic options, chronic illness, poor health, or positive assessment of alternative options are associated with dual use. Education, income, rural residence, or reporting sufficient insurance coverage are insignificant. Thus, nearly all hypotheses reveal the complexity of contemporary utilization behavior.

Blood pressure-reducing activity of Gongronema latifolium Benth. (Apocynaeceae) and the identification of its main phytochemicals by UHPLC Q-Orbitrap mass spectrometry

Background Gongronema latifolium Benth. (family Apocynaceae) leaves (GL) has interesting medicinal properties. The effects of extracts from G. latifolium on blood pressure (BP) and the possible mechanisms of action were also investigated. Methods The ultrahigh resolution liquid chromatography orbitrap MS analysis was used to identify the phytochemicals present. Normotensive Wistar rats were anesthetized with sodium pentobarbitone (40 mg/kg) intraperitoneally, and the jugular vein was cannulated for infusion of drugs while the carotid artery was cannulated for direct BP measurement. GL extract (5-20 mg) alone or with nifedipine (10 mg/kg), atropine (2 mg/kg), L-NAME (5 mg/kg), methyl blue (3 mg/kg) and propranolol (1 mg/kg) were administered intravenously to Wistar rats and direct BP measurements were carried out. Results Systolic and diastolic BP levels (128/90 mm Hg; MAP 103 ± 3 mm Hg) and heart rates were all significantly (p < 0.01) decreased after GL administration. Raised mean arterial pressure (MAP) and heart rate by atropine, L-NAME and methyl blue were significantly (p < 0.01) reduced after GL administration, while propranolol significantly (p < 0.01) inhibited hypotension caused by GL. Infusion of GL reduced MAP (95 ± 3 mm Hg) comparable with nifedipine (93 ± 2 mm Hg), a calcium channel blocker. The phytochemicals identified were 34 compounds, including oleanolic acid derivatives, flavonoids, antioxidant fatty acids, 2 coumarins and 2 iridoids. Conclusions These results suggest that G. latifolium has hypotensive properties mediated by the synergistic activity of the compounds, probably via the β-adrenergic blockade mechanism.

The Integrative Psychiatry Curriculum: Development of an Innovative Model

The Integrative Psychiatry Curriculum (IPC) was developed to train psychiatry residents and fellows to apply an Integrative Medicine (IM) approach for patients presenting with psychiatric disorders. Launched in 2015, IPC includes interactive online courses, in-person experiential sessions, and a clinical component with supervision. Twenty-one residents and fellows have completed the curriculum. The purpose of the IPC is 2-fold: to enhance patient wellness through training residents and fellows in evidence-based whole-person care and to improve physician well-being through enhanced stress management and self-awareness utilizing the practice of mind-body skills within a supportive small group setting. Course participants are trained in a broad range of prevention and treatment options and learn about their evidence base; they then practice incorporating IM into diagnosis and treatment plans through supervised clinical experience. This article describes the development of IPC and its elements. Efforts are underway to further develop and standardize the offerings and increase the portability of the course, making it easier for Psychiatry training programs with limited faculty expertise in IM to provide the curriculum for residents and fellows. To reach the goal of disseminating such a curriculum for integrative psychiatry, further funding and collaboration with multiple residency training programs is needed.

Comparing Effectiveness of a Combined Herbal Drug Based on Echium Amoenum with Citalopram in the Treatment of Major Depressive Disorder

BACKGROUND

According to new studies, only 60% of depressed patients respond to pharmaceutical treatment while suffering from their side effects. Natural products as adjuvant or alternative therapies should be examined to find safer and more effective ways to cope with depression.

OBJECTIVE

To find out the potential benefits of a combined herbal drug based on Echium amoenum compared with citalopram in the treatment of Major Depressive Disorder.

DESIGN AND SETTING

In psychiatry clinics of Mashhad University of Medical Sciences, 50 patients who met the criteria for Major Depressive Disorder based on DSM-5 were studied in a parallel randomized controlled trial.

INTERVENTION

Subjects were randomly assigned to receive Echium amoenum compound syrup (EACS) or citalopram tablet for 8 weeks.

OUTCOME MEASURES

The efficacy of treatments and recurrence of disease were surveyed and compared according to Hamilton depression rating scale at weeks 0, 4, 8, 12.

