PSYCHOLOGICAL/EMOTIONAL DISORDERS RESEARCH (© JCM Ltd)

ACUPUNCTURE BENEFICIAL FOR SCHIZOPHRENIA
A Korean systematic review of studies examining the use of acupuncture in treating the symptoms of schizophrenia has provided some evidence for its effectiveness. Thirteen randomised clinical trials (RCTs) met the inclusion criteria. One RCT reported significant effects of electro-acupuncture (EA) plus drug therapy for improving auditory hallucinations and positive symptoms compared with sham EA plus drug therapy. Four RCTs showed significant effects of acupuncture compared with antipsychotic drugs. Seven RCTs showed significant effects of acupuncture plus antipsychotic drug therapy compared with drug therapy alone. The authors conclude that the total number of RCTs, the total sample size and the methodological quality were too low to draw firm conclusions. In addition they conclude that since all studies originated from China, further international studies are needed. (Acupuncture for schizophrenia: a systematic review and meta-analysis. Int J Clin Pract. 2009 Nov;63(11):1622-33).

ACUPUNCTURE APPEARS TO BE EFFECTIVE IN TREATMENT OF INSOMNIA.
Acupuncture appears to be effective in the treatment of insomnia according to a systematic review and meta-analysis carried out by Chinese authors. Forty-six randomised trials involving 3811 patients were included and the methodological quality of trials was judged to be generally fair. Meta-analyses showed a beneficial effect for acupuncture compared with no treatment, and for real acupressure compared with sham acupressure. Acupuncture was superior to medication in terms of the number of patients whose total sleep duration increased by more than three hours. However, there was no difference between acupuncture and medication in average sleep duration compared to medication alone. Acupuncture plus medication showed a better effect on total sleep duration. Acupuncture plus herbs was significantly better than herbs alone in increase of sleep rate. The authors conclude that further large, rigorously designed trials are warranted. (Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials. J Altern Complement Med. 2009 Nov;15(11):1171-86).

SEVEN-STAR NEEDLING IMPROVES LANGUAGE AND SOCIAL INTERACTION IN AUTISTIC CHILDREN
Acupuncture stimulation may help improve language and social functioning in children with autistic spectrum disorders (ASD) according to a study carried out in Hong Kong. Thirty-two children with ASD were randomly assigned to treatment or a waiting list control. Those in the treatment group received 30 sessions of stimulation using a seven-star needle on the head, front and back of their body over a six week period. Children in the treatment group demonstrated significant improvement in language and social interaction, but not in stereotyped behavior or motor function, compared with the control group. Quantitative electroencephalogram measurements also showed significant reductions in spectral amplitude in the treatment group but not in the control. (Seven-star needle stimulation improves language and social interaction of children with autistic spectrum disorders. Am J Chin Med. 2009;37(3):495-504).

ACUPUNCTURE FOR OCD
Hong Kong researchers have carried out a pilot study suggesting that acupuncture is beneficial in the treatment of obsessive-compulsive disorder (OCD) that is refractory to pharmacological and cognitive-behavioural therapy. Nineteen patients with treatment-resistant OCD were assigned to either electro-acupuncture (EA) treatment for 12 sessions (five sessions per week) or a waiting list control, while continuing their anti-OCD medication. EA produced significantly greater improvements in OCD severity scores compared with the waiting list control group (10.2 versus 18.8). (Electroacupuncture for refractory obsessive-compulsive disorder: a pilot waitlist-controlled trial. J Nerv Ment Dis. 2009 Aug;197(8):619-22).

