,研究设计," /> ,研究设计,"/> ,STICTA,research designi,"/> A case study exploration of the value of acupuncture as an adjunct treatment for patients diagnosed with schizophrenia: Results and future study design [an error occurred while processing this directive]

Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (5): 503-514.doi: 10.3736/jcim20110507

Special Issue: Acupuncture & Moxibustion

• Original Clinical Research • Previous Articles     Next Articles

A case study exploration of the value of acupuncture as an adjunct treatment for patients diagnosed with schizophrenia: Results and future study design

Patricia Ronan1(), Nicola Robinson2, Dominic Harbinson3, Douglas Maclnnes4   

  1. 1. Health Wellbeing and the Family, Beckett House, Canterbury Christ Church University, Canterbury, Kent, UK
    2. Allied Health Sciences Department, Faculty of Health and Social Care, London South Bank University, London, UK
    3. Canterbury Complementary Health Clinic, Canterbury, Kent, UK
    4. Centre for Health and Social Care Research, Canterbury Christ Church University, Chatham Maritime, Kent, UK
  • Received:2010-12-26 Accepted:2011-02-15 Online:2011-05-20 Published:2011-05-15
  • Contact: Ronan Patricia E-mail:patricia.ronan@canterbury.ac.uk
  • Supported by:
    This study was supported by grants from the British Acupuncture Council, the Sir Charles Jessell Foundation and Canterbury Christ Church University

Objective: This study explored the effects of individualized acupuncture when used alongside routine care for patients diagnosed with schizophrenia in order to assess the possibility and nature of potential benefits for this patient group. This study used an exploratory case study approach that included both quantitative and qualitative research tools, in order to generate a hypothesis questioning the possible benefits of acupuncture and develop future study designs.
Methods: Eleven patients diagnosed with schizophrenia were given multiple validated quantitative and qualitative assessments before, during and after a 10-week acupuncture intervention. A range of qualitative and quantitative assessments were employed including review of acupuncture, general practitioner and mental health clinical case notes. Qualitative data were interrogated to explore the reliability of participants’ reports to researchers, their clinicians and their carers while acting as informants in the study.
Results: Eight out of eleven participants completed a course of acupuncture treatment and all eleven reported positive benefits as a result of acupuncture, including improvements in the symptoms of schizophrenia, side effects of medication, energy, motivation, sleep, addictions and other associated physical problems. However, participants’ reports to the researcher and the acupuncturists varied at times and were often inconsistent between treatments, with participants revealing more information to the team towards the end of the study.
Conclusion: The study indicates that patients diagnosed with schizophrenia would benefit from acupuncture treatment alongside conventional treatment. Triangulation of the data highlights some inconsistencies in reporting from participants, but also that this can be overcome through the use of mixed research methods. Comparison of data also shows that future studies would benefit from using a Positive and Negative Syndrome Scale, the Standards for Reporting Interventions in Controlled Trials of Acupuncture and an enhanced questionnaire regarding side effects of medication, exercise, sleep and daily routine. It is also worth noting that future studies of this nature must maintain consideration for the vulnerability of participants as they recover and make support easily accessible.

Key words: schizophrenia, acupuncture, ')">the positive and negative syndrome scale, ')">STICTA, research designi

Figure 1

Data collection flow chart for the study of acupuncture as an adjunct treatment for schizophrenia PANSS: the Positive and Negative Syndrome Scale; SQLS: the Schizophrenia Quality of Life Scale; PSQI: the Pittsburgh Sleep Quality Index; STRICTA: the Standards for Reporting Interventions in Controlled Trials of Acupuncture."

"

Figure 2

PANSS total score of each interview Time points 1 and 2 are questionnaires or interviews carried out before the course of acupuncture treatment; time point 3 was carried out afterwards. PANSS: the Positive and Negative Syndrome Scale."

Figure 3

PSQI total score of each interview Time points 1 and 2 are questionnaires or interviews carried out before the course of acupuncture treatment; time point 3 was carried out afterwards. PSQI: the Pittsburgh Sleep Quality Index."

