Quick viewing(Text Mode)

Characteristics Table for the Clinical Question: in the Treatment of GAD, What Are the Risks and Benefits Associated with Different Complimentary Therapies?

Characteristics Table for the Clinical Question: in the Treatment of GAD, What Are the Risks and Benefits Associated with Different Complimentary Therapies?

Characteristics Table for The Clinical Question: In the treatment of GAD, what are the risks and benefits associated with different complimentary therapies?

Comparisons Included in this Clinical Question Acupuncture and chinese medication Acupuncture vs Behavioural Acupuncture vs Behavioural Acupuncture vs vs Doxepin desensitization desensitization + acupuncture ZHANG2003 RUAN2003 GUIZHEN1998 GUIZHEN1998

Acupuncture vs /Paroextine Acupuncture vs vs Acupuncture vs & plant Acupuncture vs medication + combined extract acupuncture YUAN2007 Zhou 2003 ZHILING2006 Zhou 2003

Chamomile vs Placebo Chinese Taoist Psychotherapy vs Galphimia glauca vs lorazepam Ginkgo biloba vs Placebo AMSTERDAM2009 HERRERA2007 WOELK2007 ZHANG2002

Hypnotherapy vs Passionflower vs Silexan vs Lorazepam Study vs Placebo ZHAO2005 AKHONDZADEH2001A WOELK2010 HANUS2004

Valerian extract vs extract vs Placebo ANDREATINI2002 ANDREATINI2002 Characteristics of Included Studies Methods Participants Outcomes Interventions Notes AKHONDZADEH2001A Study Type: RCT n= 36 Data Used Group 1 N= 18 Funding: no details Adverse events provided. Quality assessed: - Study Description: 4 week double-blind study Age: Range 19-47 Oxazepam. Mean dose 30mg/day - . To date, the only comparing passion flower extract and Data Not Used 30mg/day plus placebo drops. Sex: 16 males 20 females published oxazepam. HAMA - no data Group 2 N= 18 looking at effects of Diagnosis: Notes: Assessed by a psychiatrist at baseline and Type of Analysis: Completers Other active treatments. Mean dose 45 passionflower on treatment 100% Generalised Disorder (GAD) by 4, 7, 14, 21 and 28 days after the medication drops/day - Passionflower 'passiflora' of anxiety. Blindness: Double blind DSM-IV started. extract. 45 drops per day plus placebo Duration (days): Mean 28 tablet. Exclusions: History of serious suicide attempt or current Setting: Outpatients: Iran. acute suicidal ideation, an unexpected recent panic attack or full DSM-IV panic disorder within the previous 6 months, a Notes: RANDOMISATION: no details provided. life-time diagnosis of DSM-IV , psychosis, paranoia or Info on Screening Process: No details provided. dementia, concurrent or recent diagnosis of substance abuse, drug psychosis, OCD, , or major . Pregnant and lactating women. Notes: Ppts had a HAM-A score >=14. Ppts were free from all psychotopic medication for a minimum of 7 days before

