Week 13: Complementary and alternative therapies Flashcards
an inappropriate patient for progressive relaxation
if your pt. has accute psychotic symptoms
CAM
Complementary and Alternative Medicine
- Healing approaches focus on the whole person- biopsychosocial and spiritual care
- Alternative medicine (outside traditional western medicine approaches)
- Combination alternative therapies ( mixing of traditional with non-traditional)
- Complementary or integrative medicine (combined with traditional therapies)
Most usually treated problems with alternative medicine are?
- anxiety and depression
- pain
Safety with CAM
- Combination of herbal preparations and conventional medications
- Lack of quality control (not managed by the FDA)
- Unfounded claims about safety and effectiveness
- Public view as safe and harmless
National Center for Complementary and Alternative Medicine (NCCAM)
- Whole medical systems
- Mind-body interventions
- Biologically based therapies
- Manipulative and body-based methods
- Energy therapies
whole medical systems
Evolved independently of conventional medical approach
- _Traditional Oriental medicine: _oldest, accupunture, massage, herbal approaches
- Ayurveda: 3,000 years old based in asian/indian culture. Used extensively in Indian medical system. Disease approach uses herbs and preparatinos. Be careful bc some are actually toxic. Universal interconnectedness. Body systems are organized (like greek system).
- Homeopathy: Treat a like problem with a like substance (like allergy shots). Treat milk allergy with a tiny amount of milk protein progressively in a pill until they tolerate it.
- Naturopathy: Based on principles that are similar to primary care medicines. “Do no harm” by avoiding harmful side effects of any substance. Used physician as a teacher. Treats whole person. Concentrated on prevention, healing power of nature, and causes of a disease or condition rather than symptoms. Ex: nutrition counseling, use of vitamins and minerals, other supplements and herbal medicines
Mind-Body Interventions are and include?
Techniques facilitate mind’s capacity to affect body function and symptoms
- Meditation
- Hypnosis
- Prayer
- Art
- Music
- Dance
Biologically Based Therapies
Naturally based products, some overlap with conventional medicine’s use of dietary supplements
- Herbal
- Dietary exclusions and additions
- Aromatherapy
ex: macrobiotics
Body Based Methods
Based on manipulation and/or body movement
- Chiropractic
- Massage
- Reflexology
- Yoga
- Tai Chi
- Qigong
- Movement Therapies
Energy Therapies
Focused on biofields or electromagnetic fields
- Therapeutic Touch
- Electromagnets
most common complemetary approaches in adults
- Natural Products
- Deep Breathing
- Meditation
CAM Assumptions
- Need for maintenance of balance within biopsychosocial and spiritual systems
- Individual is an open system exchanging energy with the environment to maintain balance
- Illness = energy imbalance
- Adaptation is synonymous with health
Ethics
- Credentials and expertise of practitioner
- Communication between CAM and traditional health care providers
- Nurses need to inquire about premorbid or comorbid use
- Nonjudgmental approach
Drug Interactions
- Ginkgo biloba interacts with warfarin or aspirin
- St. John’s Wort lowers blood levels of protease inhibitors (HIV drugs).
- Herbal products metabolized by same cytochrome enzyme system as psychotropics may increase or decrease therapeutic drug levels of psychotropics
Patient Safety Concerns
- Masking signs and symptoms
- Delay of effective treatment
- Harmful interactions
- Purity and potency unregulated
- www.fda.gov
Non-traditional therapies for depression
- exercise
- acupuncture
- meditation
- yoga
- massage
- light therapy
- guided imagery
Acupuncture how it may work?
- Needles inserted into acupoints located along body meridians to restore energy balance
- May stimulate synthesis and release of endorphins, serotonin, norepinephrine
- RCT support effectiveness in improvement or depression rating scale scores
Mindfulness-Based Cognitive Therapy
- Meditation to deal with negative thinking
- Teaching viewing events
- Evidence supports lifting of depressive symptoms
Meditation Effects: suggest supervision due to?
potential stimulating effect, which could evoke mania
Yoga/Meditation effects
- Antidepressant and stress reduction effects
- Increase focus, attention, and self regulation
- Breathing techniques may be associated with vagus nerve stimulation and balancing of the autonomic nervous system
St. John’s Wort evidence of efficacy with? Potentially dangerous effects?
- Some evidence of efficacy when compared to placebo in patients with depressive disorder
Potentially significant and dangerous
- Interferes with post transplant antirejection drugs, oral contraceptives, statins, protease inhibitors, antineoplastics, antiretrovirals, anticonvulsants. Digoxin, theophylline, SSRIs, anticoagulants
- Two week “wash out” is recommended before starting another antidepressant.
Melatonin effects?
- Used to promote sleep
- May be used to decrease need for benzodiazepines
- May improve sleep in older adults without postural effects, or change in mental status
- May decrease therapeutic effects of antidepressants and benzodiazepines
In an older pt., St. John’s wort “wash out” will be longer or shorter?
longer
Exercise benefits?
- benefits to physical and mental health
- decrease in tension
- increase in energy
Omega-3 Essential Fatty Acids effects?
- reduction of depressive disorders when used with traditional antidepressants
Massage effects
- Reports of improved mood, increased feelings of well being
- Effects are short term
- Few empirical studies
Light therapy treatment of and effects?
- Phototherapy effective treatment of Seasonal Affective Disorder
- Disruption of circadian rhythms due to low light levels
Anxiety and depression are often?
often comorbid, many therapies the same
Relaxation Techniques with anxiety
- Progressive muscle relaxation
- Sleep hygiene methods
energy therapies with anxiety
- Therapeutic touch, Reiki, Tai Chi, qigong
- Limited evidence in the literature
Kava
- May take up to two weeks to begin effects on anxiety. Relaxing in ways similar to alcohol
- Overuse or combined with alcohol may produce toxic liver damage
Valerian
- Used to combat insomnia
- Potentiates other CNS depressants
Ginkgo Biloba and it’s role with dimensia?
- May act by dilating blood vessels to increase blood supply, reducing viscosity
- May have effect on neurotransmitters
- May interfere with anticoagulants and ASA to increase bleeding risk
- GI side effects are difficult
Can nurses prescribe and implement complementary therapies?
- Yes. Be careful to only suggest if you’re in concert with the interdisciplinary care team
