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PATRICIA RONAN & DOMINIC HARBINSON
Acupuncture and SchizophreniaChoices for collecting evidence:
Limitations and Significance
Research Context
Audience & Funders: Western Medical CAM – BAcC & Medical Harmony Charities – Sir Charles Jessell Fund University - CCCU limited understanding of acupuncture many sceptics bio-pharmacological competition economics of medical research
The problem with acupuncture ....
PhilosophyTerminologyNo standard approach (5 element / stems &
branches / TCM etc...)No standard treatment (even within individual
approaches)Problems regarding ShamTherapist effect
The problem with schizophrenia
• Difficult to define• Difficult to diagnose• Arguments about validity of the condition• Complex condition• Confounded by antipsychotic medicine and
other associated treatments• Lifestyle factors• ?unpredictable client group
Challenge 1
How to do this research? RCT Experimental study Delphi Feasibility study Case study
Best Research approach – who’s right?
Challenge 2
Recruitment
Psychotic vs schizophrenic?Forensic vs acute vs primary careAllies and sceptics Busyness of teamsGeographical area
Challenge 3
Time and Money Acupuncturists not employed by NHS or university Too long and bias if PR trained Acceptability of such a study to NHS & NHS funders Time to write a bid vs PhD timescale Experience and credibility of researchers and
academic institution Allies in all camps
Challenge 4
The ethics process We loved it! Not! Guidance 60 pages long NHS process changed again halfway through University process as well (and different) Peer review and academic arguments about best
research approach
Challenge 5
Administration Research Passport – great, but... Interpretation of new rules Co-ordination of honorary contracts / letters of access Signatures Local rules, paperwork and access IT training
Challenge 6
Recruitment in real life Getting the teams on board Orientation & room bookings Clinicians understanding/portrayal of the study? Patient reaction to information What worked best? Co-ordination of first information sessions, consent,
interviews and timetable
And suddenly......
We had 10 participants and a schedule for interviews that meant the acupuncture could begin on January 18th 2010.
But then.......
It snowed ........
After the Snow...
Schedule uninterrupted (thanks to a handsome man with a 4X4)
10 participants assessed and began treatment on January
7 weeks of treatment now complete
Data Collection
Case Study Approach PANSS QoL SQLS PSQI History (case notes, medication, diet) STRICTA Observational data
Themes
• Sleep – Time in bed • Energy• Weight• Diet• Addictions and cravings• Exercise• Isolation• Sex• Hallucinations, Anxiety & Paranoia• Side Effects
Changes so far...
• Sleep & Energy: improvements in most• Weight: improvements for 2 or 3• Diet: improvements for 2 or 3• Exercise: improvements for most• Socialisation & work: improvements for most• Sex: improvements for most• Use of Addictive substances: decreased use for most• Muscular Tension : decreasing• Anxiety: decreasing• Paranoia : decreasing• Hallucinations : decreasing• Side-effects: decreasing
Initial Reflections and Quandaries
Differences between what participants report to acupuncturists and to researcher
What to treat: Physical illness / symptom / what participant wants treated?
Getting up, getting there: how to deal with motivation and excessive sleep
Addictions, motivation and schizophrenia
Reflections on Methods
STRICTA: Helpful, but differences in acupuncture approach / philosophy?
Triangulation : helpfulness of variety of collection methods – acupuncturists, case notes, interviews, carers
Researcher / Nurse / Person?Recruitment: culture & understanding of
research and acupuncture
Reflections on Methods
PANSS – helpful, but problems in validationPANSS – helpful before QoL InterviewQoL – good & quick method of capturing
picture, but: ? Christmas ? Inclusion of sex, weight & excretion ? Consistency of information given – e.g. PSQI vs QoL,
Int 1 vs Int 2, embarrassment
Diagnosis
Syndrome D W
Liver Depression Qi Stagnation 6 1Heart Fire 1Heart-Kidney not Harmonised 2Stomach Yin & Spleen Qi Deficiency 1Spleen Qi Deficiency generating Dampness 2 1Kidney Deficiency / Kidney Qi not Firm 1 1Phlegm-Fire Harassing the Mind 4Liver & Heart Blood Deficiency 2 1Liver Yang Rising 2Liver & Kidney Yin Deficiency 2Kidney Failing to Receive Qi 1Lung & Kidney Deficiency leading to Phlegm in the Lung 1Local Stagnation of Qi & Blood 3 1
Acupuncture Treatment
• Points used – same as used everywhere else!• Du 20; Liv 3; GB 34; LI 4; GB 21; SJ 5; P 8; Sp 6;
St 8-36-40; Ren 4-6-12-17; Kid 3-6-7-10 back shu/outer Bl points
• Ear acupuncture • Ashi points – vs pain/tension • Other Treatments:• Cupping / TDP lamp / relaxation tapes / ear seeds
/ herbal teas• Advice: diet, exercise, mental patterns, dating,
alcohol, salt pipe
The Up & Down Sides
Ups Treating twice a week Very good attendance Actually managed to
effect some positive change!
Really great health centre
Downs Moving rooms each day Travel Stricta NHS Budgets being cut
Surprise!
Young age group
Weak pulses
Good attendance
Gains in main complaints are v difficult to make & hold because the problems are so deep-rooted
Will it stand the test of time?
Patricia Ronan Dominic Harbinson
Social Work, Community & Mental Health
Canterbury Christ Church University
CanterburyKentCT1 [email protected]
07903 054699
21 Hospital LaneCanterburyKentCT1 2PE
[email protected]. canterburyacupuncture
.co.uk
07903 363912
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