Integrative Therapeutic Approach Research Articles

Integrative Therapeutic Approaches for the Management and Control of Nausea in Children Undergoing Cancer Treatment: A Systematic Review of Literature.

Chemotherapy-induced nausea and vomiting (CINV) continues to be a common symptom experienced by children undergoing cancer treatment despite the use of contemporary antiemetics. Integrative therapeutic approaches in addition to standard pharmacologic antiemetic regimes offer potential to control CINV. The purpose of this review was to identify current evidence on integrative therapeutic approaches for the control of CINV in children with cancer. Online search engines (PubMed, CINAHL, PsychINFO) were queried using MESH terms. Titles, abstracts, and then full-text articles were reviewed for relevance to the review. The search resulted in 53 studies. Twenty-one studies met our review criteria. Integrative therapies identified included acupuncture/acupressure, aromatherapy, herbal supplements, hypnosis, and other cognitive behavioral interventions. Our review identified little information on the effectiveness and safety of most integrative therapeutic approaches for the control and management of CINV in children with cancer. However, evidence from adult cancer studies and some pediatric studies identify promising interventions for further testing.

Atopic dermatitis and the therapeutic methods: a literature review

Atopic dermatitis is an inflammatory skin disease that starts in the early life and usually persists by the end of life in 20% of cases. The disease shows multiple periods of relapse, and significantly affects the patient’s quality of life. The etiology of this disease is unknown, yet recent studies have reported incidence of immunological disorders and mutation in the filaggrin gene as the major causes. In some cases, concurrent incidence of infection with these inflammatory lesions reinforces the significance of treatment. Various methods of treatment such as emollients, corticosteroids, and calcineurin inhibitors are applied to manage this disorder. Traditional and complementary approaches may also help to control the disease. This disease is not usually easily controllable, thus requires full awareness of physicians on the underlying prospects of this disease. This review paper deals with the important aspects of the clinical perspectives and presents an integrative therapeutic approach for treating atopic dermatitis.

Review of local herbal compounds found in the Iranian traditional medicine known to optimise male fertility.

The male reproductive function can be influenced by many different factors, including genetic, environmental and socioeconomic parameters leading to a progressive decline. However, the cause of infertility cannot be found in a significant proportion of couples, and even with the presence of the sign of testicular dysfunction or obstructive azoospermia, the main aetiology is not identified. In the absence of knowledge about predisposing factor, targeted therapeutic modalities for male infertility may not be possible, and a wide variety of empiric drug approaches, even with low scientific evidence, have been utilised in current conventional medicine. According to the recently updated reports of the European Association of Urology guidelines on male infertility, the implication of previous recommendations and complementary alternative medicine based on the old literature has been suggested to improve a multifaceted integrative therapeutic approach for this disease. We have reviewed the potential herbal active compounds optimising male fertility, according to the principles of Iranian traditional medicine.

Herba Epimedii: An Ancient Chinese Herbal Medicine in the Prevention and Treatment of Osteoporosis.

Herba Epimedii (HEP) known as YinYangHuo in Chinese is the dried leaf of the Epimediium, and has been historically used in combination with other herbs to treat skeletal diseases in traditional Chinese medicine (TCM). Here, we review the historical TCM interpretation of the action of HEP, its use in clinical trials, its main phytochemical constituents and its pharmacological findings. 85 clinical trials were identified which used HEP in TCM prescriptions with other herbs to treat primary and secondary osteoporosis from 2005 to now. More than 60 individual compounds were isolated and characterized from HEP and studied in various animal and cell models. HEP and its constituents exhibited a variety of anti-resorptive and bone formation-stimulating effects, which target different pathways in the bone remodeling cycle. These compounds may provide new perspectives in alternative treatment regimes and reveal novel chemical scaffolds for the development of anti-osteoporotic drugs. These approaches are also useful for guiding our research to employ an integrative therapeutic approach to treat complex diseases such as osteoporosis diseases which could be superior to the conventional single target - single drug approach.

Targeted nanoparticles for image-guided treatment of triple-negative breast cancer: clinical significance and technological advances.

