Alternative Health Care Systems in the practice of Psychiatry

Moderator: Dr. Sandhya Gupta Presenter: Mr.Ganesh.K

Introduction
‡ A diverse range of autonomous health-care practices used both for health support and prevention and for care in illness. ‡ There is well documented evidence for the increasing widespread use of complementary and alternative medicine in the treatment of physical and psychiatric symptoms and disorders within Western populations. ‡ The World Health Organization refers to the increase in the use of nonconventional medicine, meaning traditional, complementary and alternative medicine, in countries all over the world in its Traditional Medicine Strategy 2002‡ 2005.

Introduction

‡ (NCCAM. 2006) . Western Medicine Complementary and Alternative Medicine ‡ A group of diverse medical and health care systems. and products that are not presently considered to be part of conventional medicine.Definitions Allopathic Medicine: ‡ A system of medicine that embraces all methods of proven value in the treatment of disease. ‡ Conventional medicine. practices.

Definitions Alternative medicine:: ‡ Used in place of conventional medicine ‡ using special diet to treat cancer instead of chemotherapy.. surgery. . Complementary medicine: ‡ Used together with conventional medicine ‡ using aroma therapy to relieve discomfort following surgery ‡ Integrative medicine: ‡ combines mainstream and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.. etc.

. radiation. An example of a complementary therapy is using to help lessen a patient's discomfort following surgery. Alternative medicine is used in place of conventional medicine. or chemotherapy that has been recommended by a conventional doctor. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery.Are complementary medicine and alternative medicine different from each other? Complementary medicine is used together with conventional medicine.

art therapy. herbalism. herbal therapy. ‡ China: acupuncture. ‡ India: Ayurvedic medicine. ‡ Shamanistic practices folk healing that involves entering altered states of consciousness . ‡ The Far East: energetic-touch therapies.Roots of Nontraditional Therapies ‡ Ancient Greece: massage.

Circulatory.Principles of CAM ‡ Human Body is Self Regulating and has a ability to heal itself. ‡ Working on body can bring deeper changes in muscular. ‡ Cellular Memories stored in tissues and muscles. endocrine and immune system of body. Lymphatic. Joint. Soft Tissue. ‡ Focuses on Structures and Systems of Body ± Bones. ‡ Parts of Human Body are inter dependent. . nervous.

CAM Modalities Now in Mainstream Medicine ‡ Codeine for pain ‡ Digitalis for heart failure ‡ Ipecac for poisoning ‡ Quinine for malaria ‡ Aspirin for fever ‡ Behavioral therapy for headache ‡ Hypnosis for smoking cessation ‡ Low fat. low cholesterol diets ‡ Exercise for diabetes ‡ Support groups for breast cancer .

2004 Report by NCCAM & NCHS .The Use of CAM in the US.

Who uses CAM the most? ‡ ‡ ‡ ‡ Women more than men people with higher education people who have been hospitalized in past year former smokers (more than current or never smoked) .

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Why? ‡ Positive motives ± Perceived effectiveness or safety ± Spiritual ± Holism ± All things natural ± Active role ± Control over treatment ± Pleasant therapeutic experience ± Good patient/therapist relationship ‡ Fewer time restraints ‡ On equal terms ‡ Empathy ± Non-invasive ± Accessibility ± Affluence .

Why? ‡ Negative motives ± Dissatisfaction with conventional health care ‡ Ineffective ‡ Adverse effects ± Doctor-patient relationship ‡ insufficient time ‡ waiting lists ± Reject science and technology ± Reject the establishment ± Desperation .

CAM domains .

‡ Manipulative and body-based therapies ± Based on movement of one or more parts of the body ‡ Mind-body interventions . foods & vit.Types of CAM ‡ Biologically based practices ± Use substances found in nature such as herbs.uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. ‡ Energy therapies ± are meant to restore disturbances in the body's natural energy .

Types of CAM (Common) ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Acupuncture Alexander Technique Allergy testing Aromatherapy Art Therapy Autogenic Training Auricular Acupuncture Ayurveda Bodywork ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Bowen Biofeedback Chiropractic Chinese Herbal Medicine Counselling Craniosacral Therapy Crystal Therapy Dowsing Flower Therapy Healing Herbalism Homeopathy .

Types of CAM (Common) ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Hydrotherapy Hypnotherapy Indian Head Massage Iridology Kinesiology Music Therapy Naturopathy Nutrition Osteopathy ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Physiotherapy Radionics Reflexology Reiki Shiatsu Tai Chi TENS therapy Traditional Chinese Medicine ‡ Thought Field Therapy ‡ Yoga Therapy .

