Nutraceutical and Alternative Treatments for Obsessive-Compulsive and Related Disorders

2017 ◽  
Author(s):  
David A Camfield ◽  
Jerome Sarris
Keyword(s):  
Symptom Severity ◽  
Current Evidence ◽  
Future Research ◽  
Controlled Trials ◽  
Milk Thistle ◽  
Efficacy And Safety ◽  
Obsessive Compulsive ◽  
Open Label ◽  
Nail Biting ◽  
Antidepressant Use

This chapter reviews current research regarding nutraceutical substances that have been systematically investigated through either case studies, open-label and/or randomized placebo-controlled trials and found to have some evidence of efficacy in the treatment of obsessive compulsive and related disorders (specifically, trichotillomania, compulsive nail biting, and excoriation). The substances to be considered are myo-inositol, St. John’s wort, milk thistle, borage, glycine, sarcosine, psilocybin, and N-acetylcysteine. A description of each substance is presented, together with relevant biochemistry and interpretation regarding the current evidence of efficacy and safety/tolerability as well as what can be determined about factors that may moderate its efficacy, including OCD symptom severity, and advice in regard to concomitant antidepressant use. Conclusions and recommendations for future research are also presented.

scholarly journals Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials

2021 ◽  
Vol 18 (23) ◽  
pp. 12757
Author(s):  
Bryan Yijia Tan ◽  
Tivona Thach ◽  
Yasmin Lynda Munro ◽  
Soren Thorgaard Skou ◽  
Julian Thumboo ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Scoping Review ◽  
Psychological Intervention ◽  
Care Delivery ◽  
Data Extraction ◽  
Psychosocial Interventions ◽  
Current Evidence ◽  
Future Research ◽  
Controlled Trials ◽  
Knee Oa

Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocial interventions. Our scoping review searched five databases from 2000 to 2021 where complex lifestyle or psychosocial interventions for patients with knee OA were compared to other interventions. Screening and data extraction were performed by two review authors independently and discrepancies resolved through consensus and in parallel with a third reviewer. A total of 38 articles were selected: 9 studied the effectiveness of psychological interventions; 11 were on self-management and lifestyle interventions; 18 looked at multifaceted interventions. This review highlights the substantial variation in knee OA interventions and the overall lack of quality in the current literature. Potential areas of future research, including identifying prognostic social factors, stratified care models, transdisciplinary care delivery and technology augmented interventions, have been identified. Further high-quality RCTs utilizing process evaluations and economic evaluation in accordance with the MRC guidelines are critical for the development of evidence-based knee OA programs globally.

scholarly journals The Current Status of Clinical Research Involving Microneedles: A Systematic Review

Pharmaceutics ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1113
Author(s):  
Seung-Yeon Jeong ◽  
Jung-Hwan Park ◽  
Ye-Seul Lee ◽  
Youn-Sub Kim ◽  
Ji-Yeun Park ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Osteoporosis Treatment ◽  
Current Status ◽  
Current Evidence ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Randomized Controlled ◽  
And Control

In recent years, a number of clinical trials have been published on the efficacy and safety of drug delivery using microneedles (MNs). This review aims to systematically summarize and analyze the current evidence including the clinical effect and safety of MNs. Three electronic databases, including PubMed, were used to search the literature for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that evaluated the therapeutic efficacy of MNs from their inception to 28 June 2018. Data were extracted according to the characteristics of study subjects; disorder, types, and details of the intervention (MNs) and control groups; outcome measurements; effectiveness; and incidence of adverse events (AEs). Overall, 31 RCTs and seven CCTs met the inclusion criteria. Although MNs were commonly used in skin-related studies, evaluating the effects of MNs was difficult because many studies did not provide adequate comparison values between groups. For osteoporosis treatment, vaccine, and insulin delivery studies, MNs were comparable to or more effective than the gold standard. Regarding the safety of MNs, most AEs reported in each study were minor (grade 1 or 2). A well-designed RCT is necessary to clearly evaluate the effectiveness of MNs in the future.