Effective treatment of triple-negative breast cancer (TNBC) with its aggressive tumor biology, highly heterogeneous tumor cells, and poor prognosis requires an integrated therapeutic approach that addresses critical issues in cancer therapy. Multifunctional nanoparticles with the abilities of targeted drug delivery and noninvasive imaging for monitoring drug delivery and responses to therapy, such as theranostic nanoparticles, hold great promise toward the development of novel therapeutic approaches for the treatment of TNBC using a single therapeutic platform. The biological and pathological characteristics of TNBC provide insight into several potential molecular targets for current and future nanoparticle-based therapeutics. Extensive tumor stroma, highly proliferative cells, and a high rate of drug resistance are all barriers that must be appropriately addressed in order for these nanotherapeutic platforms to be effective. Utilization of the enhanced permeability and retention effect coupled with active targeting of cell surface receptors expressed by TNBC cells, and tumor-associated endothelial cells, stromal fibroblasts, and macrophages is likely to overcome such barriers to facilitate more effective drug delivery. An in-depth summary of current studies investigating targeted nanoparticles in preclinical TNBC mouse and human xenograft models is presented. This review aims to outline the current status of nanotherapeutic options for TNBC patients, identification of promising molecular targets, challenges associated with the development of targeted nanotherapeutics, the research done by our group as well as by others, and future perspectives on the nanomedicine field and ways to translate current preclinical studies into the clinic.

Metacognitive capacity as a predictor of insight in first-episode psychosis.

Impaired insight is common in the first episode of psychosis (FEP). Although considerable research has examined the factors that are associated with impaired insight in chronic psychosis, less is known about the factors that underlie and sustain poor insight in FEP. Impaired metacognition, or the ability to form integrated representations of self and others, is a promising potential contributor to poor insight in FEP. To explore this possibility, the authors assessed insight and metacognition in 40 individuals with FEP and then examined the relationship between these areas and social cognition domains, neurocognitive domains, and psychotic symptoms. Correlation analyses revealed that improved insight was associated with higher metacognition, better vocabulary and Theory of Mind scores, and fewer symptoms. The domain of metacognitive mastery also predicted clinical insight. Results support the need to develop an integrative therapeutic approach focused on improving metacognition, hence addressing poor insight in FEP.

Dealing with the Aftermath: The Needs Acquisition and Behavior Change Model for Couples With a Recovering Alcoholic Partner

This article addresses the application of the Needs Acquisition and Behavior Change approach to providing therapeutic support for couples with a recovering alcoholic partner. The Needs Acquisition and Behavior Change Model was originally developed at the McGill Domestic Violence Clinic. It uses an integrated therapeutic approach combining observation and elucidation of client process, using concepts also described in cognitive-behavioral, motivational, narrative, and emotion-focused models. The Needs Acquisition and Behavior Change Model is distinguished by its focus on how unmet relational needs and the emotions they predict contribute to the maladaptive behaviors which bring clients into treatment. In the context of providing therapy for couples it provides a unique approach that helps clients to understand the origins of their behavior individually and in the context of their dyad and supports them in the formulation of more constructive ways to react to relational concerns both past and present.

Spanish consensus on the physical health of patients with depressive disorders

Comorbidity between depression and physical illnesses is very common and has a significant impact on the health and management of the patient. With the support of the Sociedades Españolas de Psiquiatría y Psiquiatría Biológica and Sociedad Española de Médicos de Atención Primaria (SEMERGEN) a consensus was prepared on physical health in patients with depression and it is summarised in the present work. The literature review highlighted the high frequency of cardiovascular and endocrine–metabolic disorders in patients with depression such as diabetes and obesity, thus making the primary and secondary prevention recommendations for patients with cardiovascular or metabolic risk applicable to patients with depression. Comorbidity between depression and chronic pain is also frequent, and requires an integrated therapeutic approach. The presence of physical illness in patients with depression may condition, but not preclude, the pharmacological treatment; drug selection should take into account potential side effect and drug–drug interactions. On the other hand, psychotherapy may contribute to the patient's recovery. Overall, coordination between the primary care physician, the psychiatrist and other health professionals involved is essential for the management of patients with depression and concomitant physical illness.

An Integrated therapeutic approach: do COPD comorbidities justify it?

An Integrated therapeutic approach: do COPD comorbidities justify it?

Total bilirubin level as a biomarker for dampness-heat differentiation in traditional Korean treatment for jaundice

Objectives: Classifying the pattern of jaundice during diagnosis will significantly improve the outcome of common KM interventions. This study aimed at determining an objective index for accurately diagnosing heat and dampness KM patterns in patients with jaundice. Methods: We systematically reviewed laboratory findings from case reports published in the scientific literature of Korean medicine. Cases were classified as following either the heat or dampness pattern. Biochemical indices were compared using a Bayesian factor (BF) analysis and standard t-tests. Results: The laboratory findings of 32 patients were evaluated. The heat pattern was observed in 17 patients and the dampness pattern in 15. No significant differences were observed between the 2 groups in terms of white blood cell count (BF=1.659); hemoglobin concentration (BF=2.627); platelet count (BF=1.019); or levels of direct bilirubin (BF=1.453), aspartate aminotransferase (BF=1.226), alanine aminotransferase (BF=1.340), alkaline phosphatase (BF=2.344), or gamma-glutamyl transpeptidase (BF=2.782). However, total bilirubin levels were significantly higher in the dampness pattern group (BF=0.854, P-value=0.070). Conclusions: Patients with high total bilirubin levels may predominantly follow the dampness pattern, while those with low levels may predominantly follow the heat pattern. These results are expected to be useful for the development of timely and efficient KM treatments as well as new integrative therapeutic approaches for jaundice. However, further studies are essential to fully validate the utility of total bilirubin as a biomarker for differentiating between heat and dampness patterns.