Types (Rarer) ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Auricular Acupuncture Australian Flower Essences Therapy Bach Flower remedies Bee Venom Therapy Chelation Therapy Colonic Hydrotherapy Colour Therapy Dream Therapy Eye Movement Desensitization and Reprogramming Exercise Healing Health Clubs Health Screening Juice Therapy Light Therapy ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Light Touch Therapy Magnotherapy Marma Therapy Meta-Aromatherapy Microwave Resonanace Therapy Naturotherapy Oxygen Therapy Panchakama Therapy PIP scans Raw Vegetable Juice Therapy Rolfing Spiritual Counselling Stress Management Swimming Therapy Transdecendal Meditation Tragerwork Vegetable Juice Therapy .

which indicate that complementary and alternative therapies are used more than conventional therapies by people with anxiety and severe depression. anxiety and insomnia to be among the most common reasons for people to use complementary therapies.Research input ‡ Kessler et al reported data on the use of complementary therapies to treat anxiety and depression in the USA. . ‡ This large-scale study found depression.

‡ The findings of a large postal survey conducted in Australia showed that people who were experiencing mild to moderate depression chose self-help strategies and complementary therapies such as aromatherapy. . with acupuncture being identified as one of the most popular forms of complementary treatment. St John's wort. estimates of the proportion of the general population using CAM range from 14% to 30% and positive public attitudes toward the use of complementary therapies. meditation and nutritional supplements rather than seeking professional help.Research input ‡ In the UK.

Mind-body therapies .

relaxation. imagery. . and hypnosis and spiritual therapies. ‡ Self-regulatory techniques include meditation. biofeedback.MIND/BODY INTERVENTIONS ‡ Methods by which an individual can consciously control some sympathetic nervous system functions.

producing a state of relaxation and stress relief.MEDITATION ‡ State of consciousness in which individual eliminates environmental stimuli from awareness. ‡ Health benefits include decreased respiration. heart rate. spiritual calm and heightened awareness. . improved mood. and oxygen consumption.

Meditation types ‡ All the meditation techniques can be grouped into two basic approaches: ± Concentrative meditation and ± Mindfulness meditation. Some indications: Recurrent Depression Chronic anxiety Chronic insomnia Overall emotional well-being .

Uses of meditation ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Anxiety or tension Chronic bereavement Chronic fatigue syndrome Irritability Hypertension Mild depression Low self esteem or self blame Sleep disorders Psychological disorders .

Limitations ‡ Over meditation may precipitate psychoses episode. ‡ Augments the effect of certain medications .

investigated the effectiveness of a meditation-based stress management programme in patients with anxiety disorder.Research input ‡ Lee et al. ‡ There were significant decreases in all anxiety scale scores for themeditation programme group compared with patients on the education programme. relaxation and hypnotic suggestion) or the education programme. which included some education on coping with anxiety. ‡ Forty-six patients diagnosed with anxiety disorders were randomly assigned to either the meditation programme (MBSR. exercise. . muscle build up.

. which integrates aspects of CBT with components of MBSR programmes.Research input ‡ Pilkington et al concluded that two recent trials suggest that mindfulness-based cognitive therapy. may be useful in preventing relapse in people who have recovered from depression.

reduces the neural impulses sent to brain and thus decreases the activity of brain as well as other body systems. ‡ Acquisition of cognitive skills to replace negative thoughts with positive thoughts.RELAXATION ‡ Relaxation is the state of generalized decreased cognitive. ‡ The process of relaxation elongates the muscles. physiological or behavioral arousal. .

g.Relaxation therapy ‡ Types: ± Progressive relaxation ± Passive relaxation ‡ Clinical applications ± lowering HR.RR and muscle tension ± Improving well being ± E. deep breathing ‡ Limitation ± Predormescent start .

touch.e. (i. ‡ Two types ± Self directed ± Guided . sound). maintain health or relax by way of an inner communication involving all senses. visual.IMAGERY ‡ It is a process of incorporating the "power of the mind" to assist the body to heal. smell. sight.

adverse effects of chemotherapy.Guided imagery ‡ Nurses can use guided imagery with clients capable of hearing and understanding the nurse s suggestions. ‡ Decreases physical tension. . anxiety.

BIOFEEDBACK ‡ Measures physiological responses like muscle tension. chronic pain. . ‡ Effective for a number of conditions. urinary incontinence. including headaches. skin temperature. hypertension. and heart rate to improve health by using signals from client s own body.

