Week 13: Complementary and alternative therapies

Question 1

an inappropriate patient for progressive relaxation

Answer 1

if your pt. has accute psychotic symptoms

Question 2

CAM

Answer 2

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)

Question 3

Most usually treated problems with alternative medicine are?

Answer 3

• anxiety and depression
• pain

Question 4

Safety with CAM

Answer 4

• 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

Question 5

National Center for Complementary and Alternative Medicine (NCCAM)

Answer 5

• Whole medical systems
• Mind-body interventions
• Biologically based therapies
• Manipulative and body-based methods
• Energy therapies

Question 6

whole medical systems

Answer 6

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

Question 7

Mind-Body Interventions are and include?

Answer 7

Techniques facilitate mind’s capacity to affect body function and symptoms

• Meditation
• Hypnosis
• Prayer
• Art
• Music
• Dance

Question 8

Biologically Based Therapies

Answer 8

Naturally based products, some overlap with conventional medicine’s use of dietary supplements

• Herbal
• Dietary exclusions and additions
• Aromatherapy

ex: macrobiotics

Question 9

Body Based Methods

Answer 9

Based on manipulation and/or body movement

• Chiropractic
• Massage
• Reflexology
• Yoga
• Tai Chi
• Qigong
• Movement Therapies

Question 10

Energy Therapies

Answer 10

Focused on biofields or electromagnetic fields

• Therapeutic Touch
• Electromagnets

Question 11

most common complemetary approaches in adults

Answer 11

1. Natural Products
2. Deep Breathing
3. Meditation

Question 12

CAM Assumptions

Answer 12

• 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

Question 13

Ethics

Answer 13

• Credentials and expertise of practitioner
• Communication between CAM and traditional health care providers
• Nurses need to inquire about premorbid or comorbid use
• Nonjudgmental approach

Question 14

Drug Interactions

Answer 14

• 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

Question 15

Patient Safety Concerns

Answer 15

• Masking signs and symptoms
• Delay of effective treatment
• Harmful interactions
• Purity and potency unregulated
  
  • www.fda.gov

Question 16

Non-traditional therapies for depression

Answer 16

• exercise
• acupuncture
• meditation
• yoga
• massage
• light therapy
• guided imagery

Question 17

Acupuncture how it may work?

Answer 17

• 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

Question 18

Mindfulness-Based Cognitive Therapy

Answer 18

• Meditation to deal with negative thinking
• Teaching viewing events
• Evidence supports lifting of depressive symptoms

Question 19

Meditation Effects: suggest supervision due to?

Answer 19

potential stimulating effect, which could evoke mania

Question 20

Yoga/Meditation effects

Answer 20

• 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

Question 21

St. John’s Wort evidence of efficacy with? Potentially dangerous effects?

Answer 21

• 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.

Question 22

Melatonin effects?

Answer 22

• 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

Question 23

In an older pt., St. John’s wort “wash out” will be longer or shorter?

Answer 23

longer

Question 24

Exercise benefits?

Answer 24

• benefits to physical and mental health
• decrease in tension
• increase in energy

Question 25

Omega-3 Essential Fatty Acids effects?

Answer 25

* reduction of depressive disorders when used with traditional antidepressants

Question 26

Massage effects

Answer 26

* Reports of improved mood, increased feelings of well being * Effects are short term * Few empirical studies

Question 27

Light therapy treatment of and effects?

Answer 27

* Phototherapy effective treatment of Seasonal Affective Disorder * Disruption of circadian rhythms due to low light levels

Question 28

Anxiety and depression are often?

Answer 28

often comorbid, many therapies the same

Question 29

Relaxation Techniques with anxiety

Answer 29

* Progressive muscle relaxation * Sleep hygiene methods

Question 30

energy therapies with anxiety

Answer 30

* Therapeutic touch, Reiki, Tai Chi, qigong * Limited evidence in the literature

Question 31

Kava

Answer 31

* 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

Question 32

Valerian

Answer 32

* Used to combat insomnia * Potentiates other CNS depressants

Question 33

Ginkgo Biloba and it's role with dimensia?

Answer 33

* 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

Question 34

Can nurses prescribe and implement complementary therapies?

Answer 34

* Yes. Be careful to only suggest if you're in concert with the interdisciplinary care team