Appendix 16d 60 starting study. Baseline: No data provided. AMSTERDAM2009 Study Type: RCT n= 57 Data Used Group 1 N= 28 Quality assessment Funded Response (50% reduction in HAMA score) by the National Institutes of Study Description: Efficacy and tolerability trial Age: Mean 46 Chamomile extract therapy. Mean dose Health/National Center of chamomile extract therapy in patients with Psychological General Well Being Index 220mg - Capsules containing Sex: no information for Complementary and GAD. Beck Anxiety Inventory pharmaceutical grade German Alternative Medicine grant Diagnosis: HAMA chamomile extract standardized to a Type of Analysis: ITT (LOCF) content of 1.2% apigenin. 1-5 capsules 100% Generalised (GAD) by Notes: Capsules made identitcal in appearance Blindness: Double blind per day depending on tolerability. DSM-IV and aroma. Outcome measures obtained at Duration (days): Mean 56 baseline, 2,4,6,8 weeks of treatment. 8 dropouts: Group 2 N= 29 Exclusions: HAMA <9. Another primary DSM-IV Axis I 2 had adverse events, 3 withdrew consent, 2 lost Placebo - Capsule containing lactose Setting: Department of Family Medicine and disorder. Current diagnosis of MDD, BD, to follow up and 1 non compliance. monohydrate National Formulary. 1 per Community Health outpatient clinic. PD, phobic disorder, OCD, PTSD, acute stress disorder, day one week. 2 per day in second week. substance induced anxiety disorder, psychosis, dementia, or Notes: Blocked randomization with varying 1-5 capsules per day depending on substanceabuse or dependence within the preceding 3 block sizes. tolerability. months. Unstable medical condition, hepatic/renal Info on Screening Process: 61 screened. 4 insufficiency, malignancy, abnormal serum thyrotropin level failed (1 for non comliance and 3 for no of 5 KIU/mL or more, or known sensitivity to chamomile, consent) 57 randomized. plants of the Asteraceae family, mugwort, or birch pollen. Concurrent use of , , mood stabilizers, sedatives, or CAM remedies (eg, St John’s wort) or other chamomile preparations. Negative test and medically proven contraception for women.

Baseline: HAMA: Chamomile 15.4 (4.2) Placebo 14.3 (2.8) BAI: Chamomile 9.5 (5.6) Placebo 12.0 (602) PGWB: 62.0 (14.7) Placeno 58.9 (14.1) ANDREATINI2002 Study Type: RCT n= 36 Data Used Group 1 N= 12 Drug company funded: BYK STAI-trait Quimica e Farmaceutica Study Description: ITT using LOCF included all Age: Mean 41 Diazepam. Mean dose 6.5mg/day - Ltds (Brazil). Quality those who completed at least 1 week of HAMA Following a two week washout period, Sex: 17 males 19 females assessment score = + treatment Leaving the study due to inefficacy study were administered in identical The study included a Diagnosis: Leaving the study due to adverse events capsules containing 2.5mg. The capsules Type of Analysis: ITT were adminstered three times a day with number of participants with 100% Generalised Anxiety Disorder (GAD) by Notes: TAKEN AT: baseline, end of treatment (4 current social phobia and Blindness: Double blind DSM-III-R thelowest dose consisting of two placebo weeks) and one active capsules based on simple phobias in addition to Duration (days): Mean 28 DROPOUTS:Diazepam 1/12 (8.3%), Valepotriate response. 4 week GAD Exclusions: - No DSM-III-R diagosis of GAD 2/12 (16.6%), Placebo 2/12 (16.6%) Setting: Sao Paulo ,BRAZIL - current or previous MDD, manic episode, panic disorder, Group 2 N= 12 OCD, drug dependence or any psychotic symptoms Notes: RANDOMISATION: used a computer Placebo - Following a two week washout - major medical disorders (e.g. CVD, renal disorders etc.) programme period, study drugs were administered in - drug treatment apart from over the counter drugs identical capsules. The capsules were Info on Screening Process: 132 people were - receiving psychotherapy adminstered three times a day. interviewed of which 96 were excluded and 36 - Patients under treatment with were participated in the study. Participants were excluded if: excluded due to the presence of another mental 1) they had a clinical response or no evidence of side illness, refusal, marked reduction in HAMA prior effects to the curent drug to study, use of other medications. 2) they did not undergo a gradual reduction of medication followed by a 2 week wash-out period - Social phobia or simple phobia excluded if anxiety was secondary to these disorders - females not using a medically accepted form of birth control

Appendix 16d 61 Notes: All participants were evaluated using the SCI-R Group 3 N= 12 Baseline: HAMA - Placebo: 25.1(7.5), Diazepam: 25.2(4.5), Valepotriates. Mean dose 81.3mg/day - Valepotriates: 22.8(7.6) Following a two week washout period, study drugs were administered in identical capsules containing 50mg. The capsules were adminstered three times a day with thelowest dose consisting of two placebo and one active capsules based on response.

