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Title: INTEGRATIVE%20PSYCHIATRY:%20%20AYURVEDA%20IN%20CLINICAL%20CARE


1
INTEGRATIVE PSYCHIATRY AYURVEDA IN CLINICAL
CARE
  • Sudha Prathikanti, MD
  • University of California, San Francisco
  • www.prathikanti.com/teaching

2
INTEGRATIVE PSYCHIATRY
  • A healing approach that uses both
    conventional and complementary / alternative
    medicine to
    understand and treat psychiatric conditions.

3
NIH DEFINITION OF COMPLEMENTARY
ALTERNATIVE MEDICINE (CAM)
  • Healthcare systems, practices, and products not
    presently considered to be part of conventional
    medicine.
  • Complementary together with
  • conventional practice
  • Alternative in place of
  • conventional practice

4
NIH CLASSIFICATION OF CAM
  • Alternative Medical Systems
  • Ayurveda of India
  • Traditional Chinese Medicine
  • Homeopathy
  • Mind-Body Therapies
  • Meditation
  • Biofeedback
  • Hypnosis and Guided Imagery
  • Biologically-Based Therapies
  • Botanicals and Herbs
  • Diet and Nutritional Supplements
  • Energy Therapies
  • Reiki
  • Qi Gong
  • Magnets
  • Manual Therapies
  • Massage
  • Chiropractic

5
USE OF CAM IN THE UNITED STATES
  • General publics use of CAM 42 (Eisenberg
    1998)
  • 27 billion spent annually, mostly non-reimbursed
  • Among people with self-reported anxiety or
    depression,
  • CAM use exceeds conventional care (Eisenberg
    2001)
  • --For anxiety, CAM 57 vs conventional 41
  • --For depression, CAM 54 vs conventional 35
  • Among people with self-reported anxiety or
    depression
  • who seek conventional care
  • -- 66 with anxiety also use CAM
  • -- 67 with depression also use CAM
  • CAM use by patients with anxiety / depression
  • -- Mind-body therapies 34
  • -- Spiritual healers 10
  • -- Manual therapies 8
  • -- Herbs / supplements 7

6
EVOLUTION OF MODERN BIOMEDICINE
  • European Enlightenment
  • Germ Theory of Disease
  • Flexner Report

7
THE BIOMEDICAL PARADIGM
  • Body, mind, spirit are discrete
  • Body can be treated independently
  • Body is like machine
  • Isolate eradicate source of malfunction
  • Physician is specialized technician
  • Treatment is specific to illness
  • Treatment should pass scientific tests
  • Physician -patient relationship has little
    bearing on outcome as long as adherence to
    treatment prevails
  • Emphasis on fighting disease

8
LIMITATIONS OF BIOMEDICINE
  • Poorer results when condition
  • - Chronic
  • - Non-bacterial
  • - Non-mechanical
  • - Autoimmune
  • - Unknown or multifactorial etiology
  • Adverse effects of biomedical therapies
  • Rigid treatment delivery systems
  • Less time with physician
  • Possible sense of de-humanization
    compartmentalization

9
THE RE-DISCOVERY OF
ALTERNATIVE MEDICINE
  • The more I learn of physics,
    the more I am drawn to metaphysics.
  • Albert Einstein

10
AYURVEDA SCIENCE OF LIVING
FIVE GREAT BHUTAS
THREE GREAT DOSHAS
11
AYURVEDA THE THREE GREAT DOSHAS
Each dosha has specific expression in every
dimension of human being Vata moves ---gt
body, mind, subtle energy Pitta heats ----gt
body, mind, subtle energy Kapha binds ---gt
body, mind, subtle energy
. There is implicit and explicit understanding
that body, mind and spirit are manifestations of
the same life-force.
12
AYURVEDA IMPORTANCE OF INDIVIDUAL CONSTITUTION
  • Each person has unique
  • constitution of 3 doshas
  • Constitution ascertained
  • thru careful history exam
  • Speech / Motor Activity
  • Emotional Tendencies
  • Memory Cognition
  • Eating / Elimination Patterns
  • Sleeping Patterns
  • Pulse
  • Body Build Weight
  • Tongue, Skin, Hair, Nails
  • Circulation
  • Climate Tolerance

