,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
Search JIM Advanced Search

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] Sherman Gu, Arthur Yin Fan. Controversial conclusions from two randomized controlled trials for acupuncture's effects on polycystic ovary syndrome or in vitro fertilization support. Journal of Integrative Medicine, 2020, 18(2): 89-91.
[2] Arthur Yin Fan, David Dehui Wang, Hui Ouyang, Haihe Tian, Hui Wei, Deguang He, Changzhen Gong, Jipu Wen, Ming Jin, Chong He, Sarah Faggert Alemi, Sudaba Rahimi. Acupuncture price in forty-one metropolitan regions in the United States: An out-of-pocket cost analysis based on OkCopay.com. Journal of Integrative Medicine, 2019, 17(5): 315-320.
[3] Tamer Aboushanab, Mohamed Khalil, YaserAl Ahmari. The present state of complementary medicine regulation in Saudi Arabia. Journal of Integrative Medicine, 2019, 17(3): 147-149.
[4] Xin-yu Yue, Zhuo-qi Feng, Xi-yi Yu, Jia-min Hu, Xiao-Jing He, Shi Shu. Fire-needle acupuncture for upper limb spastic paralysis after stroke: Study protocol for a randomized controlled trial. Journal of Integrative Medicine, 2019, 17(3): 167-172.
[5] Ya-ru Huangfu, Wei Peng, Bao-jun Guo, Zhi-fu Shen, Li Li, Shi-wei, Liu, Hui Zheng, You-ping Hu. Effects of acupuncture in treating insomnia due to spleen-stomach disharmony syndrome and its influence on intestinal microbiome: Study protocol for a randomized controlled trial. Journal of Integrative Medicine, 2019, 17(3): 161-167.
[6] Arthur Yin Fan, Hui Ouyang, Xinru Qian, Hui Wei, David Dehui Wang, Deguang He, Haihe Tian, Changzhen Gong, Amy Matecki, Sarah Faggert Alemi. Discussions on real-world acupuncture treatments for chronic low-back pain in older adults. Journal of Integrative Medicine, 2019, 17(2): 71-76.
[7] Michelle T. Jesse, Mathew Kulas, Josephine Unitis, Nemie Beltran, Marwan Abouljoud. Acupuncture in living liver and kidney donors: a feasibility study. Journal of Integrative Medicine, 2019, 17(1): 3-7.
[8] Jillian Marie McDowell, Susan Heather Kohut, Debra Betts . Safe acupuncture and dry needling during pregnancy: New Zealand physiotherapists’ opinion and practice. Journal of Integrative Medicine, 2019, 17(1): 30-37.
[9] Fung-Kei Cheng. An overview of the contribution of acupuncture to thyroid disorders. Journal of Integrative Medicine, 2018, 16(6): 375-383.
[10] Arthur Yin Fan, Sarah F. Alemi, Yingping H. Zhu, Sudaba Rahimi, Hui Wei, Haihe Tian, Deguang He, Changzhen Gong, Guanhu Yang, Chong He, Hui Ouyang . Effectiveness of two different acupuncture strategies in patients with vulvodynia: Study protocol for a pilot pragmatic controlled trial. Journal of Integrative Medicine, 2018, 16(6): 384-389.
[11] Xin-fang Zhang, Shui-ying Xiang, Wen-ye Geng, Wen-juan Cong, Jing Lu, Chuan-wei Jiang, Kun Wang, Zi-bing Liu . Electro-acupuncture regulates the cholinergic anti-inflammatory pathway in a rat model of chronic obstructive pulmonary disease. Journal of Integrative Medicine, 2018, 16(6): 418-426.
[12] Jia Xu, Fu-qing Zhang, Jian Pei, Jun Ji . Acupuncture for migraine without aura: A systematic review and meta-analysis. Journal of Integrative Medicine, 2018, 16(5): 312-321.
[13] Nobuari Takakura, Miho Takayama, Morihiro Nasu, Masako Nishiwaki, Akiko Kawase, Hiroyoshi Yajima . Patient blinding with blunt tip placebo acupuncture needles: Comparison between 1 mm and 2 mm skin press. Journal of Integrative Medicine, 2018, 16(3): 164-171.
[14] Ching-Feng Su. Home care with acupuncture increased the quality of life in a patient with advanced cancer with neuropathic pain induced by bone metastasis: A case report. Journal of Integrative Medicine, 2018, 16(3): 208-210.
[15] Arthur Yin Fan, Sarah Faggert. Distribution of licensed acupuncturists and educational institutions in the United States in early 2015. Journal of Integrative Medicine, 2018, 16(1): 1-5.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[2] 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
[3] Zhi-chun Jin. Problems in establishing clinical guideline for integrated traditional Chinese and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 5-8
[4] SUN Ming-yu, ZUO Jian, DUAN Ji-feng, HAN Jun, FAN Shi-ming, ZHANG Wei, ZHU Li-fang, YAO Ming-hui. Antitumor activities of kushen flavonoids in vivo and in vitro. Journal of Chinese Integrative Medicine, 2008, 6(1): 51-59
[5] Wei Zhang, Xiang-feng Lu, Xiao-mei Zhang, Jian-jun Wu, Liang-duo Jiang. A rat model of pulmonary fibrosis induced by infusing bleomycin quickly through tracheal intubation. Journal of Chinese Integrative Medicine, 2008, 6(1): 60-67
[6] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88
[7] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. Guiding principles of clinical research on mild cognitive impairment (protocol). Journal of Chinese Integrative Medicine, 2008, 6(1): 9-14
[8] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013
[9] Xin-jun Wang, Ling-ling Wang . A mechanism of endogenous opioid peptides for rapid onset of acupuncture effect in treatment of depression. Journal of Chinese Integrative Medicine, 2010, 8(11): 1014-1017
[10] Ya-bing Zhou, Jian-er Yu, Jie Wu, Li Bai, Li-li Huo, Xin-guang Zhang, Li-qing Li . Effects of Chinese herbal medicine Bushen Gubiao Recipe on toll-like receptor 4 and CD4 +CD25 +foxp3 +regulatory T cells in mice with recurrent respiratory tract infections. Journal of Chinese Integrative Medicine, 2010, 8(11): 1053-1059