Course outline. Acupuncture in Mental Health. History of Acupuncture and Psychiatry in HK
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1 Course outline Acupuncture in Mental Health Simon HUI Senior Physiotherapist Kwai Chung Hospital Updated evidences for using acupuncture in Mental health A literature review Local experience for using acupuncture in Psychiatric Hospital Introduction of ear acupuncture in Substance Abuse Practical in ear acupuncture 1 2 History of Acupuncture and Psychiatry in HK Wen, H.L. & S.Y.C. Cheung: "Treatment of Drug Addiction by Acupuncture and Electrical Stimulation. American Journal of Acupuncture Nos. 2, Vol. 1, April-June 1973, pp Wong S.W.: "A Brief Review of Acupuncture in Psychiatric Practice" Hong Kong Journal of Mental Health: Vol.4, No. 2, October
2 The use of Acupuncture in Psychiatry in China Within TCM, acupuncture has already been used beyond the experimental stage in the treatment of psychiatric illnesses. Unfortunately, little controlled / evidence based studies have been done or published. However, acupuncture treatment is proclaimed as very effective in the treatment of mental illness. Literature Review: 5 6 Review on depression 2008 : Hao Wang Et al Journal of Affective Disorders 111 (2008) Review: Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? The following databases were searched: MEDLINE, EMBASE, BIOSIS, Cochrane Central Register of Controlled Trials, and Chinese Scientific Journal Database. The following terms were used: acupuncture, acupressure, depression, depressive disorder, clinical trial, and randomized controlled trial. 7 8
3 Results: Eight small-randomized controlled trials comparing 477 subjects were included in the meta-analysis. The results confirmed that acupuncture could significantly reduce the severity of depression, which was indicated by decreased scores of Hamilton rating scale for depression (HAMD) or Beck Depression Inventory (BDI). 9 Conclusion: Although this meta-analysis might be discounted due to the low quality of individual trials, it supported that acupuncture was an effective treatment that could significantly reduce the severity of disease in the patients with depression : MATS S et al. THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 14, Number 1, 2008, pp Auricular Acupuncture Versus Sham Acupuncture in the Treatment of Women Who Have Insomnia Treatment of Women Who Have Insomnia Design: A single-blind, randomized pilot study where the treatment group received auricular acupuncture treatment (AAT) on active points and the control group received AAT on sham points during a 6-week treatment period. Setting: Participants were recruited from the psychiatric outpatient clinics in the geographical area connected to a local hospital in central Sweden
4 Treatment of Women Who Have Insomnia Subjects: In all, 28 women were included in the study, with 14 in each group. Their mean and median age was 53 years. Outcome Measures: Sleep parameters were obtained by using the Karolinska Sleep Diary. Inclusion criteria Insomnia according to DSM-IV-TR1 Informed consent Female Age years Exclusion criteria Pregnancy Substance abuse Medicated with neuroleptics, hypnotics, or antiepileptics Affective bipolar disorders Results: No statistically significant differences were observed between the groups relating to parameters associated with the definition of insomnia 2008: Noah S et al. Behavioral Medicine. Vol 34, Summer 2008, p55-62 Acupuncture for Psychiatric Illness: A Literature Review 15 16
5 A Literature Review Scientific research has found that acupuncture increases a number of central nervous system hormones (ACTH, betaendorphins, serotonin, and noradrenaline) and urinary levels of MHPG-sulfate, an adrenergic metabolite inversely related to the severity of illness in schizophrenics. 17 Literature Review Acupuncture can have positive effects on depression and anxiety, although evidence is still lacking as to its true efficacy for these conditions. No trials have been conducted for schizophrenia, and researchers evaluating acupuncture in cases of substance abuse have found conflicting results. Further research is warranted. 18 Cocaine Addiction 2000: Avants S K; Margolin A; Holford T R; Kosten T R Archives of internal medicine 2000;160(15): A randomized controlled trial of auricular acupuncture for cocaine dependence. 82 cocaine dependent, methadone maintained patients/ oupt program Random assignment Auricular acupuncture 4 points Auricular control 4 points Relaxation control: videos and relaxation training 5x/ week for 8 weeks No financial incentive 40 min of each tx, after methadone dose 19 20
6 Results Patients assigned to acupuncture group significantly more likely to provide cocaine negative urines compared to both the needle control and relaxation training. P=.01 odds ratio 3.41 confidence interval : Margolin et al. JAMA : the journal of the American Medical Association 2002;287(1): Acupuncture for the treatment of cocaine addiction: a randomized controlled trial Cocaine/Opiate Addiction Margolin (2002) RCT single blind/ outpatient study 6 community based clinics : 3 hospital affiliated/3 methadone maintenance N=620 Adults, ave. age= =cocaine only 208=opiate & cocaine Cocaine and Opiate Random assignment to 3 arms Auricular acupuncture = 222 Needle control auricular = 203 Relaxation training = 195 Treatments 5X/week for 8 weeks Paid 2$/session and 10$/week Drug counseling N.A. provided not required 23 24