RESULTS

Patients in both groups of citalopram and EACS showed remarkable reduction in scores of Hamilton questionnaire. At the eighth week of treatment, the mean scores in EACS group were significantly lower than citalopram group (p-value = 0.03). 52% of patients suffered from various complications in citalopram group while just 12% of patients in EACS group reported few complications.

CONCLUSION

Clinical efficacy of this herbal drug was significantly higher than citalopram, and complications were also less and lower in EACS group. Further studies with larger groups and para-clinical assessments such as serologic tests and QEEG would improve our understanding of the impacts and mechanisms of EACS.

Acupuncture for Anxiety and Anxiety Disorders – a Systematic Literature Review

Introduction

The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxiety disorders by systematic review of the relevant research.

Methods

Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made to identify unpublished research. No language restrictions were imposed and translations were obtained where necessary. Study methodology was appraised and clinical commentaries obtained for studies reporting clinical outcomes.

Results

Twelve controlled trials were located, of which 10 were randomised controlled trials (RCTs). Four RCTs focused on acupuncture in generalised anxiety disorder or anxiety neurosis, while six focused on anxiety in the perioperative period. No studies were located on the use of acupuncture specifically for panic disorder, phobias or obsessive-compulsive disorder. In generalised anxiety disorder or anxiety neurosis, it is difficult to interpret the findings of the studies of acupuncture because of the range of interventions against which acupuncture was compared. All trials reported positive findings but the reports lacked many basic methodological details. Reporting of the studies of perioperative anxiety was generally better and the initial indications are that acupuncture, specifically auricular acupuncture, is more effective than acupuncture at sham points and may be as effective as drug therapy in this situation. The results were, however, based on subjective measures and blinding could not be guaranteed.

Conclusions

Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies.

Complementary and alternative medicine contacts by persons with mental disorders in 25 countries: results from the World Mental Health Surveys

AIMS

A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.

METHODS

In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18-100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.

RESULTS

An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6-17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.

CONCLUSIONS

CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.

The Impact of Yoga Nidra and Seated Meditation on the Mental Health of College Professors

BACKGROUND

World statistics for the prevalence of anxiety and mood disorders shows that a great number of individuals will experience some type of anxiety or mood disorder at some point in their lifetime. Mind-body interventions such as Hatha Yoga and seated meditation have been used as a form of self-help therapy and it is especially useful for challenging occupations such as teachers and professors.

AIMS

In this investigation, we aimed at observing the impact of Yoga Nidra and seated meditation on the anxiety and depression levels of college professors.

MATERIALS AND METHODS

Sixty college professors, men and women, aged between 30 and 55 years were randomly allocated in one of the three experimental groups: Yoga Nidra, seated meditation, and control group. Professors were evaluated two times throughout the 3-month study period. Psychological variables included anxiety, stress, and depression.

RESULTS

Data analysis showed that the relaxation group presented better intragroup results in the anxiety levels. Meditation group presented better intragroup results only in the anxiety variable (physical component). Intergroup analysis showed that, except for the depression levels, both intervention groups presented better results than the control group in all other variables.

CONCLUSIONS

Prepost results indicate that both interventions represent an effective therapeutic approach in reducing anxiety and stress levels. However, there was a tendency toward a greater effectiveness of the Yoga Nidra intervention regarding anxiety, which might represent an effective tool in reducing both cognitive and physiological symptoms of anxiety.

Treatment preferences and help-seeking behaviors for sleep problems among psychiatric outpatients

OBJECTIVE

To understand treatment preferences and help-seeking behaviors among psychiatric patients for their sleep problems, and to examine determinants of problem recognition and help-seeking among patients with sleep difficulties.

METHOD

A cross-sectional survey was conducted among psychiatric outpatients in Singapore (n=400). Participants completed questionnaires that assessed their sleep quality, daytime fatigue, help-seeking behavior, treatment preferences for sleep problems, and sociodemographic information. Multiple logistic regressions were used to identify correlates of patients who recognized their sleep difficulties and of those who had sought help.

RESULTS

Mental health professionals were the most preferred choice (60.8%) for consultation on sleep problems. Among patients with poor sleep quality (n=275), 28.4% denied having any problems and 38.9% had not sought help. Patients with chronic physical comorbidity were less likely to recognize their sleep problems (OR=0.432, p-value=0.009), while those with psychiatric comorbidity were twice as likely to perceive the problems (OR=2.094, p-value=0.021) and to seek help (OR=1.957, p-value=0.022). Daytime fatigue was associated with higher odds of problem recognition (OR=1.106, p-value=0.001) and help-seeking (OR=1.064, p-value=0.016).