Figure 4

PSQI: the need for medication to improve sleep Time points 1 and 2 are questionnaires or interviews carried out before the course of acupuncture treatment; time point 3 was carried out afterwards. The star represents an outlier who did regular shift work, including nights. PSQI: the Pittsburgh Sleep Quality Index."

Figure 5

SQLS total score of each interview Time points 1 and 2 are questionnaires or interviews carried out before the course of acupuncture treatment; time point 3 was carried out afterwards. SQLS: the Schizophrenia Quality of Life Scale."

"

[1] McGrath JJ . Myths and plain truths about schizophrenia epidemiology — the NAPE lecture 2004[J]. Acta Psychiatr Scand, 2005,111(1):4-11
doi: 10.1111/j.1600-0447.2004.00467.x pmid: 15636588
[2] Sundquist K, Frank G, Sundquist J . Urbanisation and incidence of psychosis and depression: follow-up study of 4.4 million women and men in Sweden[J]. Br J Psychiatry, 2004,184:293-298
doi: 10.1192/bjp.184.4.293
[3] Torrey EF, Mortensen PB, Pedersen CB, Wohlfahrt J, Melbye M . Risk factors and confounders in the geographical clustering of schizophrenia[J]. Schizophr Res, 2001,49(3):295-299
doi: 10.1016/S0920-9964(00)00081-5 pmid: 11356590
[4] Peen J, Dekker J . Admission rate for schizophrenia in the Netherlands[J]. Acta Psychiatr Scand, 1997,96(4):301-305
doi: 10.1111/j.1600-0447.1997.tb10167.x pmid: 9350960
[5] Lewis G, David A, Andréasson S, Allebeck P . Schizophrenia and city life[J]. Lancet, 1992,340(8812):137-140
doi: 10.1016/0140-6736(92)93213-7
[6] Lambert TJ, Velakoulis D, Pantelis C . Medical comorbidity in schizophrenia[J]. Med J Aust, 2003,178(Suppl):S67-S70
[7] Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Bo Mortensen P, Munk-Jørgensen P, Nielsen J, Nordentoft M, Saarinen P, Zisook S, Wilson ST, Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future[J]. Ann Gen Psychiatry, 2007,6:10
doi: 10.1186/1744-859X-6-10 pmid: 1845151
[8] Dyer JG, McGuinness TM .Update on early intervention in schizophrenia[J]. J Psychosoc Nurs Ment Health Serv, 2008,46(6):19-22
doi: 10.3928/02793695-20080601-03 pmid: 18595455
[9] Lewis SW, Davies L, Jones PB, Barnes TR, Murray RM, Kerwin R, Taylor D, Hayhurst KP, Markwick A, Lloyd H, Dunn G .Randomised controlled trials of conventional antipsychotic versus new atypical drugs,new atypical drugs versus clozapine,in people with schizophrenia responding poorly to,or intolerant of,current drug treatment[J].Health Technol Assess, 2006, 10(17):iii-iv, ix- xi, 1-165
[10] Ross CA, Read J. Antipsychotic medication: myths and facts. In: Read J, Mosher LR, Bentall RP. Models of madness: psychological, social and biological approaches to schizophrenia[M]. Hove and New York: Brunner-Routledge, 2004: 101-114
[11] Rampes H. Mental health and complementary therapies: a research perspective. In: Darnell P, Pinder M, Treacy K. Searching for evidence: complementary therapies research[M]. London: The Prince of Wales’s Foundation for Integrated Health, 2006
[12] Harbinson D, Ronan P . Acupuncture in the treatment of psychosis: the case for further research[J]. Eur J Orient Med, 2006,5(2):24-33
[13] Ong CK, Banks B . Complementary and alternative medicine: the consumer perspective[M]. London: The Prince of Wales’s Foundation for Integrated Health, 2003
