Complementary and alternative medicine (CAM) refers to practices that are different from conventional Western medicine. CAM includes mind-body interventions like meditation, biologically based therapies using herbs, and body-based methods like acupuncture, yoga, and massage. National research centers study CAM practices to evaluate safety and effectiveness. While some CAM therapies show promise for treating mental health conditions, scientific evidence is still limited for most. Integrative psychiatry selectively incorporates CAM into conventional treatment by taking a holistic approach and addressing lifestyle factors.

1. C
COMPLEMENTARY
&
ALTERNATIVE MEDICINE
IN
PSYCHIATRY
DR SHUBHIKA AGGARWAL PGJR1 SMS&R

2. • The term complementary
and alternative medicine
(CAM) refers to the various
disease- treating or disease
preventing practices whose
methods and efficacies differ
from traditional or
conventional biomedical
treatment
• Other terms- integrative
medicine and holistic
medicine

3. National Centre for Complementary and
Alternative Medicine (NCCAM)
• It isthe US Government's agency forscientific
research on complementary and alternative
medicine (CAM)
• Mission: - Is to evaluate the usefulness and
safety of a broad range of nonorthodox
healing practises, train CAM researchers
and disseminate information
• IBAM- A Internationally Recognized
Government Institution of CAM providing
world-wide research in the field of
complementary and alternative medicines

4. NCCAM classifies CAM therapies into
•Whole Medical Systems: – Built upon complete systems of theory and practice
•Mind-Body Interventions - Technique designed to enhance the mind's capacity to affect
bodily function and symptoms
•Biologically Based Therapies: - Substances found in nature are used
•Manipulative and Body based methods- Manipulation or movement of one or more
parts of the body
• Energy Medicine - Healers can channel healing energy into a patient

6. • Acupuncture and acupuncture are Chinese
healing techniques
• Two opposing energy fields (yin and yang ) must
be in balance for health to be sustained
• Acupressure- acupoints are manipulated by
fingers
• Acupuncture- Sterilized gold or silver needles
are inserted into skin to varying depths and are
rotated for varying periods
• In the West, explained on the basis of nerve
stimulation that releases endogenous NTs,
endorphins
• Pain management, headache, depression,
substance abuse, insomnia, anxiety

7. • Ayurveda means “knowledge of life”
• Technique originated in India about 3000 B.C.
• A vital force(prana) must be in balance to maintain
the health
• Ayurveda has eight ways to diagnose illness, called Nadi
(pulse), Mootra (urine), Mala(stool), Jihva (tongue),
Shabda (speech), Sparsha (touch), Druk (vision), and
Aakruti (appearance)
• Ayurvedic practitioners approach diagnosis by using
the five senses
• Treatment relies on diet, medicinal herbs
• Researchers have studied Ayurvedic approaches for schizophrenia; however, scientific
evidence for its effectiveness is inconclusive

9. • It is based on the premise that when someone works creatively
under the guidance of a qualified therapist, they become
more expressive and communicative
• Music therapy: - It is use of music to accomplish individualized
goals within a therapeutic relationship by a professional
• Art therapy: - A mental health professional uses this creative
process to improve and enhance the physical, mental, and
emotional wellbeing of individual
• Drama therapy: - Use this to achieve therapeutic goals
• Dance therapy: - The psychotherapeutic use of movement
which furthers the emotional, cognitive, physical and social
integration of the individual

10. • In dementia regular singing, engaging in
d a n c e therapy, listening to music, an d
participating in musical games improve
cognitive a n d behavioural functioning in
individuals with severedementia.
• They also experienced reduced
agitation, irritability & wandering,
enhanced social interaction m o o d &
cooperative behaviour

11. modifications
• ↓ refined sugar and caffeine→ improves mood in some
depressed patients
• Caffeine→ general feelings of "nervousness"
• Atkins Diet – low carb, high protein diet has proved effective in
short term weight loss. Also been used to
treat refractory childhood epilepsy