Results from this paper:

GUIZHEN1998 Study Type: RCT n= 240 Data Used Group 1 N= 80 FUNDING: No mention, Remission (clinical symptoms gone & SAS Quality assessed = Study Description: Comparative study on Age: Range 16-73 Acupuncture. Mean dose 10-30 <45) moderate quality acupuncture combined with behavioural Sex: 109 males 131 females sessions - A detailed history and physical desentisization for treatment of anxiety neurosis Response (symptoms improved & SAS exam was performed & stainless stel on 240 patients Diagnosis: reduced sign) filofrom needles were inserted into 3-6 100% Anxiety Neurosis Notes: Subjects were evaluated immediately after selected body points during each session Type of Analysis: ITT the last therapy in all three groups. Evaluation & manipulated with uniform reinforcing Blindness: No mention included physical examination and SAS score reducing. Treatment was performed once Exclusions: Those with underlying medical disorders or evaluation. Response: SAS reduced by 20 or every other day. Duration (days): scores of <50 on the Zung self assessment score (SAS) more points. No drop outs. Group 2 N= 80 Notes: Diagnosis tool unclear. Zhung self assessment Setting: China Behavioural desensitization. Mean dose scores (SAS) were greater than 50 (i.e moderate to severe 10 sessions (twice per week for 30 min) - Notes: RANDOMISATION: Unclear anxiety) Treatment consisted of self-relaxation Info on Screening Process: Unclear Baseline: Duration of disease: Acupuncture = one month to techniques, psychotherapy, & a program 16 years, Behavioural desentization = 6 months to 12 of behavioural desensitization. Received years, Combined = 2 weaks to 16 years instruction in muscle relaxation techniques to be practiced daily. Psychotherapy incorporated desensitization techniques. Group 3 N= 80 Behavioural desensitization + acupuncture. Mean dose 10-40 sessions - Underwent the above program of behavioural desensitization followed by acupuncture treatments on the same day, as described for the acupuncture group. Received 1-4 courses of treatment with an interval of 3-7 days between courses. HANUS2004 Study Type: RCT n= 264 Data Used Group 1 N= 130 Quality assessment: low risk Response (50% reduction in HAMA score) of bias. Funded by Study Description: Clinical efficacy of fixed Age: Mean 45 Range 18- Study drug. Mean dose 375mg - 2 plant Laboratoires Innothera, quantities of two plant extracts and Visual Analog Scale (VAS) extracts (Crataegus oxyacantha and Sex: 50 males 214 females France vs placebo in anxiety disorders with functional HAMA eschscholtzia californica) and disturbances. Diagnosis: Data Not Used magnesium. Drug name: Sympathyl. 100% Generalised Anxiety Disorder (GAD) by Tablet form. 75mg Crataegus Type of Analysis: ITT (LOCF) CGI - no data DSM-III-R oxyyacantha, 20mg Eschscholtzia Blindness: Double blind californica, 75mg elemental magnesium. 2 tablets per day for 3 months. Duration (days): Mean 90 Exclusions: <18 years. No consent. No GAD according to DSM-III-R criteria. Patients with suicide risk. Use of Setting: Multi outpatient centers in Paris.

Appendix 16d 62 Notes: Randomized box design used for psychotropic drugs or drugs with psychotropic properties or Notes: Efficacy assessment before at baseline Group 2 N= 134 randomization. magnesium salts within one month. and 7, 14, 30, 60 and 90 days after treatment. 31 Placebo - Tablets made from same drop outs due to inefficacy. ingredients as study drug except for active Info on Screening Process: Not mentioned Notes: Total Hamilton Anxiety score between 16 and 28 ingredients. Indistinguishable. Baseline: HAMA: Study group 22.7 Placebo 22.4