[14] Perkins R, Farmer P, Litchfield P . Realising ambitions: better employment support for people with a mental health condition[M]. London: The Stationary Office, 2009
[15] World Health Organization . International classification of diseases 10 (ICD-10). 1992.
[16] Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T . Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review[J]. Arch Gen Psychiatry, 2005,62(9):975-983
doi: 10.1001/archpsyc.62.9.975
[17] Stahl SM. Essential psychopharmacology: the prescriber’s guide[M]. Cambridge: Cambridge University Press, 2005
[18] Chakos M, Lieberman J, Hoffman E, Bradford D, Sheitman B . Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trials[J]. Am J Psychiatry, 2001,158(4):518-526
doi: 10.1176/appi.ajp.158.4.518
[19] Ellenbroek BA. The pharmacotherapy of schizophrenia, past, present, and possible future. In: Bosch P, van den Noort M. Schizophrenia, sleep and acupuncture[M]. Gottingen: Hogrefe & Huber Publishers, 2008: 35-57
[20] Goff DC, Shader RI. Non-neurological side-effects of antipsychotic drugs. In: Hirsch SR, Weinberger DR. Schizophrenia [M]. Oxford: Blackwell Publishing, 2003,( 2nd ed):573-588
[21] Joint Formulary Committee. British National Formulary.[ online] 2011 ed. London: British Medical Association and Royal Pharmaceutical Society, 2011[2010-12-1]. .
[22] Lee MS, Shin BC, Ronan P, Ernst E . Acupuncture for schizophrenia: a systematic review and meta-analysis[J]. Int J Clin Pract, 2009,63(11):1622-1633
doi: 10.1111/j.1742-1241.2009.02167.x pmid: 19832819
[23] Rathbone J, Xia J .Acupuncture for schizophrenia[J].Cochrane Database Syst Rev, 2005,( 4):CD005475
[24] Bosch P, van den Noort M . The search for the mechanism behind acupuncture: research with neuroimaging. In: Bosch P, van den Noort M. Schizophrenia, sleep and acupuncture[M]. Gottingen: Hogrefe & Huber Publishers, 2008: 175-201
[25] Pegram A . What is case study research?[J]. Nurse Res, 1999,7(2):5-16
doi: 10.7748/nr1999.10.7.1.5.c6100
[26] Vallis J, Tierney A . Issues in case study analysis[J]. Nurse Res, 1999,7(2):19-35
[27] Platt J . “Case study” in American methodological thought[J]. Curr Sociol, 1992,40(1):17-48
doi: 10.1177/001139292040001004
[28] Stoecker R . Evaluating and rethinking the case study[J]. Sociol Rev, 1991,39(1):88-112
doi: 10.1111/j.1467-954X.1991.tb02970.x
[29] Sandelowski M . One is the liveliest number: the case orientation of qualitative research[J]. Res Nurs Health, 1996,19(6):525-529
doi: 10.1002/(SICI)1098-240X(199612)19:63.0.CO;2-Q pmid: 8948406
[30] Yin RK . .Case study research: design and methods[M].Thousand Oaks: Sage Publications, 2003,( 3rd ed):
[31] Bergen A, While A . A case for case studies: exploring the use of case study design in community nursing research[J]. J Adv Nurs, 2000,31(4):926-934
doi: 10.1046/j.1365-2648.2000.01356.x pmid: 10759989
[32] Hamel J, Dufour S, Fortin D . Case study methods[M]. Newbury Park: Sage Publications, 1993
[33] Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M ; Medical Research Council Guidance.Developing and evaluating complex interventions: the new Medical Research Council guidance[J]. BMJ, 2008,337:a1655
[34] Medical Research Council. A Framework for development and evaluation of RCTs for complex interventions to improve health. 2000; Apr 01.