HYPNOSIS ‡ Induces an altered state of consciousness or awareness resembling sleep and during which the person is more receptive to suggestion. .

which were run over 16 weeks. ‡ Patients were randomly assigned to the two treatment groups. with that of standard CBT in 84 patients with major depression. which they termed cognitive hypnotherapy.Research input ‡ Alladin and Alibhai compared the effectiveness of the combination of hypnosis and CBT. The investigators found that treatment outcomes were significantly enhanced when CBT was combined with hypnotherapy. .

. ‡ Healing prayer when praying. Prayer can affect well-being. people believe they are communicating directly with God or a Higher Power. The healer is a channel for divine power.SPIRITUAL THERAPIES ‡ Faith healing usually accomplished through prayer.

tai chi.MANIPULATIVE AND BODY-BASED METHODS ‡ Use techniques of manipulating or moving various body parts to achieve therapeutic outcomes. . ‡ Includes movement/exercise. and chiropractic treatment. yoga.

celebration. ‡ Other positive outcomes include sleeping better and having more energy. and healing rituals. . ‡ The primary goal of exercise is fitness.MOVEMENT/EXERCISE ‡ Associated with athletic exercise. dance.

EXERCISE ‡ Aerobic exercise most studies ‡ Adherence rates in exercise studies comparable to those in medication trials ‡ Randomized controlled trials ‡ Antidepressant effects comparable to CBT ‡ Feasible in older subjects ‡ Total caloric expenditure/wk more critical than frequency/wk .

Alexander therapy ‡ Alexander technique is actually a method to relieve the pain and stress caused by the way we have misused our body during daily activities. .

and movement in the body .Alexander therapy (contd) ‡ The Alexander Technique (awareness. posture. neck. and touch) teaches people to change dysfunctional movement patterns by educating clients in how to change their daily habits of movement and posture to ± restore the correct relationship of head. and back ± promote proper balance. movement.

posture. weight distribution.YOGA/YOGA THERAPY ‡ Means union in Sanskrit. ‡ Promotes relaxation. develops proprioception. and movement. and spiritual energies to promote health and wellness. physical. and position. awareness of movement. . ‡ Integrates mental. ‡ Breathing.

Yoga of purifying physical and mind y Karma Yoga.Yoga of controlling mind .Yoga of action y Jhana Yoga.Yoga of devotion y Raja Yoga.Yoga of knowledge y Bhakti Yoga.Yoga y Main branches of Yoga: y Hatha Yoga.

Yoga Most common yoga practice includes asanas (body postures) & pranayama (breathing exercises) Randomized controlled trials ± Pranayama + asana reduces symptoms in depressed college students ± Pranayama comparable to tricyclic in treating depressed psych inpatients ± Asanas superior to wait-list in reducing depressive symptoms ± Short-term antidepressant effects of pranayama + asana comparable to PMR and superior to control .

range of motion. ‡ A series of slow. muscle strength. continuously flowing movements.TAI CHI ‡ Looking for harmony with nature and the universe through complementary (yin and yang) balance. and balance. ‡ Improves flexibility. .

‡ Hands-on therapy especially adjustment of the spine is central to chiropractic care. ‡ Focuses on the relationship between the body's structure mainly the spine and its functioning. Misalignments of the spine can interfere with the flow of energy needed to support health.CHIROPRACTIC THERAPY ‡ Combines the Greek words cheir (hand) and praxis (action) to describe a treatment done by hand. .

self image. y Basis of practice is the belief that misalignment of myofascial (soft) tissue may have detrimental effect on person s energy level. . muscular efficiency and general health.Rolfing (Structural integration) y Technique of deep massage intended to realign the body by altering the length and tone of muscle. fascia and connective tissues.

pelvis. y The Rolfing practitioner manipulate and stretch the body's fascial tissues to reestablish proper physical alignment of the head. y To promote emotional balance and emotional relaxation.Rolfing y Pressure or deep painful massage is applied with the fingers and elbows. . legs. and feet and y To promote mental balance. torso.

‡ Includes touch. therapeutic touch. healing touch. . therapeutic massage. and reflexology. acupressure.ENERGY THERAPIES ‡ Use of the hands to direct or redirect the flow of the body s energy fields and enhance balance within those fields.

‡ The meaning of touch and the body areas acceptable to touch vary from culture to culture. .TOUCH ‡ The means of perceiving or experiencing through tactile sensation.

THERAPEUTIC TOUCH ‡ Based on the ancient practice of the laying on of hands and using the hands to direct energy to achieve a balanced state. .

