Ubat herba Cina untuk skizofrenia
Abstract
Background
Traditional Chinese medicine (TCM) was the main form of treatment in China for psychiatric illnesses until the development of antipsychotic drugs in the 1950's. Antipsychotic drugs have become the primary intervention for schizophrenia, although herbal medicines can still form part of the treatment.
Objectives
To review Chinese herbal medicine, used alone or as part of a TCM approach, for people with schizophrenia and related psychoses.
Search methods
We undertook electronic searches of the Cochrane Schizophrenia Group's register (December 2003), the Traditional Chinese Medical Literature Analysis and Retrieval Database (TCMLARS) (October 2003), Chinese Biomedical Database (CBM) (December 2003), China National Knowledge Infrastructure Database (May 2004), Complementary Medicine Database (AMED) (December 2003). We contacted the Chinese Cochrane Centre, the Cochrane Complementary Medicine Field and first authors of included studies and inspected reference lists for additional studies.
Selection criteria
We included all relevant randomised controlled trials involving people with schizophrenia‐like illnesses, allocated to Chinese herbal medicine, including any Chinese herbs (single or mixture), compared with placebo/no treatment or antipsychotic drugs.
We updated this search July 2012 and added 45 new trials to the awaiting classification section.
Data collection and analysis
We independently extracted data and calculated fixed effects relative risk (RR), the 95% confidence intervals (CI) for homogeneous dichotomous data, and, where appropriate, the number needed to treat (NNT) on an intention‐to‐treat basis. For continuous data, we calculated weighted mean differences (WMD).
Main results
Only one small trial of the seven included studies truly evaluated TCM for schizophrenia. The other trials evaluated Chinese herbs for schizophrenia. We found one study comparing Chinese herbal medicine with antipsychotic drugs. Data for the global state outcome 'no change/worse' favoured people allocated to antipsychotic medication (n=90, RR 1.88 CI 1.2 to 2.9, NNH 4 CI 2 to 12). Six trials compared Chinese herbal medicine in combination with antipsychotic with antipsychotic drugs alone. One trial found global state 'not improved/worse' favoured the herbal medicine/antipsychotic combination (n=123, RR 0.19 CI 0.1 to 0.6, NNT 6 CI 5 to 11). Two studies (n=103) also found short‐term data from the Clinical Global Impression scale favoured the herbal medicine plus antipsychotic group (WMD ‐0.46 CI ‐0.9 to ‐0.1) compared with those given only antipsychotics. Significantly fewer people in the experimental group left the study early compared with those given antipsychotics alone (n=1004, 6 RCTs, RR 0.30 CI 0.16 to 0.58, NNT 21 CI 18 to 35). Reports of constipation were significantly lower in the treatment group compared to those receiving antipsychotics (n=67, 1 RCT, RR 0.03 CI 0.0 to 0.5, NNH 2 CI 2 to 4).
Authors' conclusions
Chinese herbal medicines, given in a Western biomedical context, may be beneficial for people with schizophrenia when combined with antipsychotics. Traditional Chinese medicine is also under‐evaluated, but results from one pioneering study that attempted to evaluate TCM should encourage further trials.
Note: the 45 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.
PICO
Plain language summary
Ubat herba Cina untuk skizofrenia
Ubat antipsikotik merupakan rawatan teras untuk para penghidap penyakit skizofrenia, dan walaupun berkesan, akan memberi kesan‐kesan sampingan yang memudaratkan kepada sesetengah pesakit Cara rawatan yang lebih selamat dan lebih berkesan amat diperlukan.
Perubatan tradisional Cina (TCM) telah digunakan untuk merawat gangguan kesihatan mental, termasuk skizofrenia, selama lebih 2000 tahun. Herba‐herba Cina juga mungkin mempunyai unsuran antipsikotik apabila digunakan dalam konteks bioperubatan Barat. Dalam ulasan ini, kami berupaya mencari kajian yang relevan kepada kesan kedua‐dua pendekatan terhadap penyakit skizofrenia. Kaedah perubatan cina tradisional pernah dinilai untuk perawatan skizofrenia, tetapi satu‐satunya kajian tersebut adalah terlalu terhad dari segi saiz sampel dan tempoh kajian untuk digunakan sebagai pembimbing amalan baik. Akan tetapi, kajian perintis ini menunjukkan bahawa TCM boleh dinilai dari segi keberkesanan terhadap pesakit skizofrenia, dan lebih kajian yang menyeluruh dalam bidang ini harus digalakkan.
Penggunaan herba Cina dalam konteks perubatan Barat, tanpa menggunakan kaedah TCM, telah dinilai dalam enam kajian, walaupun kajian‐kajian ini juga terhad dalam aspek saiz sampel dan tempoh kajian. Hasil daripada enam kajian ini mencadangkan bahawa penggunaan herba Cina semata‐mata untuk merawat gejala psikotik tidak dibolehkan , tetapi sekiranya digunakan bersamaan ubat antipsikotik barat, mungkin boleh memberi manfaat dari segi keadaan mental, fungsi global dan pengurangan kesan sampingan. Walau bagaimanapun, lebih kajian tambahan diperlukan sebelum kesan TCM terhadap pesakit skizofrenia boleh dinilai dengan keyakinan yang lebih bernas.