Long‐term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years

ACE-inhibitors, β-blockers, implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) improved prognosis of heart failure. We sought to analyse the long-term prognostic impact of evidence-based integrated therapeutic strategies in patients with idiopathic dilated cardiomyopathy (IDCM). From 1978 to 2007, 853 IDCM patients (45 ± 15 years, 72% males) were enrolled and classified as follows: Group 1, 110 patients (12.8%) enrolled during 1978-1987; Group 2, 376 patients (44.1%) enrolled during 1988-1997; Group 3, 367 patients (43.1%) enrolled during 1998-2007. ACE-inhibitors/angiotensin receptor blockers were administered in 34%, 93%, and 93% (P <0.001), and β-blockers in 11%, 82%, and 86% (P <0.001) in Groups 1, 2, and 3, respectively; ICDs were implanted in 2%, 14%, and 13% (P = 0.005); mean time to device implantation was lower in Group 3. At 8 years, heart transplant (HTx)-free survival rates were 55%, 71%, and 87% in Groups 1, 2, and 3, respectively (P <0.001). Similar progressive improvement was found for pump-failure death (DHF)/HTx, while survival free from sudden death (SD) was significantly improved only in Group 3. Multivariable models considering competing risk indicated early diagnosis (i.e. a baseline less advanced disease stage) and tailored medical therapy (HR 0.44, CI 95% 0.19-0.98) as independent protectors against DHF/HTx. Concerning SD, lower left ventricular ejection fraction emerged as a predictor, while ICD was the only therapy with a protective role (HR 0.08, CI 95% 0.01-0.61). Treatment with digitalis emerged as a predictor of both DHF/HTx and SD. An effective management and evidence-based integrated therapeutic approach progressively and significantly improved the long-term prognosis of IDCM during the last three decades.

Psychodynamic-cognitive therapy: Working from the framework of a multimodal matrix of contributors to personality development and behavior.

Psychodynamic-Cognitive Therapy (PCT) is an integrative therapeutic approach merging elements from psychodynamic psychotherapy and cognitive therapy. Human behavior is thought to emerge from a Multimodal Matrix of Contributors (MMC) including genetic predispositions, environmental and oppressive social impacts, cultural influences, object relations and attachment styles, as well as social learning during the early years of childhood development. The development of mental health problems derives from any constellation in the MMC that leads to dysfunctional or maladaptive cognitive patterns. PCT aims to promote therapeutic change by collaborating with clients to achieve the following: psychodynamically interpret and understand their cognitive patterns; gain insight on how these emerged and may be cyclically affecting their current behavior, motivations, interpersonal relations and mental states; challenge these cognitively; and test them behaviorally and interpersonally both within and outside the therapeutic parameters. PCT is critically evaluated against already existing approaches of psychotherapy integration, methods for assessing its effectiveness are discussed, and directions for future research are proposed.

The Neuro‐Immune Axis: Prospect for Novel Treatments for Mental Disorders

Disturbed bidirectional pathways between the (central) nervous system and immune system have been implicated in various mental disorders, including depressive and neurodevelopmental disorders. In this minireview, the role of the neuro-immune axis and its targetability in relation to major depression and autism spectrum disorder will be discussed. All together, the management of these and possibly other multi-factorial mental disorders needs a new and integrated therapeutic approach. Pharmacologically bioactive molecules as well as medical nutrition targeting the (gut)-immune-brain axis could be such an approach.

Where we should be: Introduction to the special section on psychotherapy integration in behavioral medicine (part I).

This is Part 1 of a special section on psychotherapy integration and behavioral medicine. The latter discipline—encompassing virtually all the psychosocial issues relevant to mainstream medicine (health behaviors, living with chronic illness, etc.)— has ascended to prominence in relation to theory and research, and clinical innovation and evidence-based practice alike, in recent decades. Accordingly, mainstream medicine is becoming a major avenue through which the behavioral sciences, and psychotherapy, are making an impact. Articles in this section address this circumstance from an integrative therapeutic approach, including end-stage renal disease (ESRD) during adolescence, functionally somatic disorders, medical issues in anorexia nervosa, substance use disorders, and the personification of chronic illness.

