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A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency

A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency. Alya Reeve, MD, MPH University Of New Mexico Health Sciences Center Professor of Psychiatry, Neurology & Pediatrics PI, Continuum of Care. Date: 10-2-2012.

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A.M.B.E.R. clinic Albuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency

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  1. A.M.B.E.R. clinicAlbuquerque Multidisciplinary Behavioral Evaluation for Recovery and Resiliency Alya Reeve, MD, MPH University Of New Mexico Health Sciences Center Professor of Psychiatry, Neurology & Pediatrics PI, Continuum of Care

  2. Date: 10-2-2012 “Complementary and Alternative Medicine (CAM) -- application to I/DD or TBI”

  3. Terms… • What constitutes CAM? • Complements allopathic medicines • Herbs & vitamins • Eastern medicine • Body work: massage, yoga, etc. • Cranio-sacral therapy • Medicine woman; medicine man • Spiritual approaches

  4. Types of CAM • Acupuncture • Anthroposophy • Auriculotherapy • Holistic Health • Homeopathy • Horticultural therapy • Mesotherapy • Mind-Body therapies • Muscolo-skeletal manipulations • Naturopathy • Organotherapy • Phytotherapy • Relexotherapy • Rejuvenation • Sensory Art therapies. • Speleotherapy • Spiritual themes

  5. When is it important • Ongoing: • Unexpected change • Secondary conditions • Medical conditions • Sensitivity to western medications • Sensitive to side effects.

  6. Sleep • Maintenance of sleep hygiene • affects cognitive patterns • energy and worry patterns • Melatonin • pharmaceutical grade (behind the counter) • Diet and exercise • Pain!

  7. Collaboration • Respect for differing frames of reference. • Has to be conveyed to patient on a consistent basis. • Communication about outcomes and expectations. • Written, verbal? • Direct; via the patient or another party? • Rates of change; • who is directing changes; • timing of changes.

  8. Pain • Sleep/wake cycle • Exercise and mobility • Soft tissue • Nervous system • Acupuncture; acupressure • Neuromodulators • Autonomic nervous system

  9. Headache • Sources of pain • Habits • Cranio-sacral therapy • Musculo-skeletal • chiropractic • massage therapies • Vitamins

  10. Anxiety • Cognitive patterns • Spiritual impact • Belief and expectation • Kava-kava, other herbal preparations • Remove activating substances.

  11. Placebo?... • Mind influence over somatic symptoms • Can trump other effects • Hypnosis – by an outside person, or by oneself.

  12. Summary • People with TBI are often sensitive to hyperarousal and side effects of standard treatments. • Engaging people and their caregivers in most comprehensive care improves outcomes. • As clinicians we need to know all the substances and modalities our patients are using. • Expertise in CAM is not required to integrate into allopathic medical treatment.

  13. Some references • Rahimi R, Abdollahi M: “Herbal medicines for the management of irritable bowel syndrome: a comprehensive review.” World J Gastroenterol. 2012 Feb 21; 18(7): 589-600. • Wong V, Cheuk DK, Lee S, Chu V: “Acupuncture for acute management and rehabilitation of traumatic brain injury.” Eur. J. Phys. Rehabil. Med. 2012 Mar; 48(1): 71-86. • Dwyer AV, Whitten DL, Hawrelak JA. “Herbal medicines, other than St. John’s Wort, in the treatment of depression: a systematic review.” Altern Med. Rev. 2011 Mar: 16(1):40-9. • Huang W, Kutner N, Bliwise DL: “Autonomic activation in insomnia: the case for acupuncture.” J. Clin. Sleep Med. 2011 Feb 15; 7(1): 95-102.

  14. Next presentation: 10-16-2012 “Psychopharmacology of Impulse Dyscontrol…” resources and back issues can be found at Continuum of Care website: http://som.unm.edu/coc/Training/powerpointnew.html

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