-Winsted ± Fry P. ‡ Therapeutic healing enhances body¶s ability to heal itself and beneficial for allergies. An intergrative renew and meta analysis of therapeutic touch & research. . Alternative therapies in Health & Medicine. heart condition & chronic pain. 7 Controlled studies had positive outcome. Kijek J.Research input ‡ In Meta Analysis of 11 Controlled Therapeutic Touch Studies.

which reactivates the mind/body/spirit connection to eliminate blockages to selfhealing. . energize. and balance the energy field.HEALING TOUCH ‡ An energy therapy using hands to clear. ‡ The practitioner re-aligns the energy flow.

Uses y y y y y y Wound healing Pain management Stress management Prevention of illness Enhance spiritual development and Provide support and assistance in dying process. ‡ Assists in soothing. ‡ Promotes bonding. . calming. ‡ Helps keep the client oriented.TOUCH IN NURSING PRACTICE ‡ An integral part of assessment. and comforting. ‡ An important means of communication.

Cultural Considerations of Touch ‡ Ask permission before touching a client. ‡ The meaning of touch and the body areas acceptable to touch vary from culture to culture. . ‡ Tell the client what is going to happen.

‡ A back rub or massage results in relaxation. . spasm. increased circulation of the blood and lymph.THERAPEUTIC MASSAGE ‡ The application of hand pressure and motion to improve the recipient s well-being.g. ‡ Used in ± Pain relief (e. pain. HR and state anxiety etc. back pain. headache) ± Reducing anxiety ± Depression and ± Temporarily reduction in BP. and relief from musculoskeletal stiffness.

ACUPRESSURE ‡ Based on Chinese theory stating that the body is divided into meridian channels through which qi. flows. or energy. . and hands. thumbs. ‡ Acupressure releases blocked energy when specific points (Tsubas) are pressed with the fingers.

Spondylitis. diabetes.Acupressure ( Contd ) y Caution: should not be applied near areas of fractures. y Psychiatry Conditions Treated: y Pain management y Insomnia y Anxiety y Depression y Substance abuse including smoking cessation. Arthritis and Rheumatism. y Medical problems.Cancer. wounds. Fractures. backaches. Paralysis . and Dislocations. asthma. Gouts/Stones in Kidney & Bladder. Intestinal Problems Colitis. broken bones or near blood clots. sore and bruises. Slipped Disks.

and traumatic and deep tissue injuries. Stress. Anxiety. ‡ Relaxation. Back pain. Headache. . ‡ Contraindications include venous stasis. Neck and shoulder pain. elbow.SHIATSU ‡ Shiatsu utilizes the forearm. Insomnia. phlebitis. Recovery from injuries. Tiredness. and foot to activate the points. knee. Premenstrual syndrome.

‡ Promotes health by relieving pressures and accumulation of toxins in the corresponding body part. .000 nerves in the feet believed to correspond to every muscle system and organ in the body.REFLEXOLOGY ‡ Art and science of enervating over 7.

Reflexology ‡ ‡ ‡ ‡ ‡ Pain relief in acute and chronic states Control of anxiety Reduction of blood pressure Relaxation Improved sleep Pebble massage sandals .

must be in balance). y Concept: disease results from disruption in the flow of Qi (vital energy) and imbalance in the forces of yin and yang (opposite energy fields.Acupuncture y The modern name is derived from the Latin words Acus (needle) and Punctura (penetration). y Component of traditional Chinese medicine that originated in China over 5. .000 years ago.

solid.Acupuncture (contd) y Technique of acupuncture y Involves penetrating the skin with thin. y Charts more than 2000 points in the body . .located along invisible energy called `meridiansµ. metallic needles that are manipulated by the hands or by electrical stimulation.

substances that transmit nerve impulses to the brain  Influences the autonomic nervous system  Stimulates circulation  Influences the electrical currents of the body .How Acupuncture Works  Stimulates the release of pain-relieving endorphins  Influences the release of neurotransmitters.

Risk and complications Small bruises on the insertion site Pneumothorax Infections and Punctured organs Soreness and pain .