scholarly journals Chinese Herbal Medicine for Aspirin Resistance: A Systematic Review of Randomized Controlled Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-16
Author(s):  
Ai-ju Liu ◽  
Hui-qin Li ◽  
Ji-huang Li ◽  
Yuan-yuan Wang ◽  
Dong Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Randomized Controlled Trials ◽  
Chinese Herbal Medicine ◽  
Aspirin Resistance ◽  
Current Evidence ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Chinese Herbal

Aspirin resistance (AR) is a prevalent phenomenon and leads to significant clinical consequences, but the current evidence for effective interventional strategy is insufficient. The objective of this systematic review is thus to assess the efficacy and safety of Chinese herbal medicine (CHM) for AR. A systematical literature search was conducted in 6 databases until December 2012 to identify randomized controlled trials (RCTs) of CHM for AR. As a result, sixteen RCTs with a total of 1011 subjects were identified, suggesting that the interests of the medical profession and the public in the use of CHM for AR have grown considerably in the recent years. Tongxinluo capsule and Danshen-based prescriptions were the most frequently used herbal prescriptions, while danshen root, milkvetch root, Leech, and Rosewood were the most frequently used single herbs. Despite the apparent reported positive findings, it is premature to determine the efficacy and safety of CHM for the treatment of AR due to poor methodological quality and insufficient safety data. However, CHMs appeared to be well tolerated in all included studies. Thus, CHM as a promising candidate is worthy of improvement and development for further clinical AR trials. Large sample-size and well-designed rigorous RCTs are needed.

The Efficacy and Safety of Pharmacological Treatments for Post-stroke Aphasia

2018 ◽  
Vol 17 (7) ◽  
pp. 509-521 ◽  
Author(s):  
Xiaoyan Zhang ◽  
Bohui Shu ◽  
Dongdong Zhang ◽  
Lina Huang ◽  
Qizhi Fu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Spontaneous Speech ◽  
Current Evidence ◽  
Controlled Trials ◽  
Auditory Comprehension ◽  
Efficacy And Safety ◽  
Pharmacological Treatments ◽  
Post Stroke ◽  
Oral Expression

Background: Aphasia is a common complication after stroke, and traditional speech and language therapy (SLT) has a limited effect on post-stroke aphasia (PSA). While there has been an increasing number of controlled clinical trials on the efficacy of drugs in the treatment of PSA, there have been very few systematic reviews on the efficacy and safety of pharmacological treatments in people with PSA. Objective: To evaluate the efficacy and safety of pharmacological interventions for PSA. Methods: The Cochrane Central Register of Controlled Trials (CENTRA), PubMed, Embase, Chinese Journal Full-text Database (CJFD), China Biology Medicine disc (CBMdisc), Wanfang Data and VIP Information System were searched for randomized controlled trials about pharmacological treatments for PSA. Literature screening using the inclusion and exclusion criteria, data extraction and methodological quality assessment of the included studies were completed by two independent reviewers. Methodological quality was considered high for modified Jadad quality scale scores of 4 to 7. RevMan 5.3 software was used to conduct a meta-analysis of high-quality studies. Results: Fifteen studies (578 participants) satisfied the eligibility criteria for this systematic review. Five trials (277 participants) assessed donepezil, four studies (124 participants) assessed memantine, three studies (72 participants) assessed bromocriptine, one trial (45 patients) evaluated galantamine, one study (21 patients) evaluated amphetamine, and one trial (39 patients) evaluated levodopa. The systematic review showed that donepezil achieved remarkable results in terms of the aphasia quotient (AQ) (SMD 0.82, 95% CI 0.48-1.17, P < 0.00001), repetition ability (SMD 0. 81, 95% CI 0.57-1.06, P < 0.00001), naming ability (SMD 0.56, 95% CI 0.29-0. 84, P < 0.00001), auditory comprehension (SMD 0.85, 95% CI 0.58-1. 13, P< 0.00001) and oral expression (SMD 0.90, 95% CI 0.54-1.26, P < 0.00001). Memantine showed no pronounced improvement in auditory comprehension (SMD 0.35, 95% CI -0.05-0.74, P = 0.09) but did improve the AQ (SMD 0.57, 95% CI 0.09-1.06, P = 0. 02), naming ability (SMD 0.81, 95% CI 0.38-1.25, P = 0.0002), spontaneous speech (SMD 0.76, 95% CI 0. 39- 1.13, P < 0.0001), and repetition ability (SMD 0.37, 95% CI 0.01-0.73, P = 0.04). Bromocriptine showed pronounced improvement in naming ability (SMD -0.20, 95% CI- 0.67-0.26, P = 0.39), verbal fluency (SMD 0.02, 95% CI 0.53-0.56, P = 0.95), and repetition ability (SMD 0.29, 95% CI -0.23-0. 81, P = 0.28). There is limited and inconclusive evidence for galantamine, amphetamine and levodopa. Conclusion: Current evidence suggests that drugs, such as donepezil and memantine, can improve the prognosis of PSA. Donepezil has a significant effect in improving the ability of auditory comprehension, naming, repetition and oral expression. Memantine has a significant effect in improving the ability of naming, spontaneous speech and repetition. Bromocriptine showed no significant improvements in the treatment of aphasia after stroke. Data regarding galantamine, amphetamine and levodopa in the treatment of aphasia after stroke are limited and inconclusive.