ACUPUNCTURE NORMALISES INFLAMMATORY MEDIATORS IN DEPRESSED PATIENTS
Imbalance between Type one (Th1) and Type two (Th2) helper T-cell functions and the resulting increase in inflammatory response have been implicated in major depression. A study by Canadian scientists has investigated the relationship between pro- and anti-inflammatory cytokines in depressed patients and the effect of electro-acupuncture (EA) and fluoxetine (Prozac) treatment on these cytokines. Ninety five patients with major depressive disorder were treated for six weeks with EA, fluoxetine or placebo. Thirty healthy volunteers served as controls. Increased pro-inflammatory cytokine interleukin (IL)-1beta and decreased anti-inflammatory cytokine IL-10 were found in depressed patients. By contrast, the Th1 produced pro-inflammatory cytokines tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma were decreased in depressed patients, while Th2 produced cytokine IL-4 was significantly increased. The ratio of IFN-gamma/IL-4 was also increased. Both acupuncture and fluoxetine treatments - but not placebo - were found to reduce IL-1beta concentrations. However, only acupuncture was found to reduce TNF-alpha concentration and IFN-gamma/IL-4 ratio towards the control level. The authors conclude that an imbalance between pro- and anti-inflammatory cytokines and between Th1 and Th2 cytokines is present in untreated depressed patients. Both EA and fluoxetine had an anti-inflammatory effect by reducing IL-1beta while EA also restored the balance between Th1 and Th2 systems by increasing TNF-alpha and decreasing IL-4. (Imbalance between pro- and anti-inflammatory cytokines, and between Th1 and Th2 cytokines in depressed patients: the effect of electroacupuncture or fluoxetine treatment. Pharmacopsychiatry. 2009 Sep;42(5):182-8).

ACUPUNCTURE REDUCES POST-STROKE INSOMNIA
Korean researchers have found that acupuncture benefits post-stroke-onset insomnia by reducing sympathetic nervous system hyperactivity. Fifty-two hospitalised stroke patients with insomnia were randomly assigned to either real acupuncture (RA) or sham acupuncture (SA). The RA group received acupuncture at Shenmen HE-7 and Neiguan P-6 over three days, while the SA group received sham acupuncture at the same points. Insomnia severity scores showed greater improvement in the RA group than in the SA group. In addition, measures of autonomic nervous function (blood pressure and heart rate variability) indicated that sympathetic hyperactivity was decreased in the RA group. (Intradermal acupuncture on shen-men and nei-kuan acupoints improves insomnia in stroke patients by reducing the sympathetic nervous activity: a randomized clinical trial. Am J Chin Med. 2009;37(6):1013-21).

ELECTROACUPUNCTURE REDUCES AUDITORY HALLUCINATIONS IN SCHIZOPHRENICS
Electroacupuncture appears to provide improvement in symptoms, including a reduction in auditory hallucinations, for schizophrenic patients. Sixty schizophrenics, who were partially responsive or non-responsive to treatment with the antipsychotic drug risperidone, were randomly allocated to a real electroacupuncture (EA) group or a sham EA group and treated for 30 sessions over six weeks. Patients in the real EA group experienced greater improvement in auditory hallucination and general symptom scores than the sham EA group at both week four and week six. Clinical response rates were 43.3% for real EA versus 13.3% for sham EA. (Electro-acupuncture versus sham electro-acupuncture for auditory hallucinations in patients with schizophrenia: a randomized controlled trial. Clin Rehabil. 2009 Jul;23(7):579-88).

ACUPUNCTURE LOWERS ANTIDEPRESSANT REQUIREMENT
Adding acupuncture to medical treatment for depression can reduce the amount of drugs needed to treat the condition and therefore reduce the side-effects of medication. In a Chinese randomised, double-blind, sham-controlled study 80 patients with major depressive disorder (MDD) were randomised to two groups: one received standardised verum acupuncture, 10 mg/day fluoxetine and placebo (VA) and the other received sham acupuncture and 20-30 mg/day fluoxetine (SA). Acupuncture was applied five times a week over a period of six weeks. At the end of the treatment period, therapeutic response rates were not significantly different between groups (80.0% for VA and 77.5% for SA). Patients in the VA group also showed better improvement than the SA group in symptoms of anxiety and suffered fewer antidepressant side-effects. (Combination of acupuncture and fluoxetine for depression: a randomized, double-blind, sham-controlled trial. J Altern Complement Med. 2009 Aug;15(8):837-44).