ACUPUNCTURE Electro-acupuncture Manual acupuncture Laser acupuncture Randomized controlled trials ± Luo et al: EA equivalent to tricyclic in depression (unipolar + bipolar subjects) ± Allen et al : EA group only marginally better than wait-list control ± Roschke et al: EA no better than sham EA as adjuvant to antidepressant ± Quah-Smith et al: Laser acupuncture superior to sham in treating depressive symptoms .

with one group receiving acupuncture. 84 patients diagnosed with PTSD were randomly assigned to one of three groups. another group receiving cognitivebehavioural therapy (CBT) and the third acting as a wait list control. depression. .Research input ‡ Recently reported RCT evaluated the efficacy and acceptability of acupuncture for treatment of posttraumatic stress disorder (PTSD) ‡ In all. and both interventions were superior to the wait listed control on all measures. ‡ Treatment effects in the acupuncture group were similar to those with the group CBT intervention. anxiety and impairment in people diagnosed with PTSD. ‡ A total of 61 participants completed the trial and the results suggest that acupuncture might be useful in reducing symptoms of PTSD.

persons who graduated from junior college. Kozumplik and V. The schizophrenic patients used CAM methods and religious support significantly more frequently than the patients with affective and anxiety disorders.Research input ‡ Psychiatric Patients' Experiences in Complementary and Alternative Medicine (CAM). examinees between 21 and 30 years of age. ‡ ‡ . Croatia In the Psychiatric Hospital »Vrap~e« an investigation on a 200 patient sample was carried out in the year 2000. those who live in cohabitation and patients of Islamic religion. Zagreb.5% of the examinees had had previous experiences of CAM and religious support. 35. The purpose of the investigation was to analyze the examinees¶ experiences of complementary and alternative medicine (CAM) and religious support. and in Religious Support ± A Pilot Study O. Psychiatric Hospital »Vrap~e«. Juki} Department of Integral Psychiatry. The examinees born in towns used CAM methods and religious support significantly more often. Non-significantly more often CAM methods and religious support were utilized by women.

Considering the possible missed benefits and harm effects of CAM treatment as well as of the interaction between utilization of CAM methods/religious support and conventional treatment. Non-significantly more often patients consulted CAM practitioners and religious practitioners without being previously advised by their relatives or friends. this problem should be given full attention.Research input ‡ Patients consulted priests most often. . ‡ Relatives of the patients advised them to consult CAM practitioners and religious practitioners significantly more often than the friends of the patients did. Significantly more often patients did not pay for the CAM treatments and religious support and non-significantly more often patients considered CAM therapy and religious support to be successful.

BIOLOGICALLY BASED THERAPIES ‡ Phytochemicals ‡ Antioxidants ‡ Herbs .

stroke. . ‡ Consumption of a wide variety of fruits and vegetables provides best supply. and cataracts. physiologically active compounds present in plants in very small amounts. ‡ Protect against cancer and prevent heart disease.PHYTOCHEMICALS ‡ Nonnutritive.

Nutritional supplements ‡ Mischoulon reported that the results of recent studies of omega-3 fatty acid supplementation. such as the elderly. . ‡ In addition. pregnant or lactating women and people with medical comorbid conditions. including the use of eicosapentaenoic acid (EPA). the omega-3 fatty acids have been shown to be safe and might be useful in specific populations. are promising in treatment of depression.

Nutritional supplements ‡ A number of controlled trials and a few open studies have suggested that supplementation with doses of EPA and docosahexaenoic acid (DHA) that are about five times higher than the standard dietary intake in the USA may have antidepressant or mood-stabilizing effects. .

lower serum omega-3 fatty acids significantly correlate with depression ± Double-blind.DIETARY SUPPLEMENTS Omega-3 Fatty Acids ± Worldwide. but no controlled studies to date re: use in psych conditions ± Food increases omega-3 absorption ± Do not heat fish oil ± Vitamin E may help in vivo potency ± Caution with anti-coagulants and hi-dose NSAIDS .5 gm/day ± Flaxseed oil also source for omega-3 fatty acids. placebo-controlled studies show efficacy of omega 3 (from fish oil) in unipolar and bipolar depression ± Typical EPA dose 2.

DIETARY SUPPLEMENTS Folic Acid ± Folate deficiency appears significantly correlated with higher rates of depression ± Data suggest low serum folate may hinder antidepressant response ± Folate (0.5 mg/day) may be important adjuvant in treating women (but not men) with resistant depression ± Folate may help prevent relapse during & after depression tx .

DIETARY SUPPLEMENTS S-Adenosyl-Methionine (SAMe) ± Several placebo-controlled trials for use in depression ± Meta-analysis shows SAMe (400mg-1600 mg by mouth) may be equivalent to tricyclics ± No data on comparison to SSRI s ± Risk of mania. serotonin syndrome .

ANTIOXIDANTS
‡ Substances that prevent or inhibit oxidation. ‡ Prevent tissue damage from free radicals, which are unstable molecules that can damage cells and trigger cancer growth. ‡ May prevent heart disease, cancer, cataracts.