HERRERA2007 Study Type: RCT n= 152 Data Used Group 1 N= 80 Funding: unknown. Quality CGI-I assessed: -. Study Description: 4 week double-blind study of Age: Mean 38 Lorazepam. Mean dose 2mg/day - 1mg HAMA galphimia glauca vs. placebo in outpatients with Sex: 35 males 117 females twice daily. GAD. Leaving the study due to adverse events Group 2 N= 72 Diagnosis: Type of Analysis: Unclear Leaving the study early for any reason Other active treatments. Mean dose 100% Generalised Anxiety Disorder (GAD) by 620mg/day - Galphimia glauca. Contained Blindness: Double blind DSM-IV 310mg of dired aqueous G.G. extract Duration (days): Mean 28 twice a day. Exclusions: No pharmacological intervention for GAD within Setting: Outpatients: Mexico. past 4 weeks, no drug or abuse for at least 6 months prior to study initiation, no suicidal behaviour or psychiatric Notes: RANDOMISATION: no details provided. co-morbidity of higher clinical importance than GAD. Info on Screening Process: No details provided. Notes: Ppts scored >=19 on HAM-A. 7% of ppts had had a drug/alcohol addiction. Baseline: None provided. HERRERA-ARELLANO2007 Study Type: RCT

Blindness: Duration (days):

RUAN2003 Study Type: RCT n= 169 Data Used Group 1 N= 86 Quality assessed: all SAS-CR selection, performance, Study Description: compare efficacy of Age: Range 14-62 Acupuncture. Mean dose 30days - attrition, detection bias are combined treatment (acupuncture and chinese Accupunture combined with chinese Sex: 63 males 106 females unclear medicine) versus Doxepin for treatment of medicine. Participants took the chinese anxiety neurosis Diagnosis: medicine twice a day for 30 days. They Anxiety Neurosis by CCMD-2-R also receive acupunture once per day for Type of Analysis: unknown 30-60min each session. Blindness: No mention Group 2 N= 83 Exclusions: Excluded those who score below 50 on CCMD-2 Duration (days): Mean 30 and SAS-CR Doxepin. Mean dose 30days - average daily intake is 150mg Setting: unknown. Probably inpatients Baseline: Did not report if both groups are comparable at baseline. Baseline score (SAS-CR) for acupuncutre group Info on Screening Process: not reported is 78.56(17.64) and Doxepin group is 77.68(18.23). Duration of diagnosis range from1 month to 8 years Results from this paper: Both treatments are similarly effective.