scholarly journals Nonpharmacological Interventions to Improve Depression, Anxiety, and Quality of Life (QoL) in People With Dementia: An Overview of Systematic Reviews

2019 ◽  
Vol 33 (1) ◽  
pp. 28-41 ◽  
Author(s):  
Naoko Kishita ◽  
Tamara Backhouse ◽  
Eneida Mioshi
Keyword(s):  
Quality Of Life ◽  
Systematic Reviews ◽  
Cognitive Stimulation ◽  
Current Evidence ◽  
Future Research ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
People With Dementia ◽  
Current Evidence Base

This overview aimed to systematically synthesize evidence from existing systematic reviews to signpost practitioners to the current evidence base on nonpharmacological interventions to improve depression, anxiety, and quality of life (QoL) in people with dementia and to discuss priorities for future research. The databases MEDLINE, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials were searched in August 2017 with an updated search in January 2019. Fourteen systematic reviews of randomized controlled trials of nonpharmacological interventions were identified. Dementia stage was rated moderate or severe in the majority of the reviews and type of dementia varied. Interventions reported to be effective were cognitive stimulation (QoL: standardized mean difference [SMD] = 0.38), music-based therapeutic interventions (depression: SMD = −0.27, anxiety: SMD = −0.43, QoL: SMD = 0.32), and psychological treatments (mainly cognitive behavior therapy; depression: SMD = −0.22, anxiety: MD = −4.57). Although health-care professionals are recommended to continue using these approaches, future research needs to focus on the type and form of interventions that are most effective for different stages and types of dementia.

scholarly journals Functional Connectivity of the Striatum as a Neural Correlate of Symptom Severity in Patient with Obsessive-Compulsive Disorder

2020 ◽  
Vol 17 (2) ◽  
pp. 87-95 ◽  
Author(s):  
Junha Park ◽  
Taekwan Kim ◽  
Minah Kim ◽  
Tae Young Lee ◽  
Jun Soo Kwon
Keyword(s):  
Functional Connectivity ◽  
Obsessive Compulsive Disorder ◽  
Symptom Severity ◽  
Rating Scale ◽  
Neural Correlates ◽  
Current Evidence ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cortical Regions ◽  
Hamilton Rating Scale

Objective It is well established that the cortico-striato-thalamo-cortical (CSTC) circuit is implicated in the pathophysiology of obsessive- compulsive disorder (OCD). However, reports on corticostriatal functional connectivity (FC) in OCD have been inconsistent due to the structural and functional heterogeneity of the striatum. Therefore, in the present study, we investigated corticostriatal FC using a fine 12-seed striatal parcellation to overcome this heterogeneity and discover the neural correlates of symptoms in OCD patients.Methods We recruited 23 OCD patients and 23 healthy controls (HCs). Whole-brain FC based on striatal seeds was examined using resting-state functional magnetic resonance imaging data and compared across OCD patients and HCs. We conducted correlation analysis between FCs of striatal subregions with significant group differences and symptom severity scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety (HAM-A).Results Compared to HCs, patients demonstrated increased FC of the dorsal caudal putamen and ventral rostral putamen (VRP) with several cortical regions, such as the intracalcarine cortex, inferior frontal gyrus, supramarginal/angular gyrus (SMG/AG), and postcentral gyrus (PCG). Furthermore, FC between the VRP and SMG/AG and between the VRP and PCG was negatively correlated with scores on the Y-BOCS compulsive subscale and the HAM-A, respectively.Conclusion These findings suggest that striatal subregions have strengthened FC with extensive cortical regions, which may reflect neural correlates of compulsive and anxious symptoms in OCD patients. These results contribute to an improved understanding of OCD pathophysiology by complementing the current evidence regarding striatal FC.

scholarly journals N-acetylcysteine for radiocontrast-induced nephropathy: Potential role in the emergency department?