ACUPUNCTURE EFFECTIVE FOR DEPRESSION
A systematic review and meta-analysis of acupuncture for various depressive conditions has concluded that it is safe and constitutes an effective treatment for some forms of depression. Of 207 clinical studies of acupuncture retrieved from databases, twenty were considered to be of high enough quality to be subjected to meta-ananysis. The results showed that the efficacy of acupuncture as monotherapy was comparable to antidepressants in improving clinical response and alleviating symptom severity of major depressive disorder, but not different from sham acupuncture. Acupuncture was also found to be superior to antidepressants and waiting-list controls in improving both response and symptom severity of post-stroke depression. The incidence of adverse events in acupuncture intervention was significantly lower than with antidepressants. (The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis. J Affect Disord. 2009 Jul 24. [Epub ahead of print]).

AURICULAR ACUPUNCTURE FOR REPETITIVE SELF-INJURY
A Canadian pilot study has tested the feasibility and potential efficacy of auricular acupuncture for the treatment of repetitive self-injurious behaviour (SIB) in depressed adolescents. In addition to providing relief of depressive symptoms there is evidence of an addictive component to this behaviour. Nine adolescent patients received three acupuncture treatments, once a week, over three weeks. The auricular points used consisted of the NADA protocol (Sympathetic, Shen Men, Kidney, Liver, Lung) and treatment was carried out in a group setting. Needles were removed after 50 minutes and replaced with adhesive metallic press balls at the same five ear sites. At one week post-treatment, it was found that the mean number of SIB urges had decreased from levels measured at pre-treatment screening, and this remained lowered at four weeks post-treatment. Self-rated and clinical ratings of depression did not change significantly post-treatment, however mean internalising anger scores were significantly reduced at four weeks post treatment follow-up. (An open trial of auricular acupuncture for the treatment of repetitive self-injury in depressed adolescents. Can Child Adolesc Psychiatr Rev. 2003 Feb;12(1):10-2.)

ACUPRESSURE AT YINTANG REDUCES KIDS’ PRE-OP ANXIETY
Acupressure at Yintang (M-HN-3) has been found to reduce preprocedural anxiety in children undergoing endoscopic examination. In the American study, fifty-two children were randomised to receive an acupressure bead placed either at Yintang (M-HN-3) or at a sham point above the left eyebrow. Children in the Yintang group were found to have experienced reduced anxiety during the 30 minute pre-operative waiting period, whereas those in the sham group experienced increased anxiety (-9% vs +2%). The acupressure intervention had no measurable effect on levels of consciousness during anaesthesia (measured by bispectral index monitoring), nor on requirements for anaesthetic during the procedure. (Extra-1 acupressure for children undergoing anesthesia. Anesth Analg. 2008 Sep;107(3):811-6).

QIGONG FOR STRESS
A small American study has investigated the effectiveness of a qigong training program in reducing stress in hospital staff. Thirty-seven subjects were randomly assigned to a six-week intervention of either qigong practice or a waiting list. The qigong group demonstrated a statistically significant reduction of perceived stress compared to the control group and also experienced a significant reduction in pain intensity compared with controls. (Qigong stress reduction in hospital staff. J Altern Complement Med. 2008 Oct;14(8):939-45).

ACUPUNCTURE EFFECTIVE FOR DEPRESSION
Chinese researchers have carried out a meta-analysis to assess the benefits of acupuncture as a treatment for depression. The analysis included eight small randomised controlled trials involving a total of 477 subjects. Their results suggested that acupuncture was an effective treatment for depression and could significantly reduce the severity of the disease. (Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? J Affect Disord. 2008 Jun 10. [Epub ahead of print]).
 
TAI CHI FOR STRESS REDUCTION
A prospective longitudinal pilot study of tai chi for young adults, carried out over 18 weeks, found that their subjective health increased. Stress, measured both subjectively (by questionnaire) and objectively (by measurement of salivary cortisol levels) was also found to decrease during tai chi practice. (Mind/body techniques for physiological and psychological stress reduction: Stress management via Tai Chi training - a pilot study. Med Sci Monit. 2007 Nov;13(11):CR488-497).

