Complementary and Alternative Medicine Usage for Behavioral Health Indications

The impact of myo-inositol supplementation on sleep quality in pregnant women: a randomized, double-blind, placebo-controlled study

BACKGROUND

Myo-inositol, a glial marker which plays a critical role in some brain regions, can supposedly affect sleep processes. The purpose of randomized controlled trial was to evaluate the impact of myo-inositol supplementation on sleep quality of pregnant women.

METHODS

The study enrolled 60 women with low risk singleton pregnancies, with a gestational age of at least 14 weeks, in Iran. The participants were block randomized to receive myo-inositol supplementation powder containing 2000 mg of myo-inositol and 200 μg of folic acid or placebo (400 μg of folic acid) for 10 weeks from the gestational age of 14-24. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). The primary outcome was the change in sleep quality from the first trimester to the second trimester (24-28 weeks). The ANCOVA with adjusted covariate variables in the first trimester was conducted to estimate the sleep quality between the two groups.

RESULTS

The results of ANCOVA boot strapped showed that the mean difference of the total sleep quality score between the two groups was -1.537; 95% CI: -3.050 to -0.024, p = .047) in the second trimester at immediately post-intervention. Also, there were significant differences between the two groups in terms of subjective sleep quality (MD: -0.427; 95% CI: -0.725 to -0.128, p = .006, sleep duration (MD: -0.670; 95% CI: -1.240 to -0.101; p = .022) and habitual sleep efficiency (MD: -0.561; 95% CI: -1.038 to -0.085, p = .022).

CONCLUSION

The research confirmed that myo-inositol supplementation can improve global sleep quality, subjective sleep quality, and sleep duration during pregnancy. Therefore, these findings applied to minimize the rate of poor sleep quality in pregnant women.

Autism Spectrum Disorders: Potential Neuro-Psychopharmacotherapeutic Plant-Based Drugs

Over the years, scientific researches have validated the healing benefits of many psychopharmacotherapeutic plant-based drugs to ameliorate psychiatric disorders. In contrast, the use of chemical procedures to isolate and purify specific compounds from plants that have been used to treat autism spectrum disorders (ASDs) and its clinical features may contribute to improve the quality of life of many patients. Also, herbal pharmacological treatments could improve the core symptoms of autism with fewer side effects. This review will focus on the uses and actions of phytopharmaceuticals in the behavioral conditions of ASDs. A large number of natural compound-based plant drugs have been tested in murine models of autism and in clinical trials with remarkable success in reversing the core and associated behaviors with autism such as flavonoids, cannabinoids, curcuminoids, piperine, resveratrol, and bacosides. This plant-based drug alternative is safer given that many psychiatric disorders and neurodegenerative pathologies do not often respond well to currently prescribed medications or have significant side effects. However, it is noteworthy to consider the need for large clinical trials to determine safety and efficacy. Many results are based on case reports or small size samples, and often the studies are open label. Standardization of procedures (i.e., purity and concentrations) and quality controls are strictly required to ensure the absence of side effects.

Complementary Therapies for Mental Health Disorders

Approximately 18% of the US adult population has a mental illness, yet only 13% with mental illness receive any treatment. Although pharmacotherapy and psychotherapy are the mainstays of treatment, treatment discontinuation and failure are common. Skepticism toward such treatments has fueled interest in and use of complementary therapies, such as acupuncture, meditation, and natural products. Many medical providers are unaware of the use of these therapies by their patients, and knowledge of the evidence base for these therapies is often lacking. This article presents current evidence-based recommendations for complementary therapies in the treatment of depression, anxiety, and posttraumatic stress disorder.