CJEM ◽  
2004 ◽  
Vol 6 (04) ◽  
pp. 253-258
Author(s):  
Elaine Chong ◽  
Peter J. Zed
Keyword(s):  
Emergency Department ◽  
Contrast Media ◽  
English Language ◽  
Potential Role ◽  
Current Evidence ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Search Terms ◽  
Adequate Hydration

ABSTRACT Objective: To systematically review the efficacy and safety of N-acetylcysteine (NAC) for the prevention of radiocontrast-induced nephropathy (RIN), and to discuss its potential role in the emergency department. Methodology: We conducted a search of MEDLINE (from 1966 to December 2003), PubMed (1966 to December 2003) and EMBASE (1988 to December 2003) for English-language, prospective, randomized, controlled trials in humans using the search terms N-acetylcysteine, acetylcysteine, radiopharmaceuticals, contrast media, and kidney failure (acute). Results: Five trials support and 4 trials refute the hypothesis that NAC helps prevent RIN. In 7 of 9 trials, oral NAC was administered twice daily for 2 days, on the day before and on the day of the radiocontrast study — a regime not feasible for emergent situations. More recent trials suggest that adequate hydration and lower volumes of radiocontrast, rather than NAC, are more effective ways to prevent RIN. Conclusion: Although further study may be indicated, current evidence does not suggest that NAC has a role in the emergency prevention of RIN.

scholarly journals Comparative Efficacy and Safety of Oral P2Y 12 Inhibitors in Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (2) ◽  
pp. 150-160 ◽  
Author(s):  
Eliano P. Navarese ◽  
Safi U. Khan ◽  
Michalina Kołodziejczak ◽  
Jacek Kubica ◽  
Sergio Buccheri ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Current Evidence ◽  
Controlled Trials ◽  
Mortality Reduction ◽  
Efficacy And Safety ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
Significant Mortality

Background: New randomized, controlled trials have become available on oral P2Y 12 inhibitors in acute coronary syndrome. We aimed to evaluate current evidence comparing the efficacy and safety profile of prasugrel, ticagrelor, and clopidogrel in acute coronary syndrome by a meta-analysis of randomized controlled trials. Methods: We performed a network meta-analysis and direct pairwise comparison analysis of efficacy and safety outcomes from 12 randomized controlled trials including a total of 52 816 patients with acute coronary syndrome. Results: In comparison with clopidogrel, ticagrelor significantly reduced cardiovascular mortality (hazard ratio [HR], 0.82 [95% CI, 0.72–0.92]) and all-cause mortality (HR, 0.83 [95% CI, 0.75–0.92]), whereas there was no statistically significant mortality reduction with prasugrel (HR, 0.90 [95% CI, 0.80–1.01] and HR, 0.92 [95% CI, 0.84–1.02], respectively). In comparison with each other, there were no significant differences in mortality (HR prasugrel versus ticagrelor, 1.10 [95% CI, 0.94–1.29] and 1.12 [95% CI, 0.98–1.28]). In comparison with clopidogrel, prasugrel reduced myocardial infarction (HR, 0.81 [95% CI, 0.67–0.98]), whereas ticagrelor showed no risk reduction (HR, 0.97 [95% CI, 0.78–1.22]). Differences between prasugrel and ticagrelor were not statistically significant. Stent thrombosis risk was significantly reduced by both ticagrelor and prasugrel versus clopidogrel (28%–50% range of reduction). In comparison with clopidogrel, both prasugrel (HR, 1.26 [95% CI, 1.01–1.56]) and ticagrelor (HR, 1.27 [95% CI, 1.04–1.55]) significantly increased major bleeding. There were no significant differences between prasugrel and ticagrelor for all outcomes explored. Conclusions: Prasugrel and ticagrelor reduced ischemic events and increased bleeding in comparison with clopidogrel. A significant mortality reduction was observed with ticagrelor only. There was no efficacy and safety difference between prasugrel and ticagrelor. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42019155648.