Herbs
‡ Used for centuries in care of the sick. ‡ Some herbs, when used with prescribed medications, can cause potentially harmful herb-drug interactions. ‡ During assessment, ask specifically about use of herbal and vitamin supplements.

HERBAL REMEDIES
St. John s Wort ± Equivalent to low-dose tricyclic in mild-mod depression ± Typical dose 900-1800 mg/day (in three divided doses) ± Watch for photo-toxicity and herb-drug interactions

Hypericum perforatum

dose-related sedative effects ± Not benzodiazapine.HERBAL REMEDIES Valerian Root ± Used for hundreds of years for anxiety / insomnia ± Seven placebo-controlled trials (400-900 mg/day) ± 6 of 7 studies found statistically significant. so little abuse potential ± Avoid if liver dysfunction ± Avoid concurrent use with benzodiazapines Valeriana officinalis .

HERBAL REMEDIES Rhodiola ± Enhances cognitive performance under stress ± Reduces mental fatigue ± Improves sexual function ± Improves overall well-being ± 300-900 mg/day for depression ± Caution with bipolar and post-MI patients Rhodiola Rosea .

. showed that kava is the only herbal remedy that has been proven to be effective in reducing anxiety. ‡ The valerian review[16**] identified one randomized controlled trial involving 36 patients with generalized anxiety disorder that was eligible for inclusion. which included 11 RCTs involving 645 patients.Research input ‡ A Cochrane review reported by Pittler and Ernst. ‡ This study found that patients taking diazepam experienced significantly greater improvement in self-reported anxiety symptoms than those in the valerian and placebo groups. with no significant differences in reported side effects between the three groups.

Herbs ‡ A recent review reported by Ernst indicated that St John's wort (Hypericum perforatum) is the only herbal remedy found to be effective as a treatment for mild to moderate depression. . ‡ Ernst cautioned against using St John's wort with other medications because it can increase the plasma levels of a range of drugs and there is a possibility that it can occasionally trigger psychosis in patients who are using selective serotonin reuptake inhibitors.

OTHER METHODOLOGIES ‡ ‡ ‡ ‡ ‡ Aromatherapy Humor Animal-assisted therapy Music therapy Play therapy .

‡ These oils should be used intelligently and with caution. . physiological and pharmacological effects of essential oils introduced by means of inhalation.Aroma therapy ‡ Aromatherapy is concerned with the psychological. olfaction and dermal application.

Aroma therapy (contd) ± Used since Egyptian times ± Distilled plant extracts ‡ 400 Oils ‡ Varying quality (RCT) ± Improve well-being ‡ Peppermint digestive effects ‡ Tea Tree Oil antibacterial ± Massage. Inhalation . Baths.

‡ The study's author reported that six of the eight participants experienced reduced anxiety and improved mood over an 8-month period of use.Research input ‡ Perry and Perry found only one small open-label study of aromatherapy in the treatment of psychiatric patients diagnosed with anxiety and depressive disorders. .

and decrease pain by stimulating endorphin production. . ‡ Can relieve anxiety. promote relaxation. enhance immunological function. improve respiratory function.Humor ‡ Determine the client s perception of what is humorous.

lowering blood pressure. and improving socialization skills and self-esteem. improving mood.ANIMAL-ASSISTED THERAPY ‡ Has many applications including overcoming physical limitations. .

or improvement of social or emotional functioning. . mental processing. maintenance. or physical health of an individual.MUSIC THERAPY ‡ Use of musical or rhythmic interventions specifically selected by a music therapist to accomplish the restoration.

) ‡ ‡ ‡ ‡ ‡ ‡ ‡ Music therapy: Promote wellness Manage stress Alleviate Pain Express Feelings Enhance Memory Improve Communication Promote physical Rehabilitation ..Music therapy ( contd.

Art therapy ‡ A form of expressive therapy that uses art materials. chalk and markers as primary mode of communication. ± Increase cognitive abilities. ± Have better relationships with family and friends. . ± Cope better with stress. such as paints. ‡ Based on the belief that the creative process of art is both healing and life-enhancing. ‡ Helps the client to: ± Increase insight and judgment.

Art therapy ‡ Goal : to improve or maintain mental health and emotional well-being. painting.. ‡ Drawing. ´It·s not about being an artist.. ‡ Therapist interpret the symbols and metaphors form the creative work. . it·s about using visual symbols to explore feeling and emotions.it·s about seeing feelings.. making them visible to yourself". sculpture and photography are used..

or liquid.Hydropathy /Aquatherapy ‡Treatment of disease by the use of water. vapor. . ‡Method of treatment that attempts to cure all diseases by the external (bath) or internal (colonic irrigation) use of water. ‡Water can be in the form of ice.