[35] Jones C, Lyons C . Case study: design? Method? Or comprehensive strategy?[J]. Nurse Res, 2004,11(3):70-76
doi: 10.7748/nr2004.04.11.3.70.c6206 pmid: 15065485
[36] Stake RE . The art of case study research[M]. Thousand Oaks: Sage Publications, 1995
[37] Kay SR, Opler LA, Fiszbein A . Positive and Negative Syndrome Scale (PANSS)[M].New York: Multi-Health Systems, Inc, 2000,( 2nd ed):
[38] Kay SR, Opler LA, Lindenmayer JP . The Positive and Negative Syndrome Scale(PANSS): rationale and standardisation[J]. Br J Psychiatry Suppl, 1989,( 7):59-67
pmid: 2619982
[39] Martin CR, Allan R . Factor structure of the Schizophrenia Quality of Life Scale Revision 4(SQLS-R4)[J]. Psychol Health Med, 2007,12(2):126-134
doi: 10.1080/13548500500407383 pmid: 17365893
[40] Wilkinson G, Hesdon B, Wild D, Cookson R, Farina C, Sharma V, Fitzpatrick R, Jenkinson C . Self-report quality of life measure for people with schizophrenia: the SQLS[J]. Br J Psychiatry, 2000,177:42-46
doi: 10.1192/bjp.177.1.42 pmid: 10945087
[41] Buysse DJ, Reynolds CF3rd, Monk TH, Berman SR, Kupfer DJ .The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989,28(2):193-213
doi: 10.1016/0165-1781(89)90047-4
[42] Watson H, Whyte R. Using observation. In: Gerrish K, Lacey A. The research process in nursing [M]. Oxford: Blackwell Publishing, 2006,( 5th ed):383-398
[43] MacPherson H, White A, Cummings M, Jobst K, Rose K, Niemtzow R, for the STRICTA Group . Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations[J]. Clin Acupunct Orient Med, 2002,3(1):6-9
doi: 10.1054/caom.2001.0114
[44] MacPherson H, White A, Cummings M, Jobst K, Rose K, Niemtzow R . Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations[J]. Complement Ther Med, 2001,9(4):246-249
doi: 10.1054/ctim.2001.0488
[45] Bosch P, Ronan P, Quinton N, Harbinson D , van den Noort M. Acupuncture and schizophrenia: first European studies — initial results. ICCMR 2010: 5th International Congress on Complementary Medicine Research. Troms?: May 19-21, 2010.
[46] Ronan P, Bosch P . Breaking new ground: designing a methodology to investigate a complex intervention for a complex condition. ICCMR 2010: 5th International Congress on Complementary Medicine Research . Troms?: May 19-21, 2010.
[47] Ronan P, Robinson N, Harbinson D, MacInnes D .Acupuncture and schizophrenia: choices for collecting evidence: limitations and significance[J]. Eur J Orient Med, 2010,6(5):15-31
[48] Faul F, Erdfelder E, Lang AG, Buchner A . G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences[J]. Behav Res Methods, 2007,39(2):175-191
doi: 10.3758/BF03193146
[49] Grandner MA, Kripke DF, Yoon YI, Youngstedt SD . Criterion validity of the Pittsburgh Sleep Quality Index: Investigation in a non-clinical sample[J]. Sleep Biol Rhythm, 2006,4(2):129-136
doi: 10.1111/j.1479-8425.2006.00207.x pmid: 22822303
[50] Carpenter JS, Andrykowski MA . Psychometric evaluation of the Pittsburgh Sleep Quality Index[J]. J Psychosom Res, 1998,5(1 Spec No):5-13
doi: 10.1016/S0022-3999(97)00298-5 pmid: 9720850
[51] Wright IC, Rabe-Hesketh S, Woodruff PW, David AS, Murray RM, Bullmore ET . Meta-analysis of regional brain volumes in schizophrenia[J]. Am J Psychiatry, 2000,157(1):16-25
doi: 10.1176/ajp.157.1.16
[52] Camm AJ . Cardiovascular risk associated with schizophrenia and its treatment[M]. London: Galliard Healthcare Communications, 2003