13
AYURVEDA CONSTITUTIONAL TYPES
. VATA Lean, bony build Rapid
walk and talk Erratic appetite
stamina Sensitive to wind cold Quick, flexible
mind Learn fast, forget fast Less willpower,
resolve Easily anxious, unsettled Respond well
to Regular, long sleep Frequent meals warm
rich Warm, moist climate
. PITTA Medium build Forceful walk
talk Strong appetite stamina Sensitive to
heat Sharp, penetrating mind Like to plan
lead Great willpower, resolve Easily irritable,
competitive Respond well to Moderate
sleep Regular meals cool sweet Cool climate
. KAPHA Large, hefty build Slow
walk and talk Steady appetite
stamina Sensitive to fog cold Deliberate,
steady mind Learn slowly, good
memory Complacent, forgiving Easily depressed,
clingy Respond well to Less sleep Fewer meals
light spicy Warm, dry climate
14
AYURVEDA CONSTITUTIONAL TYPES
. VATA Lean, bony build Rapid
walk and talk Erratic appetite
stamina Sensitive to wind cold Quick, flexible
mind Learn fast, forget fast Less willpower,
resolve Easily anxious, unsettled Respond well
to Regular, long sleep Frequent meals warm
rich Warm, moist climate
. PITTA Medium build Forceful walk
talk Strong appetite stamina Sensitive to
heat Sharp, penetrating mind Like to plan
lead Great willpower, resolve Easily irritable,
competitive Respond well to Moderate
sleep Regular meals cool sweet Cool climate
. KAPHA Large, hefty build Slow
walk and talk Steady appetite
stamina Sensitive to fog cold Deliberate,
steady mind Learn slowly, good
memory Complacent, forgiving Easily depressed,
clingy Respond well to Less sleep Fewer meals
light spicy Warm, dry climate
15
AYURVEDA CONSTITUTIONAL TYPES
. VATA Lean, bony build Rapid
walk and talk Erratic appetite
stamina Sensitive to wind cold Quick, flexible
mind Learn fast, forget fast Less willpower,
resolve Easily anxious, unsettled Respond well
to Regular, long sleep Frequent meals warm
rich Warm, moist climate
. PITTA Medium build Forceful walk
talk Strong appetite stamina Sensitive to
heat Sharp, penetrating mind Like to plan
lead Great willpower, resolve Easily irritable,
competitive Respond well to Moderate
sleep Regular meals cool sweet Cool climate
. KAPHA Large, hefty build Slow
walk and talk Steady appetite
stamina Sensitive to fog cold Deliberate,
steady mind Learn slowly, good
memory Complacent, forgiving Easily depressed,
clingy Respond well to Less sleep Fewer meals
light spicy Warm, dry climate
16
AYURVEDA HEALTH AS HARMONIOUS LIVING
  • Health
  • living in balance
  • with basic constitution
  • Illness
  • living out of balance
  • with basic constitution

17
AYURVEDA DEPRESSION AS DOSHA IMBALANCE

. VATA EXCESS -- Significant anxiety --
Insomnia -- Anorexia -- Weight loss -- Motor
agitation -- Compulsive talking
KAPHA EXCESS -- Profound anhedonia --
Hypersomnia -- Hyperphagia -- Weight Gain --
Apathy Listlessness -- Paucity of speech

18
AYURVEDA REMEDIES FOR DOSHA IMBALANCE
Dosha-correcting remedies may be applied to any
or all dimensions, not just dimension where
symptoms manifest
  • Purification Procedures
  • Food Spices
  • Herbal Medicine
  • Herbal Massage Bath
  • Yoga Asanas Exercise
  • Pranayama
  • Meditation
  • Sensory Experience
  • Social Experience
  • Attention to Nature
  • Time
  • Climate
  • Environment

19
THE PARADIGM SHIFT WITH CAM
  • Inter-dependence of body, mind, spirit
  • Body, mind, spirit treated together
  • Body not just mechanical entity
  • Specific causal factor in illness less critical
  • Physician activates self-healing capacity
  • Treatment is specific to the person
  • Treatment less amenable to scientific tests
  • Physician - patient relationship may have major
    impact on outcome
  • Emphasis on preventing disease

20
SOME LIMITATIONS OF CAM
  • Quality of Care often unregulated practice
  • Quality of Product no stringent monitoring
  • Quality of Science often unverified efficacy

21
INTEGRATIVE MEDICINE THE BEST OF BOTH WORLDS
  • Integrative Medicine might restore the soul to
    medicine
  • the soul being that part of us that is most
    important but the least easy to delineate.
  • Richard Smith
  • British Medical Journal January 2001

22
PSYCHIATRY AS BIOMEDICINE SPECIALITY
  • Historical Roots
  • Conventional medical school training
  • Vocabulary (e.g. case history, prevalence,
    pathogenesis, prognosis, cure) syntonic with
    biomedicine
  • Reductionism of classical Drive Theory
  • Separation from religion
  • Current Developments
  • Information explosion about brain and its
    function
  • Discovery of biochemical etiologies for mental
    illness
  • Creation of powerful psychotropic medications

