Psychiatric disorders

Strong scientific evidence

• Music therapy
  : Music therapy that includes either chorus or karaoke may improve interpersonal functioning in people with schizophrenia. Music therapy may also help reduce symptoms of schizophrenia, including psychosis. Non-classical music was found to be more effective than classical music. Also, it does not seem to make a difference if the music is live or recorded or if therapy is structured or not structured. Music therapy is generally known to be safe.

B

Good scientific evidence

• Hypnosis, hypnotherapy
  : Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. Hypnotherapy techniques may be used as an adjunct to cognitive behavioral therapy (CBT) for the treatment of conditions such as anxiety, insomnia, pain, bed-wetting, post-traumatic stress disorder, or obesity. Better-quality research is necessary in this area.
• Use cautiously with mental illnesses (e.g. psychosis, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
• Psychotherapy
  : Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to improve problem solving skills. Although prescription medications are usually the best way to help patients with schizophrenia, psychotherapy, especially cognitive therapy, may greatly enhance coping, social skills, and quality of life. It has also been shown to reduce psychotic relapse and re-hospitalization.
• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
• Therapeutic touch
  : There is some evidence that therapeutic touch may reduce anxiety in children with life-threatening illnesses, reduce stress in teenagers with psychiatric disease, and help relax premature infants. More research is needed before therapeutic touch can become a standard treatment for psychiatric disorders in children.
• Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
• Yoga
  : Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Yoga has been described as "the union of mind, body, and spirit." Healthy individuals with the aim to achieve relaxation, fitness, and a healthy lifestyle often practice yoga. Several human studies support the use of yoga therapy to treat schizophrenia and other psychiatric disorders.
• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

