Acupuncture for schizophrenia

 

Abstract

Background

Acupuncture has been shown to be a relatively safe health care intervention with few adverse effects. In contrast, antipsychotic drugs may have serious adverse effects. The benefits of acupuncture in the treatment of schizophrenia are unclear, and more evidence is needed to inform clinicians and people with schizophrenia of its effects.

Objectives

To review the effects of acupuncture for people with schizophrenia and related psychoses; evaluating acupuncture alone and in combination regimes compared with antipsychotics alone.

Search methods

We (JR, JX) undertook electronic searches of the Cochrane Schizophrenia Group's register (April 2005), which is compiled from systematic searches of major databases, hand searches and conference proceedings. We inspected reference lists and contacted the first author of each included study.

Selection criteria

We included all relevant randomised controlled trials involving people with schizophrenia-like illnesses, allocated to acupuncture, electro-acupuncture, laser-acupuncture, placebo, no treatment, or antipsychotic drugs produced by pharmaceutical companies.

Data collection and analysis

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

Main results

We included five trials. Two trials comparing acupuncture to antipsychotics were equivocal for global state and leaving the study early. Extrapyramidal adverse events were significantly lower in the acupuncture group (n=21, RR 0.05 CI 0.0 to 0.8, NNT 2 CI 2 to 8). Four out of the five trials also compared acupuncture combined with antipsychotics to antipsychotics alone. Global state outcomes and leaving the study early were equivocal. BPRS endpoint data (short term) favoured the combined acupuncture and antipsychotic group (n=109, WMD -4.31 CI -7.0 to -1.6), although dichotomised BPRS data 'not improved' confounded this outcome with equivocal data. Depression scores HAMD (n=42, WMD -10.41 CI -12.8 to -8.0), HAMD 'not improved' (n=42, RR 0.17 CI 0.1 to 0.5, NNT 2 CI 2 to 3) and ZDS (n=42, WMD -24.25 CI -28.0 to -20.5) significantly favoured the combined acupuncture/antipsychotic treatment group, although results were from single, small studies. Treatment emergent adverse events scores were significantly lower in the acupuncture/antipsychotic group (n=40, WMD -0.50 CI -0.9 to -0.1), again from a single, small study.

Authors' conclusions

We found insufficient evidence to recommend the use of acupuncture for people with schizophrenia. The numbers of participants and the blinding of acupuncture were both inadequate, and more comprehensive and better designed studies are needed to determine the effects of acupuncture for schizophrenia.

 

Plain language summary

Acupuncture for schizophrenia

Antipsychotic drugs have been used to treat schizophrenia since the early 1950s. While effective for some, antipsychotics can still leave many of those treated with disabling adverse effects, and safer, more effective health care interventions are being researched to try and redress this problem.

Acupuncture has been used in China to treat mental health disorders, including schizophrenia, for more than 2000 years. It has been proved that acupuncture has very few adverse effects. Also, it may be more socially acceptable, tolerable and inexpensive than the more conventional drugs manufactured by the pharmaceutical industry.

This review identifies randomised controlled trials comparing acupuncture to antipsychotics and acupuncture combined with antipsychotics, to antipsychotics alone. The limited data we found provided mostly equivocal outcomes. Although some of the data did favour acupuncture when combined with antipsychotics, the results came from small studies, and further, more comprehensive trials are needed before we can confidently determine the efficacy of acupuncture in the treatment of schizophrenia.

 

摘要

背景

精神分裂症的針灸療法

針灸療法被顯示為一種相對安全的健康照護介入，其副作用較少。相對地，抗精神病藥物可能有嚴重的副作用。使用針灸來治療精神分裂症的效用是不明確的，需要更多的證據來讓臨床醫師與精神分裂症患者瞭解其效果。

目標

回顧對精神分裂症與相關精神病患者進行針灸治療的效果。評估單獨實施針灸治療、合併實施針灸治療，與單獨使用抗精神病劑的療效。

搜尋策略

我們搜尋the Cochrane Schizophrenia Group's register (至2005年4月)的電子資料庫，這是從系統性地搜尋主要的資料庫、紙本文獻與會議資料編輯而成。我們檢視參考文獻，並與每個納入的研究之第一作者聯繫。

選擇標準

我們納入所有相關的隨機控制試驗，參與者是精神分裂症相關疾病，分配到針灸、電子針灸、雷射針灸、安慰劑、沒有治療或者是製藥公司所製造的抗精神病藥物組。

資料收集與分析

我們獨立地擷取資料。對於同質的二分變項，以治療意向分析法(intentiontotreat)為基礎，計算固定效果relative risk (RR)，95% confidence intervals (CI)，適合的話就計算number needed to treat (NNT)。對於連續變項，我們計算加權平均差異與95% CI。

主要結論

我們納入5個試驗。2個比較針灸與抗精神病藥物的試驗中關於整體狀態與提早退出試驗的訊息是不清楚的。錐體外症狀的副作用在針灸組顯著較低(21位參與者, RR 0.05 CI 0.0 to 0.8, NNT 2 CI 2 to 8)。5個試驗中的其中4個也比較合併使用針灸及抗精神病藥物，與單獨使用抗精神病藥物，整體以及提早退出試驗的訊息是不清楚的。最後BPRS的分數偏向合併使用針灸與抗精神病藥物(109位參與者, RR −4.31 CI −7.0 to −1.6)，雖然二分的BPRS資料"沒有改進"部分因資料不確定而混淆了預後的結果。HAMD的憂鬱分數(42位參與者, WMD −10.41 CI −12.8 to −8.0)，HAMD"沒有改進"(42位參與者, RR 0.17 CI 0.1 to 0.5, NNT 2 CI 2 to 3)與ZDS(42位參與者, WMD −24.25 CI −28.0 to −20.5)顯著地偏向合併針灸與抗精神病藥物組，雖然結果是從單一個小型研究而來。治療產生的副作用在合併針灸與抗精神病藥物組顯著較低(40位參與者, WMD −0.50 CI −0.9 to −0.1)，這也是從單一個小型研究而來的資料。

作者結論

我們找到不充分的證據來建議對精神分裂症患者使用針灸治療。參與者的人數以及針灸的盲目程序(blinding)都是不足的，將來需要更多包含較詳細的設計得更好的研究，來決定對精神分裂症患者使用針灸的效果。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

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

總結

從1950年代早期便開始使用抗精神病藥物來治療精神分裂症。雖然對一些人來說是有效的，抗精神病藥物仍然讓許多接受治療的人產生嚴重副作用，因此研究更安全、更有效的健康照護介入不在持續進行者。針灸在中國被使用來治療精神疾患，包括精神分裂症，已經有2000年之久。針灸的副作用已經被證實很少。同時，與製藥公司所製造的常規藥物比起來，針灸也比較能被接受、可被忍受與不昂貴。這篇回顧找到比較針灸與抗精神病藥物，以及比較合併使用針灸與抗精神病藥物與單獨使用抗精神病藥物的隨機控制試驗。我們找到的有限資料提供模稜兩可的結果。雖然其中一些資料的確支持合併使用針灸與抗精神病藥物，但這結果是從小型的研究而來，將來需要更多完整的試驗，我們才能有信心地確定針灸在治療精神分裂症的效果。