[53] Parahoo K . Nursing research:principles,process andissues [M].Basingstoke: Palgrave Macmillan, 2006,( 2nd ed):
[54] Cresswell JW . Qualitative inquiry and research design: choosing among five approaches [M].Thousand Oaks: Sage Publications, Inc, 2007,( 2nd ed):
[55] Yin RK . Applications of case study research[M]. Newbury Park: Sage Publications, Inc, 1993
[56] Gentili A, Weiner DK, Kuchibhatla M, Edinger JD . Test-retest reliability of the Pittsburgh sleep quality index in nursing home residents[J]. J Am Geriatr Soc, 1995,43(11):1317-1318
doi: 10.1111/j.1532-5415.1995.tb07415.x pmid: 7594173
[1] Lan He , Dong Li , Ying-sheng Xu. Target points: A discussion on acupuncture treatment of primary trigeminal neuralgia. Journal of Chinese Integrative Medicine, 2012, 10(9): 961-965.
[2] Jing-lin Shi, Wan-hong Miao. Effects of acupuncture on lactoferrin content in tears and tear secretion in patients suffering from dry eyes: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2012, 10(9): 1003-1008.
[3] Zhang-ling Zhou, Cheng-xin Li, Yue-bo Jiang, Cong Zuo, Yun Cai, Rui Wang. Correlation between facial nerve functional evaluation and efficacy evaluation of acupuncture treatment for Bell’s palsy. Journal of Chinese Integrative Medicine, 2012, 10(9): 997-1002.
[4] Ming T. Tan , Jian-ping Liu , Lixing Lao. Adequate application of quantitative and qualitative statistic analytic methods in acupuncture clinical trials. Journal of Chinese Integrative Medicine, 2012, 10(8): 847-852.
[5] Fan Yin, Ziyi Fan. Dr. Wu: A beautiful, moving and meditative song — In memory of Dr. Jing Nuan Wu, a pioneer of acupuncture and a Chinese medicine doctor in the United States. Journal of Chinese Integrative Medicine, 2012, 10(8): 837-840.
[6] Christoph A. Doenitz, Ana Anjos, Thomas Efferth , Tobias Greten, Henry J. Greten. Can heat and cold be parameterized? Clinical data of a preliminary study. Journal of Chinese Integrative Medicine, 2012, 10(5): 532-537.
[7] Fan Yin . The first acupuncture center in the United States: An interview with Dr. Yao Wu Lee, Washington Acupuncture Center. Journal of Chinese Integrative Medicine, 2012, 10(5): 481-492.
[8] De-bo Qi, Wei-min Li. Effects of electroacupuncture on expression of c-fos protein and N-methyl-D-aspartate receptor 1 in the rostral ventromedia medulla of rats with chronic visceral hyperalgesia. Journal of Chinese Integrative Medicine, 2012, 10(4): 416-423.
[9] Gerhard Litscher. High-tech acupuncture made in Austria — cerebral circulation. Journal of Chinese Integrative Medicine, 2012, 10(4): 362-368.
[10] Paula de Sousa Fragoso Ana, de Sá Ferreira Arthur. Evaluation of the immediate effects of manual acupuncture on brachial bicep muscle function in healthy individuals and poststroke patients: a study protocol of a parallel-group randomized clinical trial. Journal of Chinese Integrative Medicine, 2012, 10(3): 303-309.
[11] Zhuo-xin Yang, Peng-dian Chen, Hai-bo Yu, Min Pi, Wen-shu Luo, Yuan-yuan Zhuo . Study strategies for acupuncture treatment of chronic nonbacterial prostatitis. Journal of Chinese Integrative Medicine, 2012, 10(3): 293-297.