7 Results Intent to treatment analysis of Urine showed decreased cocaine use in all 3 groups p=.002 No between group differences No differences in treatment retention 44%-46% for 8 weeks Counseling ie, NA was poorly attended for all Authors state that a model of just acupuncture without more intensive psychosocial treatment led to poor outcome. 2002: Therese K. et al. Issues in Mental Health Nursing, 23: , 2002 THE EFFECT OF AURICULAR ACUPUNCTURE ON PSYCHOPHYSIOLOGICAL MEASURES OF COCAINE CRAVING Cocaine-dependent randomized pretest/posttest control group design to test the effectiveness of auricular acupuncture interventions in diminishing psychological and physiological changes associated with cocaine craving in 30 treatment-seeking cocainedependent patients. Cocaine-dependent Control group -- received sham or placebo auricular acupuncture Psychological (Cocaine Craving Questionnaire Now) and physiological (skin conductance activity) changes associated with cocaine craving were measured
8 Results: no differences between the control and the experimental group in diminishing psychological and physiological measures associated with craving. 1999: Michael S. et al. Journal of Substance Abuse Treatment, Vol. 17, No. 4, pp , 1999 The Value of Acupuncture Detoxification Programs in a Substance Abuse Treatment System Substance Abuse To compare baseline characteristics and detoxification readmission rates of clients treated at outpatient acupuncture programs and at short-term residential programs, two options available to persons seeking substance abuse detoxification. Multivariate models were used to examine the effect on 6-month detoxification readmission rates of treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients) after adjusting for baseline differences 31 32
9 Result Acupuncture clients were less likely to be readmitted for detoxification within 6 months Similar results were found when the analysis was performed on a subsample of clients that were relatively similar in terms of baseline characteristics. It determined that acupuncture detoxification programs are a useful component of a substance abuse treatment system. Schizophrenia EA is better for controlling the symptom The condition is mainly treated by medication, acupuncture can reduce the dose and side effect of anti-psychotics Depression Good result, esp for dysthymia ( 輕 性 憂 鬱 症?) Using meridian of Heart, Liver, Pericardium, Governor Vessel (face/ head) 35 Detoxification EA has a better effect on detoxification Depend on patient s willingness for treatment 36
10 针 灸 病 谱 分 級 有 些 是 针 灸 独 立 可 治 疗 的 病 种 即 针 灸 一 级 病 谱, 有 些 是 针 灸 作 为 主 要 治 疗 方 法 的 病 谱 即 二 级 病 谱, 有 些 是 针 灸 作 为 辅 助 治 疗 的 病 谱 即 三 级 病 谱 Local experience of using Acupuncture in Kwai Chung Hospital Acupuncture to substance abuse since Enhancing Acupuncture Service in Physiotherapy, 2007 Pain management & Psychosomatic Disorders Depression stress related discomforts like anxiety, Insomnia etc. Both traditional acupuncture and ear acupuncture are used
11 Common conditions by using acupuncture as a treatment modality in KCH Withdrawal symptoms Insomnia Depression / low mood Anxiety Chronic pain (pain over 6 months) Special precaution for applying acupuncture in psychiatry Apply all general precaution! Unstable mental state History of violent Clients with challenging behaviour Clients with self-harm behaviour Client s mental state is fit for consent Special Assessment? 43 44
12 Difficulties in applying acupuncture in psychiatry Good understanding in patient s mental condition Poor attendance Emotional status Difficulty in patient s handling Introduction of Auricular acupuncture in Substance Abuse What is Auricular Acupuncture? Auricular acupuncture is a variant assumes that the body is like a holograph ( 全 息 論 )and is represented entirely on the ear
13 49 50 Acupuncture and Addiction Chinese neurosurgeon HL Wen in 1972 discovered benefits on accident Noticed that acupuncture in post-surgical, opiate addicted patients seemed to alleviate withdrawal Used EA of lung point in 40 patients with opiate addiction found uniform decreases in opiate withdrawal symptoms Withdrawal symptoms It can vary significantly among individuals, but there are some commonalities. Early symptoms of withdrawal include: Agitation Anxiety Muscle aches Increased tearing Insomnia Runny nose Sweating Yawning 51 52
14 Late symptoms of withdrawal include: Abdominal cramping Diarrhea Dilated pupils Goose bumps Nausea Vomiting NADA protocol Michael Smith, a psychiatrist in the Bronx, NY, modified Wen s protocol by eliminating the EA and abbreviating the prescription to five auricular needles This prescription was not designed for withdrawal from any particular drug Instead designed to reduce anxiety, craving, and dysphoria during the early weeks of withdrawal Meant to make acupuncture more accessible and affordable NADA protocol National Acupuncture Detoxification Association 800 treatment centers use this protocol Many studies use some variant of the protocol which states 3-5 points should be used Uses 5 points in bilateral auricles left in place for 40 minutes and removed Points: Shen Men (TF4) Sympathetic (AH6a) Lung (CO14) Liver (CO12) Kidney (CO10) 55 56
15 Practical A taste of Auricular Acupuncture using NADA protocol. Video Demonstration 57 58
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