Appendix 16d 63 WOELK2007 Study Type: RCT n= 107 Data Used Group 1 N= 34 Funding unknown. Quality HAMA assessed. Low risk of bias. Study Description: -effects of ginkgo Age: Mean 47 Range 18-70 Ginkgo biloba. Mean dose 480mg - Notes: Assessment took place at baseline and on biloba in patients suffering from GAD and Sex: 41 males 66 females Patients took 2 film-coated tablets t.i.d adjustment disorder. Dosage EGb 761: 480mg, days 4, 8, 15, and 29. (80mg). Active drug and placebo were of 240mg. Diagnosis: same appearance. Generalised Anxiety Disorder (GAD) by DSM-III- Type of Analysis: ITT with LOCF Group 2 N= 36 R Ginkgo biloba. Mean dose 240mg - Blindness: Double blind Patients took 2 film-coated tablets t.i.d Duration (days): Mean 28 Range 18-70 Adjustment disorder with anxious mood by DSM- (40mg). Active drug and placebo were of III-R same appearance. Setting: Private practices of specialists in Group 3 N= 37 neurology/ psychiatry, internal medicine, GPs Exclusions: Perceived risk of suicide, severely ill, other Ginkgo biloba. Mean dose n/a - Patients and outpatient clinic of a psychiatric university anxiety disorders, anxiety related to other psychiatric took 2 film-coated tablets t.i.d (no active hospital disorders, OCD, suspected dementia or severe somatic drug). Active drug and placebo were of disorders. Substance abuselack of cooperation, inability to Notes: Validatd computer program randomly same appearance. assigned numbers to 3 treatment groups. complete self-rating questionnaires or treatment with Randomisation code sealed and stored safely. psyvhoactive drugs. Info on Screening Process: 109 screened. 2 Baseline: HAMA. No significant differences in baseline excluded. 1 responded to placebo treatment scores. and 1 withdrew consent. WOELK2010 Study Type: RCT n= 77 Data Used Group 1 N= 40 Quality assessment: Attrition Remission (less than 10 on HAMA) bias: Unclear Study Description: To investigate the Age: Mean 43 Range 21-65 Silexan. Mean dose 80mg - Patients Response (50% reduction in HAMA score) therapeutic efficacy and tolerability of silexan Sex: 18 males 59 females received one capsule of silexan and 1 compared to lorazepam in treatment of patients CGI capsule lorazepam placebo. Silexan is an with GAD. Diagnosis: SF-36 oil prodiced fro lavender. Generalised Anxiety Disorder (GAD) by DSM-IV Type of Analysis: ITT Penn State Worry Questionnaire Group 2 N= 37 Lorazepam. Mean dose 0.5mg - Patients Blindness: Double blind Self-rating Anxiety Scale (SAS) Exclusions: HAMA <18 and Item 1 'anxious mood' <2 and HAMA received 1 capsule lorazepam and 1 Duration (days): Mean 42 Item 2 'tension' <2. capsule silexan placebo. Data Not Used Followup: 2 week discontinuation phase Sleep diary Baseline: HAMA: Silexan 25 Placebo 25, PSWQ: Silexan Setting: Multi outpatient centers in Germany. 61.4 Placebo 62.2, SAS: Silexan 61.4 Placebo 61.5, SF-36 Notes: Assessment at baseline, 1, 2, 4, 6 and 8 weeks. 11 drop outs/incomplete assessment. Notes: Randomization by validated computer mental health: Silexan 39.9 Placebo 36.5, SF-36 physical program health: Silexan 59.5 Placebo 58.6. Info on Screening Process: One-week screening. Patients received placebo. Patients with decrease of 25% or more of HAMA during this phase were excluded. YUAN2007 Study Type: Quasi-randomised n= 86 Data Used Group 1 N= 29 Quality assessment: Efficacy Index Selection, performance and Study Description: To observe the therapeutic Age: Range 18-65 Western medicine - 1. Fluoxetine or detection bias efficacy of Jin-3-neeling (NL) therapy on GAD General Index (20mg) 2. Alprazolam (0.4- Sex: 30 males 56 females unknown/unclear. Attrition: through clinical global impression scale (CGI). Severity Index 1.6mg) per day. One or two of the above low risk of bias. Diagnosis: drugs were chosen with the former as the Type of Analysis: Completor 100% Generalised Anxiety Disorder (GAD) by dominant grug and alprazolam was used CCMD-3-R in addition according to patients condition. 6 weeks course.

64 Blindness: No mention Exclusions: HAMA <15. Received any anianxietic agent or Notes: Clinical Global Impression (CGI) scale Group 2 N= 29 Duration (days): Mean 36 . Patients with severe mental disorder, scored before and after 6 week treatment with 3 Jin-3-Needling therapy - Needles inserted organic diseases of the brain, addiction to alcohol or drugs, scales. SI, GI and EI. 7 dropouts. 3- worsening from four sites to produce a tightening or severe somatopathy of the , or , or women condition 2-intolerability to side-effects 1- Setting: The first affiliated hospital of heavy sensation on the patient's scalp. in pregnancy or period were excluded. economic uptightness 1-emigration. Guangzhou traditional chinese medical Needles retained for 45min and run every university, Guangzhou municipal hospital of the Notes: Diagnostic standard for GAD in the chinese 15min, once everyday, 6 times per week brain. classification scheme and diagnostic standard for psychotic for 6 weeks. Notes: Assigned to treatment groups according diseases (CCMD-3-R) Group 3 N= 28 to the sequence of their visiting between Oct Baseline: HAMA: WM 26.74 (3.51) NL 27.65 (2.86) CT Western medicine + Jin-3-Needling 04 - Dec 05. 27.33 (3.71. Severity Index: WM 5.12 (1.04) NL 5.36 (0.93) therapy - Combination of method for Info on Screening Process: 86 enrolled upon CT 5.71 (1.35). No significant difference. western medicine and J3N therapy. meeting the inclusion criteria. Doasage and manipulation as used in other 2 groups were applied simultaneously to these patients.