Hydrotherapy
‡ Can be hot or cold water which is used. ‡ Types
± Packing ± Hot air baths (Saunas) ± General baths ± Local baths ± Compress

Hydrotherapy
‡ Used in:

± Stress reduction ± Sexual arousal ± Cognitive enhancement ± Others- Musculoskeletal disorders (arthritis, ankylosing spondylitis), Spinal cord injuries, spasticity, stroke or paralysis
‡ Mech. of action:

± Heat is soothing, easing muscle tension and relieving pain. Heat also improves circulation. ± Cold can either be stimulating or soothing.

PLAY THERAPY
‡ Especially useful with children. ‡ Constitutes a method for children to communicate their needs and feelings to care providers.

‡ It exposes patients to a bank of bright lights for a variable number of hours per day. found good evidence for the efficacy of light therapy in winter depression. Jorm et al. . ‡ In a recent paper that reviewed CAM therapies in the treatment of depression in children and adolescents.LIGHT THERAPY ‡ Light therapy is another physical intervention that is used to treat depression and depressive disorders. Patients can read or engage in other activities during the period of exposure. usually between 1 and 3 h.

Bee venom therapy ± Contain sulphur ± Stimulates cortisol release ± Applied to surface ± Chronic inflammatory conditions ± RA. Myositis ± Applied for 5days with 2-3day interval ± Normally haemorrhagic .

promotes tissue alkalisation. reduce swelling. North relieve pain. increase blood and oxygen circulation and carry away toxins. neutralise histamine ‡ Unipolar ‡ either north or south. South Opposite ‡ Bipolar . increases oxygenation to tissues and calms nerves. promotes restful sleep.Magnetic therapy ‡ Magnets help to balance the acidalkaline imbalances and increase calcium ions.

Charak Samhita. Charak susruta) .Ayurveda y Ayur = Life.e. Veda = Knowledge y Ayurveda : the science of life y A system of medicine that originated in India several thousand years ago. y Two ancient books on palm leaves are first books written for Ayurveda (i.

mind.Ayurveda (contd) y Aim is to integrate and balance the body. and the universe are all related and health problems can result when these relationships are out of balance. . their health. and spirit y Philosophy is that people.

and the universe ): y All the things are joined together y Each human being has element that can be found in the universe. y All are born in a state of balance within themselves and in relation to the universe. y Health will be good if one's interaction with the immediate environment is effective .Ayurveda (contd) y Interconnectedness (among people. their health.

and earth. and kapha ) y Each dosha is made up of one or two of the five basic elements: space. water. fire. pitta. air. y Each dosha has a particular relationship to body functions .Ayurveda s Beliefs y Constitution (Prakriti) and health: y Three doshas control the constitution (i. vata.e.

breathing. and the mind y People with vata dosha are more susceptible to skin. the heart.Vata Doshas y Vata dosha: combination of the elements space and air. y most powerful dosha because it controls very basic body processes such as cell division. . neurological and mental diseases.

being angry.Pitta doshaP y Elements fire and water. y Pitta is upset by. or spending too much time in the sun. tired. for example. . or fearful. eating spicy or sour food. y People with Pitta are more susceptible to heart diseases and arthritis. y Control hormones and the digestive system.

and respiratory illnesses such as asthma. for example. . sleeping during the daytime.Kapha dosha y Elements water and earth y Help to keep up strength and immunity and to control growth y Aggravated by. eating too many sweet foods y People with kapha dosha are more susceptible to gallbladder problems. stomach ulcers.

inhalers) y Reduce symptoms: yoga. meditation y Eliminate both physical and psychological problems .. fasting. meditation. herbs with honey to improve digestion and reduce fever.Ayurveda (contd) y Treatment goals: y Eliminate impurities (Panchkarma): focuses on respiratory and digestive tract. (enema. y Reduce worry and increase harmony in the patient s life: yoga. breathing exercises etc.

Ayurveda (contd) y Some examples of use of plants y Spice turmeric is used in Rheumatoid arthritis. y A mixture (Arogyawardhini) of sulfur. Alzeihmer s disease and wound healing. . powdered dried fruits. tree root. iron. and other substances has been used to treat problems of the liver.

Unani medicine y It is influenced by Islam. y It has a base of honey which is considered to have healing properties and used in medicine and food practiced in Islamic world. y Based on theory of the presence of the elements (in Unani. water. . they are considered to be fire. earth and air) in the human body. y Pearls and metal are also used in making medicines.

bark. silver and iron powder are used. stem. . y Mainly developed by the Dravidians. y Still practiced in south India. root etc y Metals like gold. y Medicine is made of the parts of the plants and trees such as leaves. y Medicine professed and practiced by siddhas who wrote their recipes on Palm leaves.Siddha y Oldest medicine system in India.

