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Chapter 39. Complementary and Integrative Treatments

Richard P. Brown, M.D.; Patricia L. Gerbarg, M.D.
DOI: 10.1176/appi.books.9781585624201.689989

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Excerpt

Patients with traumatic brain injury (TBI) are often left with residual deficits, disabilities, and reduced quality of life despite having received conventional treatments. Integrative treatments combining medication, rehabilitation, and complementary approaches are being developed to optimize patient outcomes (Brown et al. 2009). Complementary and alternative medicine includes herbs, nutrients, nootropics, mind-body practices, neurotherapy, and lifestyle changes. Patients seek alternative approaches when standard treatments are insufficient or cause intolerable side effects. In general, complementary treatments have fewer side effects and may ameliorate fatigue, cognitive dysfunction (attention, concentration, and executive functions), memory impairment, and aphasias. Furthermore, in our experience, psychological sequelae, such as anxiety, depression, anger, and posttraumatic stress disorder (PTSD), may respond better to complementary treatments in TBI patients, who are prone to adverse effects from psychotropic medications. Indications for complementary treatments are proposed in Table 39–1.

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Figure 39–1. Clinical decision making for target symptoms.aUltra-low-dose l-deprenyl = 10–15 mg/week.CDP-choline = citicoline; PTSD = posttraumatic stress disorder; SAMe = S-adenosylmethionine.
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Table 39–1. Indications for complementary treatments in traumatic brain injury
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Table 39–2. Putative mechanisms of action for alternative compounds
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Table 39–3. Treatment guidelines
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Table 39–4. How to obtain quality complementary compounds
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Table 39–5. Evidence for cholinergic enhancing agents
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Table 39–6. Evidence for nutrients and vitamins
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Table 39–7. Evidence for herbs
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Table 39–8. Evidence for nootropics

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