CONCLUSION

A considerable number of patients did not perceive their poor sleep as an issue and had not sought help for it. General sleep hygiene education is needed for psychiatric patients.

Complementary and Alternative Medicine Treatments for Generalized Anxiety Disorder: Systematic Review and Meta-analysis of Randomized Controlled Trials

INTRODUCTION

The objective was to evaluate efficacy/safety of complementary and alternative medicine (CAM) methods for generalized anxiety disorder (GAD) based on randomized controlled trials in adults.

METHODS

Data sources. Six electronic databases ("generalized anxiety (disorder)" and "randomized trial") and reference lists of identified publications were searched to March 2017.

STUDY SELECTION

Eligibility: full-text publications (English, German language); CAM versus conventional treatment, placebo/sham or no treatment; GAD diagnosed according to standard criteria; and a validated scale for disease severity. Of the 6693 screened records, 32 were included (18 on biologically-based therapies, exclusively herbal preparations; eight on manipulative and body-based therapies; and three on alternative medical systems and three on mind-body therapies).

DATA EXTRACTION

Cochrane Collaboration methodology was used for quality assessment and data extraction.

RESULTS

Direct comparisons of Kava Kava (Piper methysticum) extracts to placebo (4 quality trials, n = 233) were highly heterogeneous. Network meta-regression reduced heterogeneity and suggested a modest Kava effect [end-of-treatment Hamilton Anxiety scale score difference adjusted for baseline scores and trial duration: - 3.24 (95% CI - 6.65, 0.17; P = 0.059), Kava Kava 4 arms, n = 139; placebo 5 arms, n = 359]. Lavender (Lavandula angustifolia) extract (1 quality trial, 10 weeks, n = 523) and a combination of extracts of C. oxycantha, E. californica and magnesium (1 quality trial, 12 weeks, n = 264) were superior to placebo and balneotherapy was superior to paroxetine (1 quality trial, 8 weeks, n = 237) indicating efficacy. All other trials were small and/or of modest/low quality and/or lacked assay sensitivity. Safety reporting was poor.

CONCLUSION

Evidence about efficacy/safety of most CAM methods in GAD is limited. Apparent efficacy of certain herbal preparations and body-based therapies requires further confirmation.

Treatments recommended by health shops for symptoms of depression

Aims and Method

We assessed the appropriateness of treatments recommended by health shop staff for symptoms of mild-to-moderate depression using participant observation with ten members of staff from ten different health shops selling herbal medicinal preparations.

Results

A wide range of treatment options were suggested by health shop staff when presented with common symptoms of depression. The majority have no firm evidence base, with the exception of St John's wort (Hypericum perforatum).

Clinical Implications

Most alternative treatments recommended by health shops for the treatment of depression have a poor evidence base. Implications for training and communication between agencies are discussed.

Surely you take complementary and alternative medicines?

A substantial proportion of our patients use or consider using complementary and alternative medicines (CAM) and other coping strategies. It is important that we acknowledge this, know something about the subject and are aware of current or potential developments in the field. These remedies might be harmless, beneficial or harmful and their side-effects might alter and confuse clinical presentations. We need to be vigilant of the potential for significant drug interactions between complementary and orthodox treatments. There is a substantial growth in complementary and alternative medical research in the USA, now beginning to follow in the UK. This will hopefully bring useful future progress.

Use of Complementary and Alternative Medicine among Older Adults: Differences between Baby Boomers and Pre-Boomers

OBJECTIVES

To compare use of complementary and alternative medicine (CAM) across age cohorts.

DESIGN

Secondary analysis of data from the Collaborative Psychiatric Epidemiology Surveys.

PARTICIPANTS

Adults born in 1964 or earlier (N = 11,371). Over half (61.3%) are baby boomers and 53% are female. Seventy-five percent of the sample is white, 10.2% African American, 0.6% black Caribbean, 9.35% Latino, and 4.1% Asian.

MEASUREMENTS

The dependent variable is a dichotomous variable indicating use of any CAM. The main predictor of interest is age cohort categorized as pre-boomers (those born in 1945 or earlier) and baby boomers (those born between 1946 and 1964). Covariates include the use of traditional service providers in the past 12 months and 12-month levels of mood, anxiety, and substance disorder. Disorders were assessed with the Diagnostic and Statistical Manual World Mental Health Composite International Diagnostic Interview. Logistic regression was used to test the association between use of CAM and age cohort.