ACUPUNCTURE FOR ANXIETY
A systematic review of the evidence for the efficacy of acupuncture in the treatment of anxiety disorders has shown positive findings. Authors based at London’s University of Westminster performed searches of the major biomedical databases as well as specialist CAM databases. Twelve controlled trials were located, of which ten were randomised controlled trials (RCTs). All trials reported positive findings, but the reports were found to lack many basic methodological details. Positive findings were reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis, however the poor quality of the evidence prevented firm conclusions from being drawn. Limited evidence was also found in favour of auricular acupuncture for perioperative anxiety. Overall, the authors concluded that the findings were ‘promising’ and warranted further well-designed, adequately powered studies. (Acupuncture for anxiety and anxiety disorders - a systematic literature review. Acupunct Med. 2007 Jun;25(1-2):1-10).

ACUPUNCTURE FOR POST-TRAUMATIC STRESS DISORDER
A pilot study has evaluated the efficacy of acupuncture for post-traumatic stress disorder (PTSD). Participants diagnosed with PTSD were randomised to either an empirically developed acupuncture treatment, cognitive-behavioural therapy (CBT), or a wait-list control. The primary outcome measure was self-reported PTSD symptoms, assessed at baseline, end of treatment and at three-month follow-up. Acupuncture was found to provide large treatment effects for PTSD, similar in magnitude to CBT and symptom reductions were maintained at three-month follow-up for both interventions. (Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial. J Nerv Ment Dis. 2007 Jun;195(6):504-13).

ACUPUNCTURE REDUCES ANXIETY OF EYE SURGERY
An Italian study has found that patients undergoing cataract removal are less anxious after receiving acupuncture. Participants underwent phacoemulsification, in which the cloudy eye lens is emulsified with an ultrasound probe, before being aspirated and replaced by an artificial lens. The procedure is carried out under topical anaesthesia while the patient is awake and can therefore provoke significant anxiety. In this prospective randomised double-blind controlled trial, anxiety levels were assessed before and after surgery in three groups (no acupuncture, true acupuncture and sham acupuncture) of 25 patients. Preoperative anxiety levels were significantly lower only in the true acupuncture group. The difference in postoperative anxiety levels between the real acupuncture and no acupuncture groups was also significant. (Sedative effect of acupuncture during cataract surgery: prospective randomized double-blind study. J Cataract Refract Surg. 2006 Nov;32(11):1951-4).

ACUPRESSURE DECREASES DEMENTIA AGITATION
A pilot study has suggests that acupressure can decrease the agitated behaviour associated with dementia. Thirty-one subjects with dementia were assigned to a six-week acupressure treatment programme consisting of five minutes treatment, twice a day, five days a week, for four weeks. After a treatment-free period of one week, all the subjects then served as controls, undergoing a four-week protocol consisting of companionship and conversation. Twenty patients completed the trial. Researchers found that acupressure therapy significantly reduced verbal and physical attacks, compared with the control treatment. In addition, acupressure led to an immediate improvement in patient behaviour and appeared to prevent aggressive symptoms from occurring in the first place. (The efficacy of acupressure for decreasing agitated behaviour in dementia: a pilot study. J Clin Nurs. 2007 Feb;16(2):308-15).

ACUPUNCTURE & DEPRESSION
Previous studies have shown acupuncture at depression specific points to be superior to acupuncture at points not specific to depression (see NEWS 78 and 59). In a recent study, however, it appears that the non specific acupuncture was superior to the specific acupuncture. Study participants (151) were randomised to receive depression specific acupuncture, non-specific acupuncture or no treatment (waiting period) for eight weeks. All patients eventually underwent the depression specific acupuncture. At the end of the first eight weeks, the effective response was 22%, 39% and 17% respectively in the three groups. By the end of the study around half of patients had responded to the treatment. One notable factor is that while the depression-specific acupuncture was tailored to the individual patient at the first session, the study required those same points to be treated during the remainder of the study period. (Acupuncture for Depression: A Randomized Controlled Trial. Journal of Clinical Psychiatry 2006; 67: 11, 1665-1673).

