Acupuncture for schizophrenia
Comment: The quality of evidence is downgraded by study quality (lack of allocation concealment), inconsistency (heterogeneity in interventions and outcomes) and indirectness (short follow-up time, all except one study conducted in China).
A Cochrane review 1 included 30 studies, which evaluated 6 categories of acupuncture. All included studies were undertaken in China except one in Tunisia. The participants suffered from schizophrenia. Study duration varied from 2 weeks to 6 months. When acupuncture plus standard antipsychotic treatment was compared with standard antipsychotic treatment alone, people were at less risk of being 'not improved' (medium-term RR 0.40, CI 0.28 to 0.57; 3 RCTs, n=244). Mental state findings were mostly consistent with this finding as was the time in hospital (days MD -16.00, CI -19.54 to -12.46; 1 RCT, n = 120). Adverse effects were less for the acupuncture group (e.g. central nervous system, insomnia: short-term RR 0.30, CI 0.11 to 0.83; 3 RCTs, n = 202). When acupuncture was added to low dose antipsychotics and this was compared with standard dose antipsychotic drugs, there were less relapses in the experimental group (long-term RR 0.57, CI 0.37 to 0.89; 1 RCT, n = 170) but there was no difference for the outcome of 'not improved'. Mental state findings were mostly consistent with the latter. Incidences of extrapyramidal symptoms - akathisia, were less for those in the acupuncture added to low dose antipsychotics group (short-term RR 0.03 CI 0.00 to 0.49; 1 RCT, n = 180), as were dry mouth, blurred vision and tachycardia. When acupuncture was compared with antipsychotic drugs of known efficacy in standard doses, there were equivocal data for outcomes such as 'not improved' using different global state criteria. Traditional acupuncture added to traditional Chinese medicine (TCM) drug had benefit over use of TCM drug alone (RR for no clinically important change 0.11, CI 0.02 to 0.59; 2 RCTs, n = 360), but when traditional acupuncture was compared with TCM drug directly there was no significant difference in the short-term. The participants given electroacupuncture were significantly less likely to experience a worsening in global state (short-term RR 0.52, CI 0.34 to 0.80; 1 RCT, n = 88). When electric acupuncture convulsive therapy was compared with electroconvulsive therapy, there were significantly different rates of spinal fracture between the groups (short-term RR 0.33, CI 0.14 to 0.81; 1 RCT, n = 68). No studies reported death, engagement with services, satisfaction with treatment, quality of life, or economic outcomes.
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