RESULTS

Baby boomers were more likely than pre-boomers to report using CAM for a mental disorder. Among identified CAM users, a higher proportion of baby boomers reported using most individual CAM modalities. Prayer and spiritual practices was the only CAM used by more pre-boomers.

CONCLUSIONS

Age cohort plays a significant role in shaping individual healthcare behaviors and service use and may influence future trends in the use of CAM for behavioral health. Healthcare providers need to be aware of patient use of CAM and communicate with them about the pros and cons of alternative therapies.

Treatment of Depression and Anxiety by Naturopathic Physicians: An Observational Study of Naturopathic Medicine Within an Integrated Multidisciplinary Community Health Center

OBJECTIVES

This project was designed to assess the quality of care received by patients with depression and anxiety who were seen by naturopathic physicians in a community health center.

METHODS

The Natural Medicine Quality Improvement Project for the Treatment of Depression and Anxiety (NMQP-DA) was conducted over a 26-month period from December 2009 through February 2012 at HealthPoint, a non-profit, consumer-governed, community health center network located in suburban King County, Washington. A total of 112 patients enrolled in the NMQP-DA, and 60 were seen for two or more visits, thus meeting eligibility criteria for inclusion in the study. The mean number of visits was 3.3. The Patient Health Questionnaire (PHQ-9) depression screener and the Generalized Anxiety Disorder 7-item scale (GAD-7) anxiety screener were the outcome measures.

RESULTS

The overall improvement in symptoms of depression and anxiety was highly significant (p < 0.0001) when comparing the group's average initial screener scores to their average final screener scores for both depression (16.4 vs. 8.6) and anxiety (12.4 vs. 7.2). The response rate, as measured by a 50% decrease in scores, for those with initial scores ≥10 was 58.6% for depression (PHQ-9) and 50% for anxiety (GAD-7).

CONCLUSIONS

This study adds new data to the limited literature on the nature and effectiveness of naturopathic medicine to treat anxiety and depression in the context of an integrative community health center.

Psychospiritual Resiliency: Enhancing Mental Health and Ecclesiastical Collaboration in Caring for Those Experiencing Dissociative Phenomena

Trauma can oftentimes be a catalyst for changes in an individual's religious and spiritual beliefs. Beliefs about the cause of the trauma, for instance, may include attributions of possessing spirits, and are to be found in an increasingly pluralistic and multicultural society. Such preternatural explanations may be referred to as dissociative identity disorder, possession form. Unwittingly, an overreliance on neurobiological explanations and relegation of cultural idioms of distress may diminish effective collaboration with ecclesiastical authorities. Concomitantly, ecclesiastical experts are confronted with bewildering posttrauma dissociative symptomatology, and may not be prepared as diagnosticians to rule out psychobiological explanations. In both instances, client care may be compromised. Noteworthy, the current investigation integrates the author's participant observation research at the Vatican's school of Exorcism in Rome, Italy.

Effect of a 12-week yoga therapy program on mental health status in elderly women inmates of a hospice

Aim and Objectives:

This study was undertaken to evaluate the effectiveness of yoga on the mental health status of elderly women inmates residing in a hospice in Puducherry.

Materials and Methods:

Forty elderly women were randomly divided into yoga and wait-listed control group. A yoga therapy program of 60 min was given twice a week for 12 weeks. This protocol was specially designed for senior citizens, keeping in mind their health status and physical limitations that included simple warm-up and breath-body movement coordination practices (jathis and kriyas), static stretching postures (asanas), breathing techniques (pranayamas), and relaxation. Hamilton anxiety scale for measuring anxiety, Hamilton rating scale for depression, and Rosenberg self-esteem scale to measure self-esteem were administered to both groups before and after the 12-week study period. Data were assessed for normality, and appropriate parametric and nonparametric statistical methods were applied for intra- and inter-group comparisons.

Results:

Overall, intra- and inter-group comparison of prepost data showed statistically significant (P < 0.001) differences for all three parameters. There was an overall improvement in the scores indicating decreased levels of depression and anxiety coupled with an increase in the level of self-esteem after the yoga therapy program.

Discussion:

The influence of yoga in the reduction of depression and anxiety scores and improvement in self-esteem scores in elderly women subjects is evident from this study. As reported in earlier studies, this may be attributed to changes in central neurotransmitters such as gamma-aminobutyric-acid coupled with increased parasympathetic tone and decreased sympatho-adrenal activity.

