Hagen Rampes

Yoga for anxiety: a systematic review of the research evidence

Between March and June 2004, a systematic review was carried out of the research evidence on the effectiveness of yoga for the treatment of anxiety and anxiety disorders. Eight studies were reviewed. They reported positive results, although there were many methodological inadequacies. Owing to the diversity of conditions treated and poor quality of most of the studies, it is not possible to say that yoga is effective in treating anxiety or anxiety disorders in general. However, there are encouraging results, particularly with obsessive compulsive disorder. Further well conducted research is necessary which may be most productive if focused on specific anxiety disorders.

Acupuncture for anxiety and anxiety disorders - a systematic literature review

Introduction The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxiety disorders by systematic review of the relevant research. Methods Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made to identify unpublished research. No language restrictions were imposed and translations were obtained where necessary. Study methodology was appraised and clinical commentaries obtained for studies reporting clinical outcomes. Results Twelve controlled trials were located, of which 10 were randomised controlled trials (RCTs). Four RCTs focused on acupuncture in generalised anxiety disorder or anxiety neurosis, while six focused on anxiety in the perioperative period. No studies were located on the use of acupuncture specifically for panic disorder, phobias or obsessive-compulsive disorder. In generalised anxiety disorder or anxiety neurosis, it is difficult to interpret the findings of the studies of acupuncture because of the range of interventions against which acupuncture was compared. All trials reported positive findings but the reports lacked many basic methodological details. Reporting of the studies of perioperative anxiety was generally better and the initial indications are that acupuncture, specifically auricular acupuncture, is more effective than acupuncture at sham points and may be as effective as drug therapy in this situation. The results were, however, based on subjective measures and blinding could not be guaranteed. Conclusions Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies.

Lithium: a review of its metabolic adverse effects.

Treatment with lithium has long been recognized to be associated with metabolic adverse effects notably hypothyroidism, hyperparathyroidism, weight gain and nephrogenic diabetes insipidus. It is important that clinicians prescribing lithium are aware of these adverse effects and have a strategy for their detection and management. We review aspects of these actions of lithium including their prevalence, risk factors, biochemical changes involved and management, and discuss some advances that have been made in their understanding in recent years.

Complications of acupuncture

Acupuncture as a treatment modality is now more widely used by the medical profession. It behoves both practitioners and patients to be aware of possible complications, the majority of which can be avoided with cautious and prudent use of this ancient therapy. There have been many isolated reports of complications of acupuncture in the literature. We surveyed the literature identifying all articles referring to complications of acupuncture. Our findings are presented and discussed.

Complementary medicine for depression

Surveys have demonstrated that complementary medicine use for depression is widespread, although patterns of use vary. A series of systematic reviews provide a summary of the current evidence for acupuncture, aromatherapy and massage, homeopathy, meditation, reflexology, herbal medicine, yoga, and several dietary supplements and relaxation techniques. The quantity and quality of individual studies vary widely, but research interest in complementary therapies is increasing, particularly in herbal and nutritional products. Major questions are still to be answered with respect to the effectiveness and appropriate role of these therapies in the management of depression. Areas for further research and some of the potential challenges to research design are discussed. Finally, several ongoing developments in information provision on this topic are highlighted.

Clozapine-induced type-2 diabetes mellitus: possible mechanisms and implications for clinical practice

The atypical antipsychotic clozapine has been reported to be associated with metabolic adverse effects, including type-2 diabetes mellitus. We present two cases of diabetes mellitus associated with clozapine treatment. One case resolved entirely upon withdrawal of the drug, whereas the other did not. We discuss the molecular basis of the diabetogenic action of clozapine and recommendations for monitoring.

Review of acupuncture for schizophrenia

There is a paucity of scientific data on the use of acupuncture or low-power laser treatment in schizophrenia. The authors have conducted a literature search, identifying eight papers on the subject: all were significantly flawed, most seriously so. The papers suggest that acupuncture and low-power laser treatment may be as effective as chlorpromazine in schizophrenia. However no scientifically sound conclusions can be drawn. Better designed research is required before acupuncture can be considered a suitable treatment for schizophrenia.

Antipsychotic Induced Prolongation of QTc Interval Treated with Magnesium

We report the case of a patient on antipsychotic medication, who developed an abnormal QTc interval, which normalized following treatment with oral magnesium sulphate.

Acupuncture in the treatment of depression: a manual for practice and research

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