Pharmacological evidence of neuro-pharmacological activity of Acacia tortilis leaves in mice

Acacia tortilis is abundantly present in Saudi Arabia but its neuro-pharmacological activity has not yet been evaluated. In this study, the antidepressant by Forced swim test, Anxiolytic (Light and Dark box) and sedative effects (by using Open Field) of Acacia leaves extract were evaluated in mice. Aqueous extracts of the Acacia tortilis leaves were prepared. Two different doses (400 and 800 mg/kg) of the extracts were administered to the mice orally (p.o.). In exploratory behavior, Acacia leave extract (800 mg/kg) produced a significant reduction (Veh, 91.00 ± 5.26; Acacia 800 mg/kg, 46.33 ± 3.24 p < 0.05) similar to the effect observed with chlorpromazine (CPZ) (Veh, 91.00 ± 5.26; CPZ 1.0 mg/kg, 24.20 ± 3.40 p < 0.05). A dose-dependent significant decrease in immobility time was also observed in mice and this effect was comparable to its positive control (Imipramine). However, In light-dark box test, mice treated with high dose (800 mg/kg/day) spent significant (p < 0.05) time on the light side of the light-dark box similar to positive control DZP. (Veh, 114.40 ± 6.30 s; Acacia 800 mg/kg, 162.2 ± 14.9; DZP 1.0 mg/kg, 184.20 ± 9.24 p < 0.05). The present research propounded that Acacia tortilis leave extract contains some active ingredients with potential anxiolytic activity at low doses and antidepressant and sedative activity at high doses.

Hyperactivity, concentration difficulties and impulsiveness improve during seven weeks' treatment with valerian root and lemon balm extracts in primary school children

BACKGROUND

Valerian root and lemon balm extracts have previously shown efficacy and excellent tolerability in children<12 years suffering from restlessness and insomnia. We now examined whether treatment with a fixed combination of both may also improve concentration, hyperactivity and impulsiveness.

METHODS

169 primary school children suffering from hyperactivity and concentration difficulties but not meeting ADHS criteria were treated in an observational study by 27 office based pediatricians with a recommended daily dose of 640 mg valerian root extract WS(®) 1014 and 320 mg lemon balm extract WS(®) 1303 (Sandrin(®)), and evaluated by pediatricians and parents using standardized questionnaires at baseline, weeks 2 and 7.

RESULTS

The fraction of children having strong/very strong symptoms of poor ability to focus decreased from 75% to 14%, hyperactivity from 61% to 13%, and impulsiveness from 59% to 22%. Parent rated social behavior, sleep and symptom burden showed highly significant improvements. Only in two children mild transient adverse drug reactions were observed.

CONCLUSION

In primary school children with restlessness, concentration difficulties and impulsiveness treatment with WS(®) 1014 and WS(®) 1303 (Sandrin(®)) provides a viable option in addition to counseling and education.

The chiropractic care of a child with extremity tremors concomitant with a medical diagnosis of conversion disorder

OBJECTIVE

To describe the care of a patient with spinal and cranial dysfunctions and medically diagnosed with conversion disorder.

CLINICAL FEATURES

The patient was an 11-yr-old girl presented by her parents with complaints of uncontrollable tremors of both arms and right leg. Conversion disorder was diagnosed following negative examination findings for an organic etiology. Prior to institutionalization, her parents requested a "second opinion" from a clinical psychologist that eventually led to chiropractic referral.

INTERVENTION AND OUTCOME

Care was provided using spinal manipulation to sites of spinal and cranial dysfunctions. With subsequent visit, the patient's tremors improved. Following 12 chiropractic visits, the patient's symptoms resolved. Long-term follow-up revealed continued resolution of the symptoms of tremors.

CONCLUSION

This case report provides supporting evidence that patients with ballistic tremors of possible unknown organic etiology may benefit from chiropractic care. We support further research in this field.

Potential pharmacokinetic interactions between antiretrovirals and medicinal plants used as complementary and African traditional medicines

The use of traditional/complementary/alternate medicines (TCAMs) in HIV/AIDS patients who reside in Southern Africa is quite common. Those who use TCAMs in addition to antiretroviral (ARV) treatment may be at risk of experiencing clinically significant pharmacokinetic (PK) interactions, particularly between the TCAMs and the protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Mechanisms of PK interactions include alterations to the normal functioning of drug efflux transporters, such as P-gp and/or CYP isoenzymes, such a CYP3A4 that mediate the absorption and elimination of drugs in the small intestine and liver. Specific mechanisms include inhibition and activation of these proteins and induction via the pregnane X receptor (PXR). Several clinical studies and case reports involving ARV-herb PK interactions have been reported. St John's Wort, Garlic and Cat's Claw exhibited potentially significant interactions, each with a PI or NNRTI. The potential for these herbs to induce PK interactions with drugs was first identified in reports of in vitro studies. Other in vitro studies have shown that several African traditional medicinal (ATM) plants and extracts may also demonstrate PK interactions with ARVs, through effects on CYP3A4, P-gp and PXR. The most complex effects were exhibited by Hypoxis hemerocallidea, Sutherlandia frutescens, Cyphostemma hildebrandtii, Acacia nilotica, Agauria salicifolia and Elaeodendron buchananii. Despite a high incidence of HIV/AIDs in the African region, only one clinical study, between efavirenz and Hypoxis hemerocallidea has been conducted. However, several issues/concerns still remain to be addressed and thus more studies on ATMs are warranted in order for more meaningful data to be generated and the true potential for such interactions to be determined.

