FREQUENTLY ASKED QUESTIONS
What is Integrative or Functional Psychiatry?
Functional Psychiatry looks for the underlying cause of the disease in order to get to the pre-disease state or to stop the progression of the disease while Integrative Psychiatry promotes health, prevents illness and helps raise awareness of “disease” (rather than merely managing symptoms) by using traditional and non-traditional interventions. Both interventions may include, but are not limited to, neurofeedback, natural products, like herbs, meditation, nutrition deficiencies, diet, genetic testing, sleep irregularities and exercise.
WHAT CREDENTIALS SHOULD A CLINICIAN HAVE TO DO FUNCTIONAL OR INTEGRATIVE MEDICINE?
Physicians can get a certification in Integrative Medicine from the American Board of Integrative Medicine or a certification in Functional Medicine (which is more rigorous) from the Institute of Functional Medicine.
Why are there so many “natural Products sold in the market and what is their level of safety?
In October 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law. Before this time, dietary supplements were subject to the same regulatory requirements as were other foods. A firm does not have to provide FDA with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products. Other than the manufacturer's responsibility to ensure