. stimulating it to produce insulin in the natural way. in DM. y Maintains the ratio of Vata. the dysfunction of which is causing the disease.Siddha (contd) y Mode of action: y Revitalizes and rejuvenates the organs. which in turn maintains the blood sugar level. corrects the function of pancreas. e.g. y It works when Allopathy fails. Pitta and Kapha.

y Based on law of similars". . meaning similar.Homeopathy y Greek words homeo. (all effective drugs produce symptoms in healthy individuals similar to those of the diseases that they can treat). and pathos. meaning suffering or disease.

Arsenic) ± Unknown purities ± Reactions are not routinely monitored ± Dietary supplements can interact with prescribed medications ‡ Difficulty establishing reliability/efficacy .Problems encountered with use of CAM ‡ Safety risk ± Especially during pregnancy ± Ayurvedic treatments ‡ Heavy metals (Lead. Mercury.

Problems encountered with use of CAM ‡ Significant lack of evidence/research ± Speculative ± Small trials ± Often biased ‡ Financial motivations ‡ Lack of regulation ± Some with registered Osteopaths (GOsC) and Chiropractors (GCC) ± Remaining registration is voluntary .

Role of nurse
y y y y y y y y y y y y y Practitioner Training Referral Research Consistency of standards Dosing Controlling organization Drug interaction Adulteration Side effects and toxicity Patient motivation Check safety in pregnancy and lactation Appropriate documentation of care

Nursing theory providing context
y Alternative/complementary modalities performed from within a context of a nursing theory/model take on meaning from within the theory. y E.g. Roy adaptation model, deals with the concept of focal, contextual and residual stimuli. y Nurse working within the context of this, assesses the stimuli and takes action to promote the client s adaptation in physiologic needs, self-concept, role function, and relations of interdependence nursing health and illness.

Nursing theory providing context
‡ With regard to contextual stimuli, she uses Music therapy to change the environment and promote the client s adaptation to stressful situation.

g. ‡ Get instruction in these therapies before trying to administer them.Using Alternative & Complementary Therapies ‡ Have a non-judgmental attitude. . massage or guided imagery). ‡ Ask clients if they use nontraditional therapies. ‡ Discuss a therapy with the client before using it. ‡ Try one or two basic therapies (e.

TT Massage Art therapy Humor Rationale to decrease perceived pain to promote relaxation.Nursing taxonomy providing the context Nursing Diagnosis/concern Impaired Comfort Disturbed Sleep Pattern Impaired Communication Impaired Coping Nursing Intervention(s) Acupressure. to relieve tensions to facilitate a sense of inner peace Spiritual Distress Spiritual support . rest to facilitate expression to facilitate appreciation of that which is funny.

Current trends ‡ Mind/body medicine and research ‡ Holism and nursing practice .

± instrument of healing. the nurse enters into a relationship with the client and can be a: ± guide.Holism and Nursing Practice As a healing facilitator. . ± change agent.

Nurse as Instrument of Healing ‡ To serve in this capacity. ‡ Respect for differences. ‡ Intentionality (having conscious direction of goals). a nurse should develop the following attributes: ‡ Knowledge base. ‡ Ability to model wellness. .

What patients should be advised ‡ Discuss with doctor .some CAMs interfere with conventional therapy ‡ Ask ‡ ‡ ‡ ‡ ‡ ‡ what benefits can be expected What are the risks Do the benefits outweigh the risks What side effects Will it interfere with conventional therapy Is it part of a clinical trial if so who s the sponsor .

Summary ‡ Definition of CAM ‡ Types ‡ Role of nurse .

look at ways to improve their own lives and those of others by using a variety of alternatives to conventional medicine. including health care professionals.Conclusion ‡ Interest in complementary and alternative medicine (CAM) continues to grow as an increasing number of people. .

References www. 313-327 y Black and Hawks.com Kaplan and Sadock s. Elsevier. Alternative therapies. Medical Surgical Nursing. 10th edi. synopsis of psychiatry.com www. Clinical Management for positive Outcome.google. Psychiatric mental health nursing. 7th edition. page no. pg 839-56 y Barbara. Complementary and alternative medicine in psychiatry. page no. y Lippincot s Perspective for Nursing Practice 5 th edition. y y y y .nccam. 109-118.com www.pubmed. 12-30.

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