Acupuncture for schizophrenia
Abstract
Background
Acupuncture has been shown to be a relatively safe health care intervention with few adverse effects. In contrast, antipsychotic drugs may have serious adverse effects. The benefits of acupuncture in the treatment of schizophrenia are unclear, and more evidence is needed to inform clinicians and people with schizophrenia of its effects.
Objectives
To review the effects of acupuncture for people with schizophrenia and related psychoses; evaluating acupuncture alone and in combination regimes compared with antipsychotics alone.
Search methods
We (JR, JX) undertook electronic searches of the Cochrane Schizophrenia Group's register (April 2005), which is compiled from systematic searches of major databases, hand searches and conference proceedings. We inspected reference lists and contacted the first author of each included study.
Selection criteria
We included all relevant randomised controlled trials involving people with schizophrenia‐like illnesses, allocated to acupuncture, electro‐acupuncture, laser‐acupuncture, placebo, no treatment, or antipsychotic drugs produced by pharmaceutical companies.
Data collection and analysis
We independently extracted the data. For homogeneous dichotomous data, the fixed effects relative risk (RR), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention‐to‐treat basis. For continuous data, we calculated weighted mean differences with 95% CI.
Main results
We included five trials. Two trials comparing acupuncture to antipsychotics were equivocal for global state and leaving the study early. Extrapyramidal adverse events were significantly lower in the acupuncture group (n=21, RR 0.05 CI 0.0 to 0.8, NNT 2 CI 2 to 8). Four out of the five trials also compared acupuncture combined with antipsychotics to antipsychotics alone. Global state outcomes and leaving the study early were equivocal. BPRS endpoint data (short term) favoured the combined acupuncture and antipsychotic group (n=109, WMD ‐4.31 CI ‐7.0 to ‐1.6), although dichotomised BPRS data 'not improved' confounded this outcome with equivocal data. Depression scores HAMD (n=42, WMD ‐10.41 CI ‐12.8 to ‐8.0), HAMD 'not improved' (n=42, RR 0.17 CI 0.1 to 0.5, NNT 2 CI 2 to 3) and ZDS (n=42, WMD ‐24.25 CI ‐28.0 to ‐20.5) significantly favoured the combined acupuncture/antipsychotic treatment group, although results were from single, small studies. Treatment emergent adverse events scores were significantly lower in the acupuncture/antipsychotic group (n=40, WMD ‐0.50 CI ‐0.9 to ‐0.1), again from a single, small study.
Authors' conclusions
We found insufficient evidence to recommend the use of acupuncture for people with schizophrenia. The numbers of participants and the blinding of acupuncture were both inadequate, and more comprehensive and better designed studies are needed to determine the effects of acupuncture for schizophrenia.
PICOs
Plain language summary
Acupuncture for schizophrenia
Antipsychotic drugs have been used to treat schizophrenia since the early 1950s. While effective for some, antipsychotics can still leave many of those treated with disabling adverse effects, and safer, more effective health care interventions are being researched to try and redress this problem.
Acupuncture has been used in China to treat mental health disorders, including schizophrenia, for more than 2000 years. It has been proved that acupuncture has very few adverse effects. Also, it may be more socially acceptable, tolerable and inexpensive than the more conventional drugs manufactured by the pharmaceutical industry.
This review identifies randomised controlled trials comparing acupuncture to antipsychotics and acupuncture combined with antipsychotics, to antipsychotics alone. The limited data we found provided mostly equivocal outcomes. Although some of the data did favour acupuncture when combined with antipsychotics, the results came from small studies, and further, more comprehensive trials are needed before we can confidently determine the efficacy of acupuncture in the treatment of schizophrenia.