Conclusion:

It is recommended that yoga should be a part of health-care facilities for elderly as it can enhance the quality of life by improving their overall mental health status. It could provide a healthy and positive alternative from depressing negative thoughts, and give them a sense of purpose and hope.

The use of CAM providers and psychiatric outpatient services in people with anxiety/depression: a cross-sectional survey

BACKGROUND

Depression has been identified as one of the most frequent predictors of CAM use. However, limited data exist about the use of CAM providers among people with anxiety/depression in Norway. The aim of this study was to investigate the use of CAM providers, and the use of CAM providers and psychiatric outpatient services in combination, among people with self-reported anxiety and/or depression.

METHODS

We used questionnaire data from 12,982 participants (30-87 years) in the cross-sectional sixth Tromsø Study (conducted in 2007-8). Eligible for analyses in our study were 1685 participants who reported suffering from anxiety and/or depression. By descriptive statistical methods, we estimated the use of CAM providers, psychiatric outpatient services, and the combination of these. By logistic regressions we studied the association between the use of these services and gender, age, income, education, and self-reported degree of anxiety/depression.

RESULTS

During the previous year, 17.8 % of people with anxiety/depression visited a CAM provider once or more, 11.8 % visited psychiatric outpatient services, and 2.5 % visited both. Men with anxiety/depression were less likely to visit CAM providers compared to women (odds ratio [OR] 0.40, confidence interval [CI] 0.30-0.55), whereas higher educated people were more likely to visit compared to the lowest educated (OR 1.47, CI 1.02-2.13). The use of CAM providers was not associated with the degree of anxiety/depression. For those who used both CAM providers and psychiatric specialist services during the previous year, severe anxiety/depression was strongly associated with use compared to moderate disease (OR 7.53, CI 2.75-20.65).

CONCLUSIONS

People with severe anxiety/depression seem to use CAM providers and psychiatric services additionally, whereas those with moderate disease seem to use these services more as alternative pathways. CAM provider treatment might be a substitute for conventional care, particularly in patients with moderate disease.

Lay Judgments of Mental Health Treatment Options: The Mind Versus Body Problem

Background: Past research shows that people believe psychologically caused mental disorders are helped by different treatments than biologically caused mental disorders. However, it is unknown how people think about treatment when limited information is known to identify the disorder. Objective: Our objective was to explore how laypeople judged the helpfulness of treatments when a limited set of mental health symptoms is presented. Method: Across four experiments, Mechanical Turk and college undergraduate participants (N = 331) read descriptions displaying sets of three mental health symptoms and rated how helpful pharmaceuticals, counseling, or alternative medicine would be on a 0 (not at all helpful) to 100 (completely helpful) scale. We measured judgments for perceived mental and medical symptoms (Experiment 1) and how judgments were influenced by symptom severity (Experiment 2), duration (Experiment 3), and if alternative medicine and conventional treatments were used in conjunction (Experiment 4). Results: Perceived mental symptoms were rated as helped by counseling, while perceived medical symptoms were rated as helped by medication. Alternative medicine was never rated as extremely helpful. For example, in Experiment 1, counseling (mean [M] = 80.1) was rated more helpful than pharmaceuticals (M = 50.5; P < 0.001) or alternative medicine (M = 45.1; P < 0.001) for mental symptoms, and pharmaceuticals (M = 62.6) was rated more helpful than counseling (M = 36.1; P < 0.001) or alternative medicine (M = 47.5; P < 0.001) for medical symptoms. This pattern held regardless of severity, duration, or the adjunct use of alternative medicine. Limitations: We employed a general population sample and measured hypothetical treatment judgments. Conclusions: Mental health symptoms viewed as problems of the mind are thought to need different treatment than mental health symptoms seen as problems of the body.