scholarly journals A Case for Alpha-Lipoic Acid as an Alternative Treatment for Diabetic Polyneuropathy

2018 ◽  
Vol 21 (1s) ◽  
pp. 192s-199s ◽  
Author(s):  
Ngoc Nguyen ◽  
Jody K Takemoto
Keyword(s):  
Lipoic Acid ◽  
Diabetic Polyneuropathy ◽  
The United States ◽  
Current Data ◽  
Current Evidence ◽  
Future Research ◽  
Alpha Lipoic Acid ◽  
Open Label ◽  
The Us ◽  
Meta Analyses

Purpose: The aim of this systematic review is to evaluate current evidence of alpha-lipoic acid (ALA) regarding efficacy, safety, and cost to accurately compare it with other diabetic polyneuropathy (DPN) treatments. The intention is to provide recommendations on future research and to promote utilization of ALA in the United States (US). Methods: A literature search was conducted on three databases: Scopus, PubMed, and Web of Science. The following criteria were used to select studies: (1) randomized controlled trials (RCTs) and open-label trials on ALA, (2) review articles and meta-analyses of RCTs on ALA, (3) study population consisting of patients with diabetes mellitus, peripheral neuropathic pain, and/or metabolic syndrome. Results: Twenty-five publications were selected including five RCTs and three open-label studies. Most clinical trials were conducted outside of the US. Current data provides evidence for the benefits of ALA in DPN treatment at a dose of 600 mg per day, either intravenously (IV) or orally, for a duration of at least 3 weeks with minimal side effects. Conclusions: ALA demonstrates effectiveness in treating DPN through multiple mechanisms to modulate pathophysiology and control symptoms. In addition, ALA exhibits activity in weight management and insulin sensitivity. The use of ALA for DPN in the US is worth considering because commonly prescribed medications have unclear mechanisms, more pronounced adverse effects, and are more expensive than ALA.  Further research needs to be conducted to assess long-term efficacy of ALA in US patients.

scholarly journals A Clinician's Guide to the Efficacy of EMDR Therapy

2019 ◽  
Vol 13 (4) ◽  
pp. 239-246
Author(s):  
Louise Maxfield
Keyword(s):  
Randomized Controlled Trials ◽  
Treatment Guidelines ◽  
Future Research ◽  
Controlled Trials ◽  
Obsessive Compulsive ◽  
Information Processing Model ◽  
Compulsive Disorder ◽  
Randomized Controlled ◽  
Traumatized Children ◽  
Emdr Therapy

Thirty years after its introduction in 1989, eye movement desensitization and reprocessing (EMDR) therapy has evolved to become a comprehensive psychotherapy, guided by Shapiro's adaptive information processing model. Her model views most mental health disorders as stemming from unprocessed earlier disturbing events. This understanding of the etiological role of trauma has opened the door for EMDR treatment of multiple types of presentations. There are now more than 44 randomized controlled trials that have investigated EMDR treatment of posttraumatic stress disorder (PTSD), early traumatic stress, and traumatized children. In addition, there are 28 randomized controlled trials which have evaluated its use with major depressive disorder, bipolar disorder, psychosis, anxiety disorders, obsessive compulsive disorder, substance use disorder, and pain. Seventy-five percent of these studies provided Shapiro's standardized procedure, while others tested modifications developed for specific populations. The focus of treatment varied across the studies, with various targets being processed to achieve good outcomes. The research demonstrates EMDR's effectiveness in reducing/eliminating PTSD and trauma-related symptoms, and in improving symptoms related to presenting problems and disorders. EMDR can be considered to have well-established efficacy for the treatment of PTSD. The emerging evidence for EMDR's efficacy with disorders other than PTSD must be considered preliminary and in need of replication conducted with randomized controlled trials using rigorous methodology. EMDR's position in various treatment guidelines is discussed, and the needs for future research are elaborated.

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