ZHANG2002 Study Type: RCT n= 143 Data Used Group 1 N= 46 Quality assessment: EPQ Selection, performance and Study Description: Combines elements of Age: Mean 35 Chinese Taoist Cognitive Psychotherapy - detection bias cognitive therapy and Taoist philosophy. Looks Coping Style Questionnaire Each session lasted 1hour. Carried out by Sex: 80 males 53 females unknown/unclear. Attrition: at efficacy of CTCP, BDZ and combined Type A Personality Scale first author and experienced psychiatrists low risk of bias. treatment in people with GAD. Diagnosis: SCL-90 Chinese version trained for method. 100% Generalised Anxiety Disorder (GAD) by Type of Analysis: ITT (no mention of drop out Notes: Phase I-one month weekly sessions. Group 2 N= 48 CCMD-2-R analysis) Phase II-5 months of twice monthly sessions. 13 BZD - Each session lasted 10 minutes. drop outs. Reason not mentioned. Drug dosage unaltered after phase I. Blindness: No mention Exclusions: Patients in psychiatric treatment prior to study. Variable doses of oral BDZ (diazepam or Duration (days): Mean 168 No consent given. alprazolam) administered according to Notes: CCMD-2-R criteria for GAD is the same as ICD-10 patient condition. 10-20mg diazepam Setting: 4 mental health centres in China and DSM-IV except that condition has duration of 3 rather equivalent. Notes: Patients were randomly assigned to than 6 months. Group 3 N= 49 treatment groups. Procedure not mentioned. Baseline: SCL-90: CTCP 90.7, Drug 113.8 Combined CTCP v BZD - Same as before Info on Screening Process: 143 patients with 107.0 No significant difference in baseline characteristics GAD included. Exclusions not mentioned. Study lasted 6 months with two phases. One month of weekly sessions and 5 months of twice monthly sessions. ZHANG2003 Study Type: RCT n= 296 Data Used Group 1 N= 157 FUNDING: no mention, SAS-CR Quality assessed: low quality Study Description: Examined the effectiveness Age: Range 16-60 Acupuncture. Mean dose 30 sessions - Response (symptoms relieved, occas of acupuncture treatment against doxepin in the Sex: 130 males 166 females The treatment was given once a day, with treatment of anxiety neurosis. emotional fluc) a one day interval every 6 consecutive Diagnosis: Remission (symptoms disappeared & stable treatments. Treatment followed four Type of Analysis: ITT 100% Anxiety Neurosis by CCMD-2-R emotions) different methods which are described in Blindness: No mention Notes: No drop outs detail in the paper. Group 2 N= 139 Duration (days): Mean 30 Exclusions: Did not achieve a score of greater than 50 on the SAS-CR. Doxepin. Mean dose 25 mg + - The dose Setting: In and out-patients, China for each session in the first week was Notes: Duration of illness ranged from one month to 6 years Notes: RANDOMISATION: no mention 25mg & it could be modified properly Baseline: no data based on the therapeutic effects and the Info on Screening Process: No mention adverse effect of the drug. ZHAO2005