Integrating Professional and Indigenous Therapies: An Urban American Indian Narrative Clinical Case Study

We present a narrative case study of an urban American Indian male college student who integrated Indigenous and professional therapies during an acute period of stress, loss, and depression. The first published case of an American Indian in an urban context, this article expands on previous clinical cases by focusing on the perspective of the client relative to his own conceptions of help-seeking behaviors. Based on qualitative analysis of five audio-recorded interviews, this case utilizes an innovative methodology to portray four approaches to healing (medication, counseling, bonding, and spirituality), which contribute to holistic well-being. Implications for counseling psychologists include being aware of how some American Indian clients may (a) view professional treatment dynamics through a Native cultural lens (e.g., seeing ideal communication as a "rhythm"); (b) utilize an expanded range of therapeutic agents;

An Integrative Approach to Depression: Part 1—Etiology

This two-part series presents an integrative model for understanding and treating depression, encompassing the biological, psychological, social, and spiritual levels of the human being. Major depressive disorder may be seen as a dysregulated form of an adaptive response. Theories regarding the adaptive functions of depression drawn from psychology, evolutionary biology, ethology, neuroendocrinology, dream research, the philosophies of naturopathy and homeopathy, and the spiritual traditions of the Native Americans and other cultures are reviewed and synthesized. This model provides the basis for the rational application of a variety of complementary and conventional therapies.

Patient Motivations for Using Complementary and Alternative Medicine

Although use of complementary and alternative medicine (CAM) is widespread, the underlying reasons patients choose CAM are not clearly understood. Several explanatory models have been suggested, including desire for personal control, compatibility with holistic beliefs, and dissatisfaction with conventional care. Methods: The relationship between CAM use and health functional status, desire for personal control over health, holistic beliefs, spirituality, and patient satisfaction were assessed in a mailed survey of 230 family practice outpatients using validated, multi-item measures. Patients with osteoarthritis, depression, or both were compared to healthy patients. Results: Holistic health beliefs, higher spirituality scores, and lower health functional status were predictive of more CAM use. Personal control over health and satisfaction with physicians were not. Conclusion: Patients use CAM when it is consistent with their worldview and conventional care is not relieving their symptoms.

Determinants of the Use of Four Categories of Complementary and Alternative Medicine

The purpose of this research is to assess the social and health determinants of the use of four separate and distinct categories of complementary and alternative medical therapies: biologically based, mind-body, manipulative, and whole CAM medical systems. The behavioral model of health services use, which holds that health service use is a function of predisposing, enabling, and need characteristics, is used as the theoretical framework for linking specific determinants with the four categories of CAM use. Data are taken from a statewide interview survey of Kansas adults ( N = 2,166) conducted in 2001. Results from multivariate analyses demonstrate that there is variation in the determinants of the use of different categories of CAM therapies. Overall, the results indicate that future research on the determinants of CAM must delineate between various CAM therapies to gain an accurate portrayal of the factors contributing to CAM use.

Considerations for the Use of Alternative Therapies in the Treatment of Depression

Approximately 65%–75% of patients with major depression will respond to drug therapy. However, conventional antidepressants may be costly and have side effects and drug interactions that may inconvenience the patient, limit the use of the particular drug, or require the discontinuation of a particular therapy. In this past decade, there has been a renewed interest in alternative medicines, especially for depression, that are available without a prescription. The ability of patients to self-medicate depression presents a risk of inappropriate treatment, thereby increasing the morbidity and mortality rates associated with this sometimes fatal disease. In addition, herbal products are not regulated by the government, leading to problems with batch-to-batch consistency and adulteration, even for products that have evidence of efficacy in depression. The potential for herbal-pharmaceutical grade drug interactions increases the need for input and follow-up from health care practitioners. There is limited quality evidence describing the efficacy and optimal dosing for these products. Clinicians must acknowledge that patients are using herbal products and educate on their use to avoid negative outcomes in patients with depressive disorders.

Rhodiola rosea L. as a putative botanical antidepressant

BACKGROUND

Rhodiola rosea (R. rosea) is a botanical adaptogen with putative anti-stress and antidepressant properties. Evidence-based data supporting the effectiveness of R. rosea for depression in adults is limited, and therefore a comprehensive review of available animal and human studies suggesting a putative antidepressant action is warranted.

PURPOSE

A review of the literature was undertaken to ascertain studies of possible antidepressant mechanisms of action and studies of the safety and effectiveness of R. rosea extracts in animals and adult humans.

METHODS

A search of MEDLINE and the Russian state library database was conducted (up to October 2015) on R. rosea.

MECHANISM OF ACTION

R. rosea extracts and its purified constituent, salidroside, has been shown to produce a variety of mediator interactions with several molecular networks of neuroendocrine-immune and neurotransmitter receptor systems likely to be involved in the pathophysiology of depression. A wide variety of preclinical in vivo and ex vivo studies with laboratory animals suggests the presence of several biochemical and pharmacological antidepressant-like actions.