C

Unclear or conflicting scientific evidence

• 5-HTP
  : 5-HTP (5-Hydroxytroptophan) is the precursor for serotonin. Serotonin is the brain chemical associated with sleep, mood, movement, feeding, and nervousness. While other cells outside the brain, such as blood platelets and some cells in the intestine, make and/or use serotonin, all serotonin used by brain cells must be made within the neurons themselves. When serotonin is not properly constructed inside the brain, the result can be irritability, aggression, impatience, anxiety, and depression. It has been suggested that 5-HTP may reduce psychotic symptoms and mania or aid in panic disorder, but studies in people with schizophrenia have shown different results. Further well-designed research is needed to better understand the potential role of 5-HTP in psychiatric disorders.
• Avoid if allergic to 5-HTP. Use cautiously with a history of mental disorders. Avoid if pregnant or breastfeeding.
• Art therapy
  : Art therapy involves many forms of art to treat anxiety, depression, and other mental and emotional problems. Art therapy became a mental health profession in the 1930s. Today, it is practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. There is limited evidence suggesting that art therapy may aid in restoring communication in people suffering from schizophrenia, including in children. Some research suggests it may also help patients adhere to treatment more reliably. However, more studies are needed to determine the best use with this population.
• Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (such as turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.
• Betel nut
  : Betel nuts come from the areca tree, a tropical palm tree. In Asia, the nuts are combined with other ingredients and chewed similarly to the way tobacco is chewed in the West. Betel nut use refers to a combination of three ingredients: the nut of the betel palm, part of the Piper betel vine, and lime. These ingredients are wrapped in a betel nut leaf and placed inside the mouth. Based on the results of a few poorly designed human studies, chewing betel nut may improve symptoms of schizophrenia. However, side effects, such as tremors and stiffness, have been reported. More research is necessary before a firm conclusion can be drawn.
• The known toxicities of chewing betel nut likely outweigh any possible benefits. Avoid if allergic to betel nut or other plants of the Palmaceae family. Avoid with a history of asthma, Huntington's disease, urinary incontinence, mental illness, chest pain (angina), blood pressure disorders, irregular heartbeat (arrhythmia), heart attack, diabetes, kidney disease, low calcium levels, cancer, or thyroid disease. Avoid if pregnant or breastfeeding. Ingestion of 8-30 grams of areca nut may be deadly.
• Bowen therapy
  : Bowen technique has been used in psychiatric inpatient care settings, but its effectiveness for psychiatric disorders is unclear at this time.
• There is currently a lack of available scientific study on the safety of Bowen therapy. Based on case study that investigated Bowen therapy as a treatment for frozen shoulder, no adverse effects were reported. Avoid the "Coccyx Procedure" in pregnant women. Avoid the "TMJ Procedure" in people whose jaws have been surgically altered at the condyles. Avoid the "Breast Tenderness Procedure" in women with breast implants. Avoid using the Bowen technique in place of more proven therapies.
• Chiropractic
  : Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, as well as interferential and electrogalvanic muscle stimulation. There is currently insufficient evidence to determine whether or not spinal manipulation can help manage emotional problems.
• Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously if at risk of developing tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency (disorder in which blood supply to the back of the brain is disrupted), aneurysms, unstable spondylolisthesis, or arthritis. Avoid if taking drugs, herbs, or supplements that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
• Chromium
  : Early study shows a lack of effect of chromium supplementation on mental state and body weight in people with schizophrenia. Additional study is needed.
• Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
• Copper
  : Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs (e.g. liver and kidneys). Some studies involving patients with schizophrenia report high blood copper levels with low urinary copper (suggesting that copper is being retained), and low blood zinc levels. In some of these cases, zinc was observed to be helpful as an anti-anxiety agent. The role of copper supplementation is not clear.
• Avoid if allergic or hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia. Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than six milligrams per liter. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking birth control pills. Use cautiously if at risk for selenium deficiency. The recommended dietary allowance (RDA) is 1,000 micrograms for pregnant women. The RDA for breastfeeding women is 1,300 micrograms.
• DHEA
  : DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Initial research reports that DHEA supplementation may help manage the negative, depressive, and anxiety symptoms of schizophrenia. In addition, DHEA may help reduce some of the side effects of prescription drugs that are used to treat this disorder. Further research is needed to confirm these results.
• Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants or drugs, herbs, or supplements that treat diabetes, heart disease, seizures, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
• Ginkgo
  : Ginkgo biloba has been used medicinally for thousands of years. Based on ginkgo's proposed antioxidant effects, ginkgo has been studied in the treatment of schizophrenia. Although early study is promising, there is currently not enough scientific evidence to make a strong recommendation.
• Avoid if allergic or hypersensitive to members of the Ginkgoaceae
  family.
  If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.
• Hypnosis, hypnotherapy
  : More high-quality studies are needed to determine the effectiveness and safety of hypnosis for schizophrenia.
• Use cautiously with mental illnesses (e.g. psychosis, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
• Melatonin
  : Melatonin is a neurohormone produced in the brain. Levels of melatonin in the blood are highest before bedtime. Melatonin products have been used for a many medical conditions. It is most often used for people who have trouble sleeping (insomnia). Limited research suggests that melatonin may help reduce the time it takes schizophrenia patients to fall asleep. Further research is needed to better understand the role of melatonin in sleep disorders associated with schizophrenia.
• There have been reports of allergic reactions to melatonin taken by mouth. Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. Use cautiously if taking anticoagulants, anti-diabetic drugs, or drugs that lower blood pressure. Use cautiously with seizure disorders, psychiatric disorders, diabetes, glaucoma, or low blood pressure.
