Complementary+and+Alternative+Psychiatry

=Reading= Brousse AI, et al. Exercise and the treatment of clinical depression in adults. Sports medinie 2002

Kessler RC, et al. The use of complementary and alt therapies to treat anxiety and depression in the US. Am j of psych, 2001

=Goals=

2. The prevalence and patterns fo alternative therapy use in the treatment of aniety and depression
==3. Basic definitions, stheory, philosophy, and history of selected modalities used to teat patients suffering from aniety and/or depression: accupuncture, exercise therapy, hermbal treatments, journalling, meditation==

6. Know how notions, biases, expectations, and past experiences play a role nin selection of IM approahes
Makes use of all appropriate therapetic approaches, healthcare profesionals and disciplines informed by evidnece focuses on whoe person reeafferms importance f relationship between practitioner, pt
 * Integrative Medicine:**

depression/anxiety is second only to pain in use of alts are likely to also use conventional tx

most used modalities: 1) number 1: relaxation techniques 2) imagery 3) spiritual healing by others/energy healing 4) oral medication: herbs, supplements 5) physical treatments: exercise, massage, accupuncture

most studied: 1) st johns wort 2) exercise 3) kava kava 4) relaxation, meditation 5) accupuncture

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Dr. Venn listen for the unfolding of the story observing body language, demanor, emotion asking clarifying questions being present
 * Symptoms,their hx, severity
 * triggering events: current, past
 * perceived meaning of symptoms
 * feelings
 * motivation, interests, hopes, fear
 * sways of coping to current and past challenges
 * supports, relationshisp, resources, strengths
 * family hx, responses
 * treatment use, beliefs, preferences, goals

Mind-Body Therpaies:

Meditation Breathwork Hypnosis Guided imagery Support groups Autogenics EMDR Mindfulness based cognitive therapy Yoga Tai Chi Qi gong PMR Writing... (5 more items)

Selecting a MBT option: stress anagement vs facilitate emotional awareness for symptom relief
 * Goal:**

time commmitment Regulatirty, elf-care practice active vs quiet Indvidiual vs group experiential vs talk
 * Personal motivation:**
 * Personal motivation**
 * Therapy focus & context:**
 * Evidene for efficacy**
 * Availability**

What is our definnition of mediation Self-direct practice of internal attention directed to relasx body and calm mind from discursive thoughts

zen, transcendental meditation paying internatl attention to 'what is' in our mind without jugement or attachment e.g., mindfulness, vipassana
 * concentration practice: directing attention to the present by focusing on particular objects...breath, sound, image
 * awareness practices...

practice implications; emotional regualtion, insidght, conscious attention, psoitve mood enhancement, connection

'mindfulness-based stress reduction MSBR: meditaiton, yoga, imagery, education 7 days or 8 weeks, 2 hrs 20-45 min daily practice benefits for chronic pain QOL anxiety, panic depression, symptoms cancer patient symptoms meta-analysis: medium strong effect Jon-Kabat Zinn, UMASS

Cognitive-behavioral therapies four basic components: not necessarily a CAM/integrative...more mainstream
 * individual or group based...
 * identifies patterns of egative cognitions nad attitudes to facilitate adaptive houghts, emotions,actions
 * education
 * skills acquidition
 * cognitive and behavioral rehersal
 * generalization and maintenance
 * strong research basis for efficacy

Relaxation/stress reductio groups 1) cognitive-behavioral 2) relaation, imagery, meditation both mutli-modal MBBSG: mslal groupp format: 8-12wks, 1x/week, 2 hrs cultaivate attention to internal emotional processes that arise for exerience, self-discovery emphasis onself-care and home rpactice researcH: PTSD, women with abuse, college sutdents Center for Mind-boyd medicing: Dr. James Gordon

Mindfullness-based cognitive therapy.... Elements of MBSR and CBT Segal, WIlliams & Teasdale, 2002 formerly called 'attentional control training focus; preventing of relaps of major depression assumptionL; ppay close attention to thoughts before they spiral downward. 5 more lines

Other techniques...Writing Journalling Decade oflab-based research.... writing 15 ins, trauatic avvent pennebaker college age, chronic illness find meaning in emotions, thoughts find improved immune, mood also benefits in breastCa pts, others many techniques

Yoga Exercise 15 million participate Hatha Yoga 4000 years old...3 components: asnaa, pranayama, dyana schools, Iyengar, Vinigyoga, Ashtanga... also Bikram, anasura, kundalini, Kriya Evidnece for depression all positive....

