Week 13: Complementary and alternative therapies Flashcards Preview

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Flashcards in Week 13: Complementary and alternative therapies Deck (34):

an inappropriate patient for progressive relaxation

if your pt. has accute psychotic symptoms



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

  1. Natural Products
  2. Deep Breathing
  3. 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



  • 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?



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



  • 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



  • 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