With the growing interest in Complementary and Alternative Medicine (CAM) among patients, psychiatrists face a new challenge of learning how the complementary treatments may interact with conventional psychopharmacology and psychotherapy.
The patient-driven growth in the use of CAM reflects our divided health care system. Medicine co-exists with many alternative and complementary fields such as naturopathy, Chinese medicine, Ayurveda, chiropractic, health coaching, yoga therapy, homeopathy, massage and manual therapies, herbal medicine, energy healing and others.
Patients may receive treatments and advice from a number of different providers, who may have quite divergent views of the causes and treatment of diseases. According to a study by Eisenberg et al., published in JAMA (1998), Americans make more visits to alternative health care practitioners than to primary care physicians (JAMA 1998;280(18):1569-1575). A 2008 survey by National Center for Complementary and Alternative Medicine (NCCAM) and the CDC showed that approximately 38 percent of U.S. adults and approximately 12 percent of children use some form of CAM in a one-year period, with most frequent use of natural products, deep breathing and meditation (www.nccam.nih.gov). Patients may not reveal the complementary treatments that they use to their doctors, even though there are many potential interactions between treatments. Other patients may ask their integrative psychiatrist NYC about integrating diet, nutritional supplements, herbs and other complementary treatments with psychopharmacology or psychotherapy. While research remains limited on many CAM treatments, substantial research accumulated on the effectiveness of a number of approaches. Good places to look for research evidence on CAM treatments are the Journal of Alternative and Complementary Medicine, Cochrane CAM Field, Natural Standard Database, and NCCAM website.
After many years of suspicion towards CAM, the current trend is for judiciously and effectively integrating CAM with mainstream medicine. Integrative Medicine is a new subspecialty of medicine, and the American Board of Physician Specialties will offer the first board exam in Integrative Medicine in November 2014. The Board defines Integrative Medicine as the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.
Psychiatrists employ both evidence-based concepts and intuitive ways of understanding and treating illness. The treatment of mental disorders calls for an artful blending of emerging and established approaches, and complementary approaches are increasingly interwoven with conventional approaches. For example mindfulness is a key feature of Dialectic Behavioral Therapy, Mindfulness Based CBT, and Acceptance and Commitment Therapy. Integrative Psychiatry embraces a holistic lifestyle-based approach to evaluating and treating mental disorders, and involves the intelligent combination of conventional and complementary treatments.
Since CAM is not typically taught in medical school, patients are often better educated in complementary treatments than their doctors. Psychiatrist may need to venture out on their own to read research literature and obtain additional training in nutrition, mind-body medicine, and other modalities to keep up with their patients and to offer the best care that is available.
INTEGRATIVE PSYCHIATRY: BLENDING COMPLEMENTARY AND ALTERNATIVE APPROACHES WITH WESTERN MEDICINE
“This article first appeared in the “The Newsletter of the New York County Psychiatric Society a District Branch of the American Psychiatric Association” Fall 2014