LASER ACUPUNCTURE & DEPRESSION
In a double-blind randomised controlled trial, active laser acupuncture was found to be significantly more effective for the treatment of mild to moderate depression (at twelve weeks from trial onset) compared to sham laser acupuncture. In this trial, the practitioner did not know during treatment whether the laser device was active or not and was asked not to communicate with the patient other than a first greeting. Treatment was given twice a week for four weeks, then weekly for four weeks. The principal points used were Qimen LIV-14 (right), Jiuwei REN-15, Juque REN-14, Shenmen HE-7, Ququan LIV-8 (left). Additional points were used in cases where anxiety scores were high, (mainly Yingu KID-10). (Acupuncture in Medicine 2005; 23(3): 103-111).

XIAO YAO WAN AND DEPRESSION
In a double-blind, placebo-controlled randomised controlled trial, the efficacy of i. Carbamazepine (CBZ), ii, CBZ plus the Chinese herbal medicine Free and Easy Wanderer (FEWP/Xiao Yao Wan), and iii. Placebo, was compared in the treatment of 124 bipolar depressed and 111 manic patients over a twelve week period. CBZ plus FEWP produced significantly better outcomes on three measures of depression at four and eight weeks and significantly greater clinical response rate in depressed subjects (84.8% versus 63.8%), but no such benefit was found in manic subjects. (J Psychiatr Res 2005, doi:10.1016/j.jpsychires.2005.06.002).

CHINESE HERBS FOR COGNITIVE IMPAIRMENT
A herbal supplement known as GETO, containing Ren Shen (Ginseng Radix), Yin Yang Huo (Epimedii Herba), Yuan Zhi (Polygalae Radix) and two other unnamed herbs might help prevent dementia. Seventy-five patients with mild cognitive impairment were given either GETO, piracetam (a drug thought to improve cognitive function) or placebos for three months.. Those who took the Chinese herbs demonstrated significantly improved cognitive function at the end of the study and at one year follow up, compared to the other groups. There was also significantly greater improvement in verbal learning and recognition skills. (Alzheimer’s Association International Conference on Prevention of Dementia, Washington, 2005).

ACUPUNCTURE FOR PREGNANCY DEPRESSION
Pharmaceutical medication is largely unsuitable for depression during pregnancy and therefore any non-pharmaceutical alternative is potentially of great value. In a study carried out at Stanford University, 61 women with major depressive disorder were randomly assigned to receive one of three treatments: i. Individually tailored true acupuncture designed to treat their depression, ii. True acupuncture but with points not chosen to treat the depression, and iii. Massage treatment (included to provide a control for attention, physical contact, relaxation and respite from daily stress). Acute phase treatment was given for twelve sessions over eight weeks, with continued treatment throughout pregnancy for those who responded. As far as possible the acupuncture treatment was double-blinded, with the treatment to be given by a treating acupuncturist determined by a different (assessing) acupuncturist. The assessment, treatment design, needle insertion, and needle stimulation were all standardised. Response rates at the end of the acute phase were 68.8% in the depression specific acupuncture, 47.4% in the non depression-specific acupuncture, and 31.6% in the massage group. The study also showed that successful treatment of depression during pregnancy offers protection from postpartum depression. (Journal of Affective Disorders, Volume 83, Issue 1, 15 November 2004, Pages 89-95).

CHINESE HERBS & DEMENTIA
In a Japanese study, 33 patients with mild to moderate dementia were assigned to received either Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia), 7.5g/day or placebo for 8 weeks. At the end of the study period, the treatment group showed significantly improved cognitive functioning and ability to complete day-to-day activities, compared to no improvement in the placebo group. The herbs were also found to increase cerebral blood flow. (Geriatrics and Gerontology International 4 (s1), S124-S128).

ACUPUNCTURE & ANXIETY
In this study, patients who required ambulance transport secondary to medical conditions, were randomised to receive auricular acupressure either at the ‘relaxation point’ or at a sham point. Patients treated with the true point reported significantly less anxiety than patients in the sham group on arrival at the hospital. Further, their perception of pain during treatment, as well as treatment outcomes for their illness, were significantly more positive than in the sham group. (Anesthesiology 2003; 98:1328-32).