EFFECTIVENESS

Clinical assessment of R. rosea L. rhizome extracts in humans with various depressive syndromes is based upon results from two randomized, double-blind, placebo-controlled trials of 146 subjects with major depressive disorder and seven open-label studies totaling 714 individuals with stress-induced mild depression (diagnosed as asthenic syndrome or psychoneurosis). Overall, results of these studies suggests a possible antidepressant action for R. rosea extract in adult humans.

SAFETY

In contrast to most conventional antidepressants, R. rosea extract appears to be well-tolerated in short-term studies with a favorable safety profile.

CONCLUSIONS

R. rosea demonstrates multi-target effects on various levels of the regulation of cell response to stress, affecting various components of the neuroendocrine, neurotransmitter receptor and molecular networks associated with possible beneficial effects on mood.

Supplement use by women during pregnancy: data from the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics

Women of reproductive age commonly use integrative treatments. However, the reproductive safety for most complementary products lacks systematic study. We aimed to study the use of supplements by women in a prospective pregnancy registry. The Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics was established to evaluate the reproductive safety of atypical antipsychotics. Exposed and control participants were systematically queried about the use of vitamins and supplements. Slightly greater than half (53.2 %) of the participants eligible for analysis (N = 534) were using at least one vitamin or supplement at the time of enrollment, not including prenatal vitamins or folic acid. The most common supplements used were omega-3 fatty acids (38.0 %), vitamin D (11.0 %), calcium (8.2 %), and iron (4.7 %). Probiotics and melatonin were used by 2.6 and 0.9 %, respectively. In this prospective pregnancy registry, we found that over half of the participants were taking supplements or vitamins other than prenatal vitamins and folic acid. These findings underscore the need for active query on the part of health care providers about the use of supplements during pregnancy, and the need to obtain rigorous reproductive safety and efficacy data for supplements used by pregnant women and reproductive aged women.

Knowledge and Attitudes towards Complementary and Alternative Medicine among Senior Medical Students in King Abdulaziz University, Saudi Arabia

Objectives. This study assessed the knowledge and attitudes regarding complementary and alternative medicine (CAM) in medical students in Saudi Arabia. Furthermore, it evaluated their views on the incorporation of CAM in their medical syllabus. Methods. The study was conducted by selecting a cross-sectional sample of senior medical students in the Faculty of Medicine. A validated and reliable self-administered questionnaire was used to explore the knowledge, attitude, and benefits of CAM. It was distributed to a sample of 273 students. Results. The study included 242 students, making the response rate 88.6%. Only two-thirds of students (62.4%) were aware of acupuncture principles and only 17.4% recognized that chiropractic is associated with pain management. The knowledge of common herbs such as St. John's Wort, Echinacea, and Ginkgo biloba was limited among the students. Older students had a positive CAM attitude compared to younger students (p = 0.027). Conclusion. Students attitudes toward CAM learning were encouraging regardless of their limited knowledge on the subject. A high percentage of students agreed that CAM in combination with conventional therapy is beneficial in treating unusual cases, but the choice of CAM should be based on evidence. Furthermore, medical students are still reluctant to have CAM practitioners in their referral network.

Complementary and Integrative Medicine at Mayo Clinic

Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review

BACKGROUND

Depression has been identified as one of the most frequent indications for CAM use and is a strong predictor of CAM use. The present article provides a critical review of CAM use for depressive disorders including bipolar depression by addressing prevalence of CAM use and CAM users׳ characteristics, motivation, decision-making and communication with healthcare providers.

METHODS

A comprehensive search of 2003-2014 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and depressive disorders.

RESULTS

A considerable level of CAM use was observed among both general and clinical populations of people suffering from depressive disorders, many of whom use CAM concurrently with their conventional medicine. In particular, high rates of CAM use were found among those with bipolar disorder, an illness known to cause substantial impairments in health-related quality of life. Concomitant prescription medication use ranged from 0.52% to as high as 100%.

LIMITATIONS

Study design such as the inclusion of bipolar and depression in the same diagnostic category hamper the differentiation and attribution of CAM usage for symptoms.

CONCLUSION

Findings of our review show that enduring impairments in function and persistence of symptoms (as reflected by increased CAM use proportional to severity of illness and comorbidity) are the impetus for sufferers of depressive illness to seek out CAM. The psychosocial factors associated with CAM use in depressive illnesses and severe mental illness are yet to be established. Subsequent research amongst those with depressive disorders would be informative in clarifying the range of motivations associated with mental illness.