• Moxibustion
  : Moxibustion is a therapeutic method that is used in traditional Chinese medicine (TCM) acupuncture and Japanese acupuncture. During the therapy, an herb (usually mugwort) is burned above the skin to introduce heat into an acupuncture point and reduce symptoms. It may be applied in the form of a cone, stick, or loose herb; or it may be placed on the head of an acupuncture needle to manipulate the temperature gradient of the needle. Limited available evidence suggests that patients with schizophrenia may respond to a treatment regime that includes acupuncture and moxibustion. Additional research is needed in this area.
• Avoid with aneurysms, any kind of "heat syndrome," heart disease, convulsions, cramps, diabetic neuropathy, extreme fatigue, anemia, fever, or inflammatory conditions. Do not use over allergic skin conditions, ulcerated sores, skin adhesions or inflamed organs. Avoid using over the face, genitals, head, or nipples. Avoid in patients who have just finished exercising or taking a hot bath or shower. Not advisable to bathe or shower for up to 24 hours after a moxibustion treatment. Use cautiously over large blood vessels and thin or weak skin. Use cautiously if elderly or with large blood vessels.
• Omega-3 fatty acids
  : Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Preliminary evidence suggests that omega-3 fatty acid may help treat patients with schizophrenia. However, further research is needed to draw a firm conclusion.
• Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. Omega-3 fatty acids appear safe during pregnancy and breastfeeding as long as they are taken in doses that do not exceed the recommended dietary allowance (RDA).
• Pet therapy
  : Pet therapy, also called animal-assisted therapy or AAT, is a goal-directed intervention in which an animal that meets specific criteria is used as part of a patient's medical treatment. Animals may be selected for friendliness, ability to interact in a non-threatening way, or simply for non-obtrusive companionship. Pet therapy is used to provide psychological benefits for patients with mental illness, such as emotional connection, stress reduction, and reduced feelings of loneliness or isolation. There is evidence that the presence of a pet dog among psychiatric inpatients promotes social interactions. In people with schizophrenia, there is evidence that pet therapy may lead to improved interest in rewarding activities, as well as better use of leisure time and improved motivation. There is also evidence of improvement in socialization skills, independent living, and general well-being. In a large, well-designed study, hospitalized patients with a variety of psychiatric disorders were found to have reduced anxiety after a single session of pet therapy. For most patients, the benefits were superior to those of a session of regular recreational therapy.
• Avoid if allergic to animal dander. Use only animals that have had veterinary screening, particularly in situations involving young children, frail elderly patients, or people with weakened immune systems. Do not provide unsupervised use of animals with the severely mentally ill or very young children. Avoid if afraid of animals or with a traumatic history involving animals.
• Prayer, distant healing
  : Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Prayer on behalf of the ill or dying has played a prominent role throughout history and across cultures. Metaphysical explanations and beliefs often underlie the practice of prayer. Further research is needed to better understand the effectiveness of prayer for psychological disorders.
• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and require an open dialog between patients and caregivers.
• Psychotherapy
  : Cognitively oriented psychotherapy for early psychosis (COPE) showed no beneficial treatment effect over the Early Psychosis Prevention and Intervention Centre (EPPIC). Preliminary studies also suggest that psychodynamic therapy and cognitive behavior therapy may be more effective treatments for personality development disorders than other forms of psychotherapy. More research is needed to evaluate these approaches.
• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
• Rutin
  : Rutin is a yellow crystalline flavonol glycoside that is found in various plants, especially the buckwheat plant, black tea, apple peels, onions, and citrus. A well-designed study suggests that O-[beta-hydroxyethyl]-rutosides may offer benefit for patients with schizophrenia. More studies are required in this area before a strong recommendation can be made.
• Avoid if allergic/hypersensitive to O-(beta-hydroxyethyl)-rutosides or plants that rutin is commonly found in, such as rue, tobacco or buckwheat. Use cautiously with skin conditions or in elderly patients. Use cautiously if taking medications for edema, diuretics, or anti-coagulation medications. Use cautiously if pregnant or breastfeeding.
• Spiritual healing
  : Early research suggests that when spiritual healing is added to psychotherapy, psychiatric patients have improved relaxation and sense of well being. However, additional research is needed to better understand the role of psychotherapy in treatment of psychiatric disorders.
• Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
• Traditional Chinese medicine (TCM)
  : Chinese medicine is a broad term that refers to many different treatments and traditions of healing. They share a common heritage of technique or theory that is rooted in ancient Chinese philosophy (Taoism) and dates back to more than 5,000 years ago. Based on early data, Chinese herbal medicines may help treat schizophrenia when combined with prescription medications. Schizophrenia should be treated by a qualified healthcare practitioner including a psychiatrist and pharmacist.
• Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ephedra (ma huang). Avoid ginseng if pregnant or breastfeeding.

D

Fair negative scientific evidence

• Choline
  : Choline is an amino alcohol that the body needs to produce acetylcholine. The largest dietary source of choline is egg yolk. Choline may also be found in high amounts in liver, peanuts, fish, milk, brewer's yeast, wheat germ, soy beans, bottle gourd fruit, fenugreek leaves, shepherd's purse herb, Brazil nuts, dandelion flowers, poppy seeds, some beans (e.g. mung beans), and a variety of meats and vegetables, including cabbage and cauliflower. Available research suggests that choline is not an effective treatment for schizophrenia.
• Avoid if allergic or hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
• Evening primrose oil
  : Evening primrose oil contains an omega-6 essential fatty acid called gamma-linolenic acid (GLA), which is believed to be the active ingredient. Results from studies of mixed quality do not support the use of evening primrose oil for schizophrenia.
• Avoid if allergic to plants in the Onagraceae family (e.g. willow's herb or enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.