Chinese herbal medicine for schizophrenia

 

Abstract

Background

Traditional Chinese medicine (TCM) was the main form of treatment in China for psychiatric illnesses until the development of antipsychotic drugs in the 1950's. Antipsychotic drugs have become the primary intervention for schizophrenia, although herbal medicines can still form part of the treatment.

Objectives

To review Chinese herbal medicine, used alone or as part of a TCM approach, for people with schizophrenia and related psychoses.

Search methods

We undertook electronic searches of the Cochrane Schizophrenia Group's register (December 2003), the Traditional Chinese Medical Literature Analysis and Retrieval Database (TCMLARS) (October 2003), Chinese Biomedical Database (CBM) (December 2003), China National Knowledge Infrastructure Database (May 2004), Complementary Medicine Database (AMED) (December 2003). We contacted the Chinese Cochrane Centre, the Cochrane Complementary Medicine Field and first authors of included studies and inspected reference lists for additional studies.

Selection criteria

We included all relevant randomised controlled trials involving people with schizophrenia-like illnesses, allocated to Chinese herbal medicine, including any Chinese herbs (single or mixture), compared with placebo/no treatment or antipsychotic drugs.

Data collection and analysis

We independently extracted data and calculated fixed effects relative risk (RR), the 95% confidence intervals (CI) for homogeneous dichotomous data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD).

Main results

Only one small trial of the seven included studies truly evaluated TCM for schizophrenia. The other trials evaluated Chinese herbs for schizophrenia. We found one study comparing Chinese herbal medicine with antipsychotic drugs. Data for the global state outcome 'no change/worse' favoured people allocated to antipsychotic medication (n=90, RR 1.88 CI 1.2 to 2.9, NNH 4 CI 2 to 12). Six trials compared Chinese herbal medicine in combination with antipsychotic with antipsychotic drugs alone. One trial found global state 'not improved/worse' favoured the herbal medicine/antipsychotic combination (n=123, RR 0.19 CI 0.1 to 0.6, NNT 6 CI 5 to 11). Two studies (n=103) also found short-term data from the Clinical Global Impression scale favoured the herbal medicine plus antipsychotic group (WMD -0.46 CI -0.9 to -0.1) compared with those given only antipsychotics. Significantly fewer people in the experimental group left the study early compared with those given antipsychotics alone (n=1004, 6 RCTs, RR 0.30 CI 0.16 to 0.58, NNT 21 CI 18 to 35). Reports of constipation were significantly lower in the treatment group compared to those receiving antipsychotics (n=67, 1 RCT, RR 0.03 CI 0.0 to 0.5, NNH 2 CI 2 to 4).

Authors' conclusions

Chinese herbal medicines, given in a Western biomedical context, may be beneficial for people with schizophrenia when combined with antipsychotics. Traditional Chinese medicine is also under-evaluated, but results from one pioneering study that attempted to evaluate TCM should encourage further trials.

 

Plain language summary

Chinese herbal medicine for schizophrenia

Antipsychotic medication is the mainstay of treatment for people with schizophrenia, and although effective, still leaves some people with distressing symptoms and/or disabling adverse effects. Safer and more effective health care interventions are needed.

Traditional Chinese medicine (TCM) has been used to treat mental health disorders, including schizophrenia, for more than 2000 years. Chinese herbs may also have antipsychotic properties when used in a Western biomedical context. In this review we sought and found trials relevant to the effects of both approaches for schizophrenia. Traditional Chinese medicine methodology has been evaluated for schizophrenia, but the one included study was too limited in terms of sample size and study length to guide good practice. However, this pioneering study does show that TCM can be evaluated for its efficacy for people with schizophrenia , and should encourage trialists to undertake further, more comprehensive trials in this area.

The use of Chinese herbs in a Western medicine context, without incorporating TCM methodology, has been evaluated in six trials, although again these are limited by their sample size and study length. The results of these six trials suggest that using Chinese herbs alone for psychotic symptoms may not be indicated, but if used in conjunction with Western antipsychotic drugs, they may be beneficial in terms of mental state, global functioning and decrease of adverse effects. However, further trials are needed before the effects of TCM for people with schizophrenia can be evaluated with any real confidence.