[12] Ke Cheng , Fan Wu , Meng-hu Guo , Ling Zhao , Hai-ping Deng , Hai-meng Zhang , Li-zhen Wang , Yao Xu , Mactavish James , Xue-yong ShenCheng Ke, Wu Fan, Guo Meng-hu, Zhao Ling, Deng Hai-ping, Zhang Hai-meng, Wang Li-zhen, Xu Yao, James Mactavish, Shen Xue-yong. Analysis of the English translation of meridians’ path in Miraculous Pivot. Journal of Chinese Integrative Medicine, 2012, 10(12): 1502-1506.
[13] De-bo Qi, Wei-min Li. Effects of electroacupuncture on expression of c-fos protein in the spinal dorsal horn of rats with chronic visceral hyperalgesia. Journal of Chinese Integrative Medicine, 2012, 10(12): 1490-1496.
[14] Yang Zhuo-xin, Chen Peng-dian, Yu Hai-bo, Luo Wen-shu, Wu Yong-gang, Pi Min, Peng Jun-hua, Liu Yong-feng, Zhang Shao-yun, Gou Yan-hua. Research advances in treatment of cerebral ischemic injury by acupuncture of conception and governor vessels to promote nerve regeneration. Journal of Chinese Integrative Medicine, 2012, 10(1): 19-24.
[15] Cai Rong-lin, Hu Ling, Wu Zi-jian, Wang Ke-ming, He Lu, Zhou Yi-ping, Zhao Lun, Hu Wu-bin. Effects of acupuncture at Shenmen (HT7) or Taiyuan (LU9) on P3a and P3b of event-related potentials in healthy young adults. Journal of Chinese Integrative Medicine, 2012, 10(1): 48-53.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[2] Hai-feng Wei, Bai-liu Ya, Ling Zhao, Cui-fei Ye, Li Zhang, Lin Li. Evaluation of tongue manifestation of blood stasis syndrome and its relationship with blood rheological disorder in a rat model of transient brain ischemia. Journal of Chinese Integrative Medicine, 2008, 6(1): 73-76
[3] Xi Lin, Jian-ping Liu. Herbal medicines for viral myocarditis. Journal of Chinese Integrative Medicine, 2008, 6(1): 76
[4] Xi Lin, Jian-ping Liu. Tai chi for treating rheumatoid arthritis. Journal of Chinese Integrative Medicine, 2008, 6(1): 82
[5] Liang-ping Hu, Hui Gao. Discrimination of errors in statistical analysis of medical papers published in the first issue of 2006 in Journal of Chinese Integrative Medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 98-106
[6] Yan-bo Zhu , Qi Wang, Cheng-yu Wu, Guo-ming Pang, Jian-xiong Zhao, Shi-lin Shen, Zhong-yuan Xia , Xue Yan . Logistic regression analysis on relationships between traditional Chinese medicine constitutional types and overweight or obesity. Journal of Chinese Integrative Medicine, 2010, 8(11): 1023-1035
[7] Wei Xu, Meng Shi, Jian-gang Liu, Cheng-long Wang . Collagen protein expressions in ischemic myocardium of rats with acute myocardial infarction and effects of qi-tonifying, yin-tonifying and blood-activating herbs and detoxifying and blood-activating herbs. Journal of Chinese Integrative Medicine, 2010, 8(11): 1041-1047
[8] Tao Wang , Feng Qin. Effects of Chinese herbal medicine Xiaoyao Powder on monoamine neurotransmitters in hippocampus of rats with postpartum depression. Journal of Chinese Integrative Medicine, 2010, 8(11): 1075-1079
[9] Ying Xu , Chang-chun Zeng , Xiu-yu Cai , Rong-ping Guo , Guang Nie , Ying Jin. Chromaticity and optical spectrum colorimetry of the tongue color in different syndromes of primary hepatic carcinoma. Journal of Chinese Integrative Medicine, 2012, 10(11): 1263-1271
[10] Xiang-ying Mao , Qin Bian , Zi-yin Shen. Analysis of the osteogenetic effects exerted on mesenchymal stem cell strain C3H10T1/2 by icariin via MAPK signaling pathway in vitro. Journal of Chinese Integrative Medicine, 2012, 10(11): 1272-1278
[an error occurred while processing this directive]