The Importance of Prions

While agent host-range and strain properties convinced early researchers of a viral etiology, the once unorthodox postulate that prion transmission occurs by conformational corruption of host-encoded cellular prion protein (PrPC) by a pathogenic isoform (PrPSc) is now widely accepted. Indeed, conformational templating is increasingly understood to be a general mechanism of protein-mediated information transfer and pathogenesis. The high infectivity of prions, their capacity to cause neurodegeneration in genetically tractable animal models, as well as the ability to culture prions in cells, or under cell-free conditions using defined components, provide finely controlled experimental settings in which to elucidate general mechanisms for all diseases involving protein conformational templating, and thus to develop integrated therapeutic approaches.

EMDR as an Integrative Therapeutic Approach for the Treatment of Separation Anxiety Disorder

This case study reports the use of eye movement desensitization and reprocessing (EMDR) and family therapy for a 10-year-old boy with severe separation anxiety disorder (SAD). It illustrates how the use of the standard EMDR protocol for the boy and his mother combined with family therapy, led to symptom alleviation and restored appropriate developmental functioning as evidenced by behavioral outcomes. The participant initially presented with severe anxiety about separating from his mother, several years after his parents went through a painful divorce. Treatment focused on processing the boy’s disturbing memories of past nontraumatic events in 14 EMDR sessions; his mother received 4 EMDR sessions to address her perceived marital failure and guilt about the effects of her ensuing depression on him. Eight family therapy sessions were used to help the family spend positive time together. Prior to treatment, the child had been unable to play outside, checked on his mother frequently, and could not attend activities without her. At the end of treatment, he was able to play with friends outside, ride his bike around town, engage in after school activities, and sleep over at his friends’ houses. Gains were maintained at 6-month follow-up. Treatment did not include instruction in parenting skills or psychoeducation for the mother, or any exposure therapy for the child.

1419 Obesity and Binge Eating Disorder in Childhood: an Integrated Therapeutic Approach

BackgroundBinge Eating Disorder (BED) is related to obesity in children; treatment of obesity could be improved by using either a nutritional and psychotherapeutic strategy.AimsTo assess the prevalence of BED and...

Interpersonal childhood trauma and the use of the therapeutic community in recovery

Purpose – This paper aims to explore an integrated therapeutic care approach for a group of children and young people who have experienced chronic and enduring interpersonal trauma.Design/methodology/approach – This paper aims to emphasise the need to routinely assess for that which could have been relationally traumatic, as this is the context in which many looked‐after children's and young people's developmental experiences occur. In particular, it explores the need to have trauma‐informed assessments, clinically effective interventions based on this knowledge, and the need to ensure that a therapeutically enabling environment and organisational functioning is maintained, in order to improve outcomes. It builds on existing work on trauma systems theory, both within an organisational context and within a holistic completely integrated (therapy/assessment, care, education) residential child care treatment process.Findings – This research raises consideration of the manner in which interpersonally traumati...

The impact of attachment: developmental neuroaffective psychology

Combining theories of neurobiology, interpersonal relationships, and intrapsychic concepts, this book explores the importance of attachment. Hart addresses children's normal development and relational disorders and presents an integrated therapeutic approach that takes attachment issues into consideration. Complex neurobiological and behavioral theory are transformed into protocols that can be easily implemented by the practicing clinician.

Preliminary study of a new integrative approach in treating post-traumatic stress disorder: SEE FAR CBT

SEE FAR CBT is a suggested new protocol for the treatment of anxiety disorders and post-traumatic stress disorder (PTSD) using creative form treatment based on empowerment through fantastic reality. The model emphasizes the role of fantastic reality and the use of imaginal re-narration of the traumatic event with the use of cards as a means of externalization or distancing. The treatment protocol incorporates methods of somatic memory reduction as well as CBT elements. The main objective of this study was to introduce the model and test the therapeutic efficacy of this new integrative therapeutic approach by comparing it to a well-established treatment approach; eye movement desensitization and reprocessing (EMDR). Adult PTSD patients, divided into EMDR ( n = 12) and SEE FAR CBT ( n = 9) groups, were assessed for traumatic symptoms at three time intervals (pre-treatment, post-treatment and 1-year follow-up). Both EMDR and SEE FAR CBT were associated with effective alleviation of traumatic symptoms, showing statistically significant decreases in their trauma symptoms over time but not differing in treatment efficacy during any of the assessment times. With some methodological limitations, results suggest further inquiry of the proposed model in clinical and experimental settings.