 

摘要

背景

中國草藥對於精神分裂症的治療

被一定程度地使用的傳統中國醫學(TCM)一直以來是中國治療精神病的方法，直到1950年抗精神病藥物的發展。現在抗精神病藥已經成為精神分裂主要的治療方式，雖然如此草藥仍被一定程度地使用著。

目標

為回顧中國草藥的使用，我們單獨或部分搜尋了TCM運在精神分裂症和其他相關的精神疾病上的文獻。

搜尋策略

我們進行電子搜尋cochrane電子資料庫關於精神分裂症的族群註冊(December 2003)，傳統中醫草藥的文稿分析和補充資料庫(TCMLARS)(October 2003)，中國生物醫學資料庫(CBM)(December 2003)，中國國家知識基礎建設資料庫(May 2004)，互補醫學資料庫(AMED)(December 2003)。我們聯繫了中國cochrane中心，cochrane互補醫學領域和被納入研究的第一作者以及審查額外研究的參考資料名單。

選擇標準

我們納入了關於精神分裂症相關疾病的所有相關隨機對照試驗，並且比較分配在中醫草藥，包含任何的草藥(單獨或混合)和安慰劑組或是沒有抗精神病藥物間的差異。

資料收集與分析

我們獨立地粹取資料和計算固定效果相對危險(relative risk, RR)，異質性和分叉性資料的95%信賴區間(CI)，並且在intentiontotreat的基礎上使用適當的number needed to treat(NNT)。在連續資料方面，我們計算了加權平均差異(weighted mean differences, WMD)

主要結論

只有一個包含七個試驗的小型研究真正地評估傳統中醫在精神分裂症上效用。其他試驗則評估了中醫草藥對精神分裂症的效果。我們亦發現其中的一個研究比較了中醫草藥和抗精神病藥物。整體資料的結果是「無變化或更糟」傾向於使用抗精神病藥物這組(n=90, RR 1.88 CI 1.2 tp 2.9, NNH 4 CI 2 to 12)。六個臨床試驗比較了中醫草藥合併抗精神病藥和單獨使用抗精神病藥的差異。一個試驗的整體結果是「沒有進步或是更糟」傾向於中醫草藥和抗精神病藥合併這組。(n=123, RR 0.19, CI 0.1 to 0.6, NNT 6 CI 5 to 11)。兩個試驗(n=103)中也發現在短期Clinical Global Impression scale評估中，草藥加上抗精神病藥這一組比只有抗精神病藥這一組效果來的好(WMD −0.46 CI −0.9 to −0.1)。和單獨使用抗精神病藥的人相比，實驗組較早離開試驗的人是比較少的(n=1004, 6 RCTs, RR 0.30 CI 0.16 to 0.58, NNT 21 CI 18 to 35)。便秘的報告中，治療組和接受抗精神病藥這組相比，便秘的發生是有意義的減少。(n=67, 1 RCT, RR 0.03 CI 0.0 to 0.5, NNH 2 CI 2 to 4)

作者結論

中國草藥醫學，若加上西方生物醫學的背景，當和抗精神病藥合併使用時可能對於精神分裂症的患者是有益處的。傳統中國醫學的效益也被低估，但從一個嘗試評估傳統中國醫學的前瞻性研究中結果中，應該能鼓勵更多的試驗。

翻譯人

本摘要由彰化基督教醫院謝明翰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

中醫草藥應用在精神分裂症的一般摘要 一直以來，抗精神病藥都是治療精神分裂症的主流。雖然有效，但產生許多令人痛苦的症狀或是失能的副作用。較安全的以及較有效率的介入是需要的。傳統中國醫學(TCM)被使用來治療心理疾病，包含精神分裂症以經超過兩千年。中醫草藥可能有如西方生物醫學般抗精神病的特質。在這個回顧中我們尋找並且發現一些和精神分裂症治療效果相關的試驗。傳統中國醫學對於精神分裂症的治療方法學已經獲得評估，但是因為樣本數以及研究時間的長短是否足夠去指引臨床應用的問題都使研究受到限制。然而，這前瞻性的研究也顯現了傳統中國中醫對於精神分裂症的療效是可以被評估的，並且應該鼓勵試驗人員在這一領域進一步採取更詳盡的研究。有六個中醫草藥的使用試驗，雖然沒有納入方法學，在西方生物醫學中獲得評估，然而因為樣本數和研究時間長短再次受限。這六個試驗的結果指出單獨使用中醫草藥治療精神症狀也許是不可行的，但是如果和西方抗精神病藥物並用，這樣對於心智狀態、整體功能和減少副作用都是有助益的。然而，在傳統中國醫學在治療精神分裂症的療效能夠獲得更有信心的評估之前，更多的試驗的必須的。