65 Study Type: RCT n= 62 Data Used Group 1 N= 32 Quality assessed: low-high HAMA risk of bias Study Description: compared the clinical Age: Mean 38 Range 20-45 Hypnotherapy. Mean dose 2 - Use Hospital Anxiety and Depression Scale efficacy of hypnotherapy and Alprazolam in the Sex: 23 males 39 females different technique of hypnotherapy treatment of GAD. (anxiety) (catered to each individual’s need) to Diagnosis: Body Sensations Questionnaire reduce the patient’s anxiety. Each session Type of Analysis: Completors (no drop outs) 100% Generalised Anxiety Disorder (GAD) by Social Adjustment Scale takes 30-40minutes Blindness: No mention CCMD-3 Notes: Assessments (HAMA and self report SAS) Group 2 N= 30 Duration (days): Mean 14 were given to both groups at pre-treatment (2 Alprazolam. Mean dose 2 - visits clinic Exclusions: No diagnosis of GAD, not between age range of weeks before treatment) and follow up (4 weeks). twice a week, each session takes at least Followup: 4 wks 20-45, scored under 14 in HAMA scale, unwilling to Clinical significance is defined as reduction > 30 minutes, the GP prescribe 0.8mg dose Setting: Outpatients, China participate, had other serious cardio diseases 50% on HAMA scale. No drop outs (taken twice a day). Notes: RANDOMISATION: according to patient Notes: In experimental group, the duration of diagnosis number & date entered into trial. ranges from 1-11 years, with an average of 4 (+/-3) years. In control group, duration of diagnosis is 1-10 years, Info on Screening Process: no mention average 4 (+/-2) years. Baseline: HAMA (total) 28.8 (3.9) Psychological anxiety (subscale) 16.6 (2.3) Sensation (subscale) 12.2 (3.3) SAS 60.9 (4.9) There were no stat sig difference between the 2 groups (chi square= 0.005, P>0.05) Results from this paper: No difference found between groups ZHILING2006 Study Type: RCT n= 65 Data Used Group 1 N= 35 Quality assessment: Self-rating Anxiety Scale (SAS) Unclear/unknown risk. Study Description: Treatment of GAD by Age: Acupuncture - Acupuncture points Remission acupuncture Sex: no information modified according to individual patient Notes: Remission criteria: disappearance of conditions. Needles retained for 30 min. Type of Analysis: Completors (no dropouts) Diagnosis: symptoms with stable emotions. 30 days treatment. Blindness: No mention 100% Generalised Anxiety Disorder (GAD) by Group 2 N= 30 CCMD-3 Duration (days): Mean 30 Medication - Control group. 0.5-2 mg loracepam (bid or tid) with additional Setting: Out and in patients Exclusions: Severe organic psychosis 20mg oryzanol (tid) or 10-20mg Notes: Randomization method not reported Notes: SAS score >50 propranolol (tid) oraly administered for 30 days. Info on Screening Process: Not mentioned Baseline: Comparible in terms of sex, age and disease course. SAS: Treatment 79.88 (6.32) Control 78.96 (5.98) Zhou 2003 Study Type: RCT n= 100 Data Used Group 1 N= 50 Quality assessed: Selection Remission bias-unclear; performance Study Description: compare effectiveness of Age: Mean 52 Range 23-72 Acupuncture - given treatment once a bias-unclear;attrition bias- combined treatment of acupuncture with Data Not Used day, 10 days as one treatment wave. Sex: 32 males 68 females unclear; detection bias- medication versus medication alone for anxiety Reliable & clinically significant change There are 5 days of rest after each unclear neurosis Diagnosis: treatment wave. Participants received 3 Anxiety Neurosis by CCMD-2-R treatment waves. Type of Analysis: unknown Group 2 N= 50 Blindness: No mention Exclusions: Not reported Study drug - 20mg of flupentixol 3 times Duration (days): Mean 40 per day. Taken 40 days continuously Baseline: No statistical difference between 2 groups on Setting: Unknown. Maybe conducted in The age, gender or chronicity. Patients in treatment group had

66 First Hospital of Yuhang District in Zhejiang, average 2.5 years of diagnosis. Patients in comparison Notes: Remission defined as no symptoms, can China group average was 2.3 years of diagnosis. lead normal daily worktask; Response (normal functioning) defined as majority of symptom Info on Screening Process: Did not report measures are lowered, can lead normal daily worktask; Response (unstable functioning) as unstable emotions, impaired daily life

Results from this paper: Combined treatment was more effective than medication alone

Characteristics of Excluded Studies Reference ID Reason for Exclusion BHATTACHARYYA2008 Not RCT BONNE2003 Not a complementary intervention Bonne2003a Not considered a complimentary therapy BYTRITSKY2008 Not RCT SMITH2007 Not GAD WANG2001 Not GAD

Top View