23
PSYCHIATRY AS DEPARTURE FROM BIOMEDICINE
  • Conversion disorders early affirmation of
    mind-body connection
  • Consultation Psychiatry more elucidation of
    mind-body and body-mind syndromes
  • Psychoanalysis as self-healing process with
    physician as catalyst
  • Acceptance of psychoanalysis despite lack
    of scientific tests
  • DSM recognition of cultural spiritual
    dimensions in diagnosis and treatment

24
CROSSING THE CARTESIAN DIVIDE
  • But what is quackery?
  • It is commonly an attempt to cure
    the diseases of man by addressing
    the body alone.
  • Henry David Thoreau

25
THE SOURCE OF HEALING
  • Too often
  • we underestimate
  • the power of
  • a touch,
  • a smile,
  • a kind word,
  • a listening ear
  • all of which have the potential
  • to turn a life around.
  • Leo Buscaglia

26
  • Psychiatry is uniquely situated to
  • integrate healing paradigms.

27
SOME UNIVERSITY-BASED INTEGRATIVE MEDICINE
CENTERS IN THE UNITED STATES
  • Columbia
  • Cornell
  • Duke
  • George Washington
  • Harvard
  • Stanford
  • Thomas Jefferson
  • Tufts
  • University of Arizona
  • University of Maryland
  • University of Miami
  • University of Michigan
  • University of Pittsburg
  • University of Texas
  • University of Washington

University of California, San Francisco
28
INTEGRATIVE MEDICINE WORLDWIDE
India China Germany Australia
29
Photo 1
30
Clinical Teaching
Classroom Lectures
31
Photo 3
32
Photo 4
33
Photo 4
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Steam chamber
37
Photo 5
38
Photo 5
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Photo 6
41
Nimhans research
42
EVIDENCE BASE FOR AYURVEDIC REMEDIES IN
PSYCHIATRY
  • MEDITATION
  • HATHA YOGA
  • HERBS BOTANICALS

43
MEDITATION
  • Chronic anxiety (TM, MBSR)
  • Chronic pain (RR, MBSR)
  • Chronic insomnia (RR)
  • Recurrent Depression (MBSR)
  • Overall emotional well-being (RR, MBSR)
  • Less anxiety and depression
  • Increased sense of control
  • Increased empathy

44
HATHA YOGA
  • Randomized controlled trials
  • Pranayama asana reduces symptoms in depressed
    college students
  • Pranayama equivalent to tricyclic in treating
    depressed psych inpatients
  • Hatha yoga methadone equivalent to
    psychotherapy methadone in reducing relapse in
    opiate users
  • Yoga breathing improves spatial memory learning
    in normal schoolchildren
  • Hatha yoga reduces anxiety depression in
    normal adults
  • Non-randomized controlled trials
  • Hatha yoga equivalent to swimming in producing
    mood benefits in women, may be
    superior to swimming in men
  • Hatha yoga superior to muscle relaxation and
    visualization in improving mood and alertness
  • Hatha yoga related to higher life satisfaction,
    better overall mood, better coping with stress

45
PSYCHOTROPIC HERBS IN AYURVEDA
Valeriana jatamansi
Rauwolfia serpentina
Centella asiatica
Antipsychotic Effect -- Rauwolfia --
Centella (in polyherbal) Anxiolytic
Effect -- Valeriana -- Centella
-- Withania -- Convolvulus -- Bacopa
Antidepressant Effect --- Withania
--- Convolvulus Soporific Effect --
Valeriana -- Centella (in
polyherbal) Cognitive Enhancement --
Centella -- Withania --
Convolvulus -- Bacopa
Jatamansi
Mandukparni
Sarpagandha
Shankpushpi
Ashwagandha
Brahmi
Bacopa Monniera
Withania somnifera
Convolvulus pluricaulis
46
DUTY TO PROTECT
  • Proven danger with specific CAM use
  • No proven benefit with CAM use and
    clear benefit with conventional treatment

47
DUTY TO PROMOTE
  • Likely benefit with specific CAM use
  • Low risk of harm

48
DUTY TO PARTNER
  • Conventional diagnosis / treatment inadequate
  • Symptoms fit CAM healing paradigm
  • Benefit nor harm of CAM unknown
    per scientific studies
  • Competent CAM practitioner / product available
  • Optimistic patient / healer expectation
  • Limited CAM therapeutic trial with monitoring

49
CAVEAT FOR HEALERS
  • The greatest mistake
  • in the treatment
  • of disease
  • is that there are
  • physicians for the body
  • and physicians for the soul.
  • Plato
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