PSYCHIATRY GRAND ROUNDS VIDEOCAST – THE INTEGRATIVE TREATMENT OF ANXIETY – 29/4/2009

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PSYCHIATRY GRAND ROUNDS VIDEOCAST – THE INTEGRATIVE TREATMENT OF ANXIETY – 29/4/2009

– integrative medicine (IM) uses conventional and non-conventional treatments [attends to a physiological, psychological, & spiritual approach to medicine]
– IM is not another name for alternative [outside Western approaches] or complementary medicine [mainstream medical theory-based approach, bit not mainstream for social/political reasons]
– conventional is a disease-centred approach
– non-conventional is individualised treatment planning based on well-being
– IM is MDT (Multi-Disciplinary Team)

WHAT IS ANXIETY?

“Anxiety is the space between the ‘then’ and ‘now’.”(Richard Abell)
“Anxiety is the hand maiden of creativity.” (T.S. Elliot)

Anxiety is:
– an experience of tension or disharmony, conscious or unconscious, within different levels of a human being – bio/psycho/social/spiritual.
– not necessarily pathological, but it can become so.

Anxiety at one level can induce anxiety/distress at another level:
– generalised ANX leading o chronic pain/tension (cognitive/somatic shift)
– elevated thyroid hormone leading to panic (biological/somatic shift)
– existential angst leading to isolation (spiritual / inter-personal shift)

The key is to be aware of the primary source of anxiety/disturbance.

Treatment planning:
– use self-directed approaches such as diet, exercise, & mindfulness.

NON-CONVENTIONAL ASSESSMENTS FOR ANX:
1. Biological
– cholesterol/serum (a possible biological marker of GAD, OCD, & Panic Disorder)
– chronically ANX patients are deficient in magnesium, selenium, or phosphorous.
– vitamin deficiencies in ANX patients (Thiamine, B6, vitamin c and e, niacin)
– urinary glutamate levels may correspond to high levels of anxiety.
2. Energetic/Informational
– EEG changes (GAD – low alpha wave; increased theta waves in OCD; paroxysmal activity in panic disorder; may predict SSRI response in OCD)
– lower heart rte variability in highly anxious patients

CONVENTIONAL TREATMENT OF ANX
– pharmacological
– psychotherapy

NON- CONVENTIONAL TREATMENT OF ANX
– biological [medicinal herbs, amino acids, amino acid precursors, & vitamins]
– somatic/mind/body [yoga, meditation, exercise, massage, and progressive muscle relaxation]
– energetic/information approaches [biofeedback, energy medicines, acupuncture]

Biological – herbs etc.,
– Kava Kava in Polynesian cultures (could be used for GAD) (it cross-reacts with BZDP) (hepatitis and liver failure risks)
– l-theanine (amino acid extracted from green tea)(does not slow reflexes, increase drowsiness, or impair concentration) (not associated with tolerance or dependence)

DIETARY CHANGES
– avoid caffeine which raises serum epinephrine, norepinephrine, and cortisol
– can lead to nervousness in “normal” individuals
– can lead to panic and GAD in predisposed individuals
– avoid foods with high glycemic index (GI) ratings
– associated with GAD
– diet rich in Tryptophan
– deficiencies lead to decreased serotonin
– GAD & panic predisposed individuals report heightened ANX symptoms in depleted diets

NON-CONVENTIONAL BIOLOGICAL TREATMENTS
– Ashwaghonda: a restorative
– 5-HTP: improves sleep; reduces daytime ANX
– aromatherapy: rosemary and lavender oils may reduce ANX
– Bach flower
– phosphorous: may reduce panic
– B6, B12, Vitamin C, Vitamin E supplementation may reduce generalised ANX

NON-CONVENTIONAL SOMATIC AND MIND/BODY TREATMENTS:
– Applied Relaxation (deep-breathing; PMR; guided imagery; systematic desensitisation
– self-care for generalised ANX
– good for re-processing trauma memories
– may not be useful in the case of Panic Disorder
– Yoga
– good for GAD
– medical advice if patient has physical, chronic pain, and/or cardio-vascular problems
– regular meditation/mindfulness practice
– decreases autonomic arousal
– MBSR (Mindfulness-Based stress reduction) (Kabat-Zinn)
– mindfulness, cognitive therapy, exercise, & yoga (intensive 8 wk program)
– Animal facilitated psychotherapy
– has beneficial physical and psychological responses on ANX individuals

NON-CONVENTIONAL ENERGY & INFORMATION TREATMENTS
– Biofeedback
– measures heart rate, blood pressure, temperature
– conveys information to patients in real time
– raises patient awareness so they can see for themselves how techniques can reduce physical symptoms
– decreases autonomic arousal
– USEFUL FOR GAD
– Virtual Reality Graded Exposure Therapy
– more effective than imaginal exposure therapy
– goal is to gradually de-sensitise patient to the feared situation/object
– USED FOR SPECIFIC PHOBIA, PANIC & PTSD
– effective as conventional therapy for the fear of flying (acrophobia)
– use in conjunction with biofeedback
– don’t use with people with migraines, panic disorder or vestibular problems
– Acupuncture
– possible benefit for GAD
– thought to improve autonomic tone

Other non-conventional treatments:
– valerian root for sleep
– nutritional consultation (biological treatment)
– EMDR for trauma
– Career Scope Assessment Profile to assist client clarify their job kills/talents (Social treatment)
– acupuncture, massage, yoga (energetic treatment)
– mindfulness/meditation – stress management training
– Omega 3 Fatty Acids for mood
– assertiveness in a healthy way
– decreased feelings of judgment in social situations

RESOURCES:
Million Clinical Multiaxial Inventory

NOTE: Benzodiazepines (BZDP) lead to cognitive slowing and impaired cognitive function.

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