Meditation, yoga class journalling: what or who inspired you what or who moved you what or who surprised you books other non-MBT life coaching

herbs St. John's wort Meta-analysis: mild-mod depression superior to placebo as affective as TCAs, fewer side effects than TCAs dose: 0.4-2.7 mg Hypericin various metanalysis show a significant effect 36 randomized controlled trials Dose: 900 mg SJW extract...300x3, 450x2, etc Side effects Theoretical risk: sunburn...based off what happens to cows. Interactions: Ramps up action of CP450 digoxin, TCAs, protease inhibitors case reports of cyclosporine, warfarin, oral contraceptives, theophylline, SSRIs Theoretical: iron Review of Natural Products, Dec 2000

Kava-Kava Root of plant grown in pacific islands 60-210 kavalactones reduce anixty induce sleep fat-soluble metanlysis...only 6 RCT 3x more likely would be helped with Kava-Kava vs placebo significantly better scores...more effective in females, younger pts

Toxicology Side effects: headache, dry skin dermopathy, GI allergic rashes 3 cases of dystonic reactions 25 cases of liver toxicity

S-adenosylmethionine for depression, osteoarthritis, fibromyalgia methyl donor on paths of monoamines, neurotransmitters, phospholipids 200-800 mg 2x/day or lower dose meta-analysis: superior to placebo, equal to TCAs SE: flatulence, vomiting, diarrhea, aniety, hypomania if used w other antdepressant-> serotonin syndrome

Folate & Viamin B12 levels low in 1/3 of depressed persons methyl donors, SAM3 high dose of folate: alter sleeppattern, vivid dreaming, irritability, seizure, gGI disturbance, bitter taste in mouth

Vitamin B6: low in depressed patients especially if taking estrogens rationale: essential in serotonin syntehsis Vitmin B complex 100--100mg of all major B vitamins >200mg qd -> neurotoxicity-abnormal sensations in hands, legs

5-HTP intermediate on pathway of tryptophan to serotonin, 70% conversion will cross BBB, increase serotonin inbody, endorphins, catecholamines 100-200 mg 3x/day as effective as SSRIs, TCAs ?? eosinophilia myalgia syndrome avoid use w other antidepressants --> serotonin syndrome

Serotonin syndrome: mentals tatus changes-agitation autonomic hyperactivity: hyperthermia, dilated pupils, dry mucus, increased bowel sounds, flushed skin, diaphoresis neuromuscular tremors, hyperreflexia, muscle rigidity

Dr. Dopp Child and adolescent fellow

depression in adults physica acitivty sleep depression phys activity sleep phys actiivty, mood

lifetime prevalence of MDD in community: 17% more comon in medical pts cardiovascualar disease, diabetes pts 2x more likely to be epressed obesity, chronic pain also affects immune system

adolescents: prevalents 8.3% by age 18, on out of four will have at least one depressive episode before puberty, equale prevallence; by age 18, males 2:1 females

physical actiity....decrease levels of physical actiities over time... males more likely to stay active

levels of physical activity in adolescence are good predcotrs for phys activity in adulthood adults with depression show abnormalities in non-REM sleep and REM sleep shorter REM latencies reduces slow-wave sleep increased fragmentation want to hit REM later in sleep

abnormalities in depressed children: sleep EEG, ultradian rhythms are abnormal low temporal coherence.....lack of synchronization between right and left hemispheric EEG rhythms predicted those youth at risk for developing a major depressive episode

persistent sleep disturbance indicates poor prognosis for sleep

physical activity and sleep: incrase in total sleep time incrase amount of slow-wave sleep prolonged REM latency should be at least 6 hr prior to going to bed moderators of theis effect include tmeperature....etc

Among insomniacs....<4h sleep per night sleep hygiene alone...-3 mintes sleep hygiene and light therapy: +17 minutes sleep hygien and brisk walk...+54 minutes interventions w/ exercise show better aid to sleep

cognitive behavioral change self-efficacy theory social-interaction hypothesis

neurobiolgical theory... increase in opiate receptor occupancy in rat brain following physical activity...pert et alia, 1979

incrase in steady-state levels of brain NE in physically active rats

increase in brain-derived neurotrophic factor in rats neuronal connectivity, brain plasticity-increase following physical activity Oliff et alia, 1998

increase in secretion of amine metabolites in depressed huans when they engage in physical activity increase in geriatric cognitive function

145 m&w >50 with mild/moderate depression were randomized to aerobic exercise, zoloft, or commbination...exercise as effective as zoloft

what does is necessary: How much activity do you need to do?

public health dose group...standards of treatment...going for 35 minute walk vs 35 minute run sinificantly mre improvement in depressive symptoms 3 vs 5 times per week: no difference no change in isolation vs group exercise

observational studies in mood and physical activity in adolescents no randomized controlled trials in depressed adolescents yet moderate involvement in sports correlates with lower depression levels

recommend exercise prescriptions for exercise refer to MFit More research

<> SamE 5HTP Jazzercise Didn't do it, felt guilty spiritually: metaphysical views of life