ACUPUNCTURE FOR POST-TRAUMATIC STRESS
The University of New Mexico Trauma & Anxiety Research Group is halfway through a 2-year study into the use of acupuncture in the treatment of post-traumatic stress disorder. The group worked with an panel of 22 doctors of oriental medicine to develop an acupuncture strategy. The $250,000 study, funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine, is comparing acupuncture to cognitive behavioural therapy, and preliminary results of the treatment look very promising according to the researchers.

ACUPUNCTURE & DEPRESSION
The UK’s Mental Health Foundation has proposed that acupuncture should be made more available to depressed patients. They carried out an investigation into ear acupuncture and its potential benefits for women with mental health problems. Eight women volunteers with long term mental health problems, including eating disorders, depression, anxiety and obsessive compulsive disorder, took part, receiving weekly ear acupuncture treatments for six months. The women involved in the study reported feeling more relaxed and calm, having improved sleep, more energy and greater confidence, and these benefits increased if the treatment was repeated regularly over a number of weeks. Two women even came off anti-depressants during the research, one after six years of taking them.

ACUPUNCTURE AND AUTISM
Autism is a complex developmental disability that normally appears within the first three years of life. It is estimated to occur in up to one in every 500 children, is more common in boys than girls, and can severely affect a child’s social interactions and communication skills. Many children develop normally for the first year of life, even walking, talking or crawling earlier then the average child, but then autistic symptoms begin to appear. Language is either slow to develop or does not develop at all, whilst some autistic children master speech but have difficulty processing information. Some will isolate themselves, rarely interacting with others. Sight, hearing, touch, smell or taste, may be impaired. Autistic children may lack the ability to play spontaneously and imaginatively, and may exhibit aggressive behaviour (to themselves or others). They may show obsessive interest in one particular thing whether a person, an activity or an object, staring at or playing with the same item or rocking repetitively for hours, and laughing or crying for no apparent reason. There are many different approaches to the treatment of autism, none offering spectacular success, but acupuncture and Chinese herbal medicine have shown promising results. Now a new acupuncture method has been pioneered by Prof. Virginia Wong of the University of Hong Kong. The technique involves stimulating regions on the tongue which, by using brain imaging techniques, were shown to affect areas of the brain related to autism. Children who were treated by this method showed improvements in language and social skills, cognition, hyperactivity, attention span and aggression. (Proceedings of the World Congress of Neurology, London).

EAR ACUPUNCTURE & ANXIETY
A study carried out at Yale University School of Medicine into the use of ear acupuncture and anxiety has shown that whilst there was no significant physiological change after acupuncture, those treated bilaterally at the “relaxation point” in the superior wall of the triangular fossa of the ear, experienced significant lowering of their anxiety levels compared to those receiving either bilateral auricular acupuncture at shenmen point or sham acupuncture at a point on the middle ear. Treatment was performed using press needles which were kept in place for 48 hours and then removed. The anxiety levels of each patient were measured just prior to needling, and at intervals of 30 minutes, 24 hours and 48 hours after treatment. Anxiety levels were determined using a variety of methods (Anesthesia and Analgesia Feb 2001;92(2):548-553).

ACUPUNCTURE AND DEPRESSION
Researchers at the University of Arizona have tested the value of acupuncture in the treatment of depression. 38 women aged 18 to 45 and suffering from major depression were divided into three groups. One group received eight weeks of acupuncture treatment specifically designed to target their depression. A second group waited for eight weeks and then received the treatment. A third group received a form of placebo acupuncture which was not designed to treat depression but rather headache or back pain, then received the depression-specific treatment for eight weeks. The symptoms of all three groups got better over time, but the group that received the depression-specific treatment immediately improved much more quickly, and once the other two groups got the specific treatment their symptoms also improved at a much faster rate. According to John Allen who led the study “These findings from a small sample of women with major depression suggest that acupuncture may hold sufficient efficacy to warrant a larger clinical trial”.  He said that although drugs and psychotherapy provide significant relief for 50 to 70 percent of patients, “about a third of people seeking treatment end that treatment prematurely, citing factors such as dissatisfaction with their current treatment or intolerable side effects. These statistics suggest that alternative treatments may be welcomed by those suffering from depression.” (Psychological Science 1998;9:397-40).