Use of complementary and alternative medicine in a large sample of anxiety patients

OBJECTIVE

To examine a large sample of patients with anxiety and the association between types of complementary and alternative treatments that were used, demographic variables, diagnostic categories, and treatment outcomes.

METHOD

Cross-sectional and longitudinal survey during the Coordinated Anxiety Learning and Management (CALM) study that assessed this intervention against the Usual Care in a sample of patients with anxiety recruited from primary care. Interviewer-administered questionnaires via a centralized telephone survey by blinded assessment raters. The interviews were done at baseline, 6, 12, and 18 months of the study. A total of 1004 adults ages 18-75 who met DSM-IV criteria for Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, or Post-Traumatic Stress Disorder. We assessed medication/herbal use, the use of any alternative therapies, and combined Complementary and Alternative Medicine (CAM) use.

RESULTS

We found an extensive (43%) use of a variety of CAM treatments that is consistent with previous study results in populations with anxiety. Only a few significant demographic or interventional characteristics of CAM users were found. Users most often had a diagnosis of GAD, were older, more educated, and had two or more chronic medical conditions. CAM users who had a 50% or more drop in anxiety scores over 18 months were less likely to report continued use of alternative therapies.

CONCLUSIONS

The study confirms the importance of awareness of CAM use in this population for possible interference with traditional first-line treatments of these disorders, but also for finding the best integrative use for patients who require multiple treatment modalities.

A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder

Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.

Advances in the treatment of attention-deficit/hyperactivity disorder: a guide for pediatric neurologists

The purpose of this article is to assist pediatric neurologists in practice and in training to better understand and distinguish between several of the most commonly prescribed treatments for attention-deficit/hyperactivity disorder (ADHD) in school-aged children. Among the various pharmacotherapies available for ADHD, 4 specific medications will be reviewed: oral release osmotic system methylphenidate hydrochloride (CON; Concerta, McNeil Pharmaceuticals), lisdexamfetamine dimesylate (LDX; Vyvanse, Shire Pharmaceuticals), atomoxetine (ATX; Strattera, Eli Lilly), and guanfacine extended-release (GXR; Intuniv, Shire Pharmaceuticals). This article contains information including medication-release pattern, administration including available dosing, adverse reactions, and case studies to serve as a guide to help determine when a particular treatment might be more appropriate than another. Although ADHD is apparent across the lifespan, this article will focus on children with ADHD from ages 6 to 12 years old. Importantly, although a number of stimulant and nonstimulant treatment options are available for school-aged children diagnosed with ADHD, choosing the best treatment options is highly dependent on obtaining thorough family and medical histories.

Complementary therapies in healthcare: design, implementation and evaluation of an elective course for undergraduate students

Complementary therapies are making a significant and cost effective contribution to the health of the community, especially in relation to chronic disease management and prevention of disease. Because of the increased use of complementary therapies, nurses, and other health professionals need to be familiar with specific practices so that they can assist clients to make informed decisions in the use of these therapies. Importantly, with the increased interest in complementary therapies, there is a need to ensure these practices are safe, cause no harm and are used to enhance the well-being of patients. This paper reports on the design, implementation and evaluation of a complementary therapies course and a linked Thai cultural studies tour. The course was implemented at The University of Newcastle for the first time in 2009 with an enrollment of 200 students. It is an elective course for both nursing students and those from other disciplines. In this paper we describe the reasons for the introduction of this course and its value in nursing education. We then provide an overview of the course and report on evaluation results from both the course and the Thai cultural studies tour.