12. • A number of nutrients, particularly vitamins, influence mood
• Low levels of folate cause nonresponse to antidepressants
• Folate deficiency associated with psychosis, agitation, dementia
• In both men and women, improved mood was associated with
levels of vitamin E and biotin
• Inositol may act as a booster of cyclic adenosine monophosphate (cAMP)
In doses of 12–20 g/day was shown to be superior to placebo
in a series of randomized trials for depression (Levine et al. 1995),
panic (Benjamin et al. 1995), and obsessive-compulsive disorder (Fux et al. 1996)
• Choline has been reported to help reduce mania
A recent small case study of patients with treatment refractory rapid-cycling bipolar disorder who were receiving lithium reported that
four of six patients responded to the addition of 2,000–7,200 mg/day of free choline
&
Nutrients

13. • Most commonly associated with fish and fish
oil—have been widely studied for their
benefits for heart health
• A diet rich in small, non-predatory fish — typically
about 2 meals a week — is good for almost everyone
• Use of a diet rich in non-predatory fish or fish oil may
prevent or moderate both depression or bipolar
disorder and may be effective in stabilizing mood and
enhancing the effectiveness of conventional anti-
depressants
• Although the evidence is preliminary, omega-3s may
also serve as a neuroprotectant

14. • S-adenosyl-L-methionine (commonly called “SAM-e”) is a naturally-occurring chemical
component present in all cells of the body where it is essential in more than 200 metabolic
pathways
• SAM-e has been approved as a prescription drug for
depression in Germany, Italy, Spain, and Russia,
and has been in use in Europe for over three decades
• It is available without a prescription in the United States
and some other countries
• SAM-e is generally safe and evidence-based for the treatment
of depression. It is also a promising neuroprotectant and may be
helpful in treating ADHD

15. Hypericum perforatum aka St John's wort, is a flowering plant
Constituents (Hyperforin) function as SSRI
St. John’s wort can help with mild to moderate depression
Although many people use St. John’s wort as long-term treatment, there is little evidence of
long-term safety or efficacy
St. John’s wort has serious potential interactions with many prescription medications, including
antidepressants, birth control medications and others

16. • Ginkgo biloba is an ancient Chinese herbal remedy that has been
shown to have significant neuroprotective effects
• Although it has a mild effect in protecting against dementia,
it probably does not prevent it
• Investigated As adjunctive therapy for schizophrenia and
attention deficit hyperactivity disorder (ADHD), for protection against the
neural damage caused by antipsychotics, and for the treatment of
depression
• Has an excellent safety record; and except for the assumed
possible risk of hemorrhage in patients taking anticoagulants,
having bleeding disorders, or [about to] undergo surgery

17. EXERCISE
• The positive effects of exercise on immune system functions are well documented
• Has been shown to ameliorate depression, anxiety, and PTSD
• Improve cognitive function and self-esteem
• Reduce psychotic symptoms in schizophrenic populations
• Promotes secretion of neurotransmitters- serotonin, adrenaline,
• and endogenous opiates
• Studies have also associated weight loss with increased social interaction, distraction from
stress, recreational enjoyment, and mastery of challenge

18. • Developed in Germany by Samuel Hahnemann at the end of
the 18th century
• Unconventional theories:
– "Like cures like“- disease can be cured by a substance that
produces similar symptoms in healthy people
–"Law of minimum dose“- lower dose of medication, has
greater effectiveness- Dilute solutions such as 1:1,020,000
• Remedies are derived from plants, minerals, or animals, such
as red onion, silver, gold, crushed whole bees, snake venom
• Formulated as sugar pellets or tinctures( mixed with 95% grain
alcohol)

19. • Widely used to self-treat generalized anxiety and other anxiety
symptoms
• Case reports of homeopathic remedies in PTSD, social phobia,
panic disorder, and OCD were published. However, findings of
placebo-controlled studies were negative or equivocal
• No uniform prescribing standard for practitioners
• Homeopathic schools are no longer found in USA
• Practice of homeopathy is increasing worldwide

20. • The manipulation of the soft tissue of the body to bring
about generalised improvements in health
• Variety of strokes- effleurage, kneading, rubbing, pinching
etc
• Therapies- Swedish, Oriental, Shiatsu
• Reduce anxiety and pain perception
• Physically and mentally restorative
• NCCAM studies- benefit in the treatment of pain

21. • Technique that involves entering a trance state by focusing on a
word or sound(Mantra), an object or movement
• Two common forms- Mindfulness meditation and
Transcendental meditation (TM)
• Mindfulness- Essential component of Buddhism
Being aware of present using all sensory modalities
• TM- Developed by Indian mystic Maharishi Mahesh Yogi
TM uses mantras based on personal characteristics to
induce a trance state