The role of global traditional and complementary systems of medicine in treating mental health problems

Traditional and complementary systems of medicine (TCM) encompass a broad range of practices which are commonly embedded within contextual cultural milieu, reflecting community beliefs, experiences, religion and spirituality. Evidence from across the world, especially from low- and middle-income countries (LMIC), suggests that TCM is commonly used by a large number of persons with mental illness. Even though some overlap exists between the diagnostic approaches of TCM and conventional biomedicine (CB), there are major differences, largely reflecting differences in the understanding of the nature and etiology of mental disorders. However, treatment modalities employed by providers of TCM may sometimes fail to meet common understandings of human rights and humane care. Still, there are possibilities for collaboration between TCM and CB in the care of persons with mental illness. Research is required to clearly delineate the boundaries of such collaboration and to test its effectiveness in bringing about improved patient outcomes.

CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans

BACKGROUND

Complementary and alternative medicine (CAM) is increasingly seen as an adjunct to traditional plans of care. This study utilized a representative sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and OEF/OIF-era veterans to explore the prevalence and characteristics of CAM users.

RESEARCH DESIGN

The National Health Study for a New Generation of US Veterans (NewGen) is a longitudinal health study of a population-based cohort of OEF/OIF (deployed) and OEF/OIF-era (nondeployed) veterans. Data from the 2009-2011 NewGen survey (n=20,563) were analyzed to determine prevalence of CAM use by demographic and military characteristics, the types of CAM modalities used, and where the modalities were sought. Results were weighted to the entire population of OEF/OIF and OEF/OIF-era veterans.

RESULTS

There was no statistically significant association between CAM use and deployment. Those who used Department of Veterans Affairs (VA) health care after separation were more likely to be CAM users compared with those who did not use VA care; however, the majority of veterans using CAM are using it outside the VA health care system. Massage was the most prevalent CAM modality followed by chiropractic treatment; males were less likely to use CAM than women.

CONCLUSIONS

CAM modalities are being utilized by OEF/OIF veterans for health problems mainly outside the VA. Policymakers should determine appropriate use of these modalities.

Type of Multimorbidity and Complementary and Alternative Medicine Use among Adults

Objective. To examine the association between type of multimorbidity and CAM use among adults with multimorbidity. Methods. The current study used a cross-sectional design with retrospective data from 2012 National Health Interview Survey. Multimorbidity was classified into two groups: (1) adults with coexisting physical and mental illnesses and (2) adults with two or more chronic physical illnesses only. CAM use was measured using a set of 18 variables. Logistic regression and multinomial logistic regressions were used to assess the association between the type of multimorbidity and ever used CAM, CAM use in the past 12 months, and type of CAM. Results. Overall, 31.2% of adults with coexisting physical and mental illnesses and 20.1% of adults with only physical illnesses used CAM in the past 12 months. Adults with coexisting physical and mental illnesses were more likely to ever use CAM (AOR = 1.68, 95% CI = 1.49, 1.90), use CAM in the past 12 months (AOR = 1.32, 95% CI = 1.15, 1.52), and use mind-body therapies in the past 12 months (AOR = 1.36, 95% CI = 1.16, 1.59) compared to adults with only physical illnesses. Conclusion. Multimorbidity of chronic physical and mental illnesses was associated with higher CAM use.

Herbal Medicine for Anxiety, Depression and Insomnia

The prevalence and comorbidity of psychiatric disorders such as depression, anxiety and insomnia are very common. These well-known forms of psychiatric disorders have been affecting many people from all around the world. Herb alone, as well as herbal formula, is commonly prescribed for the therapies of mental illnesses. Since various adverse events of western medication exist, the number of people who use herbs to benefit their health is increasing. Over the past decades, the exploration in the area of herbal psychopharmacology has received much attention. Literatures showed a variety of herbal mechanisms of action used for the therapy of depression, anxiety and insomnia, involving reuptake of monoamines, affecting neuroreceptor binding and channel transporter activity, modulating neuronal communication or hypothalamic-pituitary adrenal axis (HPA) etc. Nonetheless, a systematic review on herbal pharmacology in depression, anxiety and insomnia is still lacking. This review has been performed to further identify modes of action of different herbal medicine, and thus provides useful information for the application of herbal medicine.