22. • Faster recovery from stress
• Anxiety and Insomnia
• Substance abuse
• Depression
• High blood pressure
• No side effects of meditation have been documented
• Lack of skill could cause increased anxiety and is certain to result in boredom and discontinuation of
meditation practice

23. PRAYER
The pervasive interest in faith healing
The curative anecdotes of television evangelists
Visiting religious shrines in search of relief
Studies to date are inconclusive on the impact of prayer
on medical outcomes
Prayer was significantly related to less use of alcohol or
street drugs or both and fewer perceived worries and
depression
Recent epidemiological research indicates that religious
beliefs and practices are negatively correlated with
substance abuse and positively correlated with health
status

24. • Technique called palm healing or hands-on healing through
which a universal energy is said to be transferred through the
palms of the practitioner to the patient
• Use light, nonmanipulative touch to the head and torso
to precipitate a flow of healing energy, called Reiki,
drawn and into the patient according to the recipient's
needs.
• Studies- Reduces anxiety, depression and insomnia
• Widely used outside of mainstream medicine, to relieve
pain, especially postoperative pain and to facilitate
patient recovery

25. • This ancient Chinese technique - to increase the life force
in the body through a series of slow circular movements
• Moving form of meditation based on the search for
perfect balance between yin and yang energies
• The practitioner is expected to focus on breathing and its precise synchronization with
the movements
• Used to treat anxiety, depression, muscular tension, high blood pressure, and other
cardiovascular conditions

26. • Yoga is a Sanskrit word, meaning “to join”
• Physical postures(Asanas), controlled breathing (Pranayama) and
meditation(Dhyana)
• Technique of yoga seeks to bring balance all the aspects of body, mind, and
personality
• Positive benefits - Depression, ADHD, Anxiety, Insomnia and PTSD

27. Why people use Complementary and Alternative therapies?
Three theories have been proposed to explain the use of CAM
• 1.Dissatisfaction: - Dissatisfied with conventional treatment because it has been
ineffective, has produced adverse effects, or too costly
• 2.Need for personal contact: - They see them less authoritarian, more empowering,
offering them offer personal autonomy over their health care decisions
• 3.Philosophical congruence: - More attractable because they are seen as more
compatible with patients’ values, spiritual/religious philosophy, or beliefs

28. INTEGRATIVE PSYCHIATRY
• A new type of psychiatry selectively incorporates elements of complementary and
alternative medicine into practice methods
• Emphasizes treatment rather than diagnosis and views the patient holistically, taking
into account not only mind-body issues and interactions but spiritual values as well
• Prevention of illness emphasized by having the patient pay attention to lifestyle
factors such as diet and exercise
• Stress reduction involves use of yoga, meditation, or other relaxation exercises

29. • Any of the complementary methods described can be
integrated into standard psychotherapeutic practice
• Ideally, the psychiatrist practicing integrative
therapy should be schooled in one or more of the
complementary methods used
• Integrative psychiatrists may use psychoactive herbs
in conjunction with traditional psychopharmacologic
agents, mindful of the possibility of adverse drug-drug
interactions
• A complementary practitioner may work in
conjunction with the psychiatrist

30. Take Home
Message…
• Whenever required using an alternative therapy may be helpful
• Usage of alternative therapies based on patients religious background
• To discourage the use of non evidence based therapies
“He's the best physician that knows the worthlessness of
the most medicines” - Benjamin Franklin

31. References
• Synopsis of Psychiatry- 11th edition
• Comprehensive Textbook of Psychiatry 10th edition
• Complementary and Alternative Medicine and Psychiatry
BY Philip R. Muskin, M.D. volume 19
• http://www.mentalhealthamerica.net/sites/default/files/M
HA_CAM.pdf
• Mental Disorders and the Use of Alternative Medicine:
Results From a National Survey Jürgen Unützer, Ruth Klap,
Roland Sturm, Alexander S. Young, Tonya Marmon, Jess
Shatkin, Kenneth B. Wells, American Journal of Psychiatry,
Vol 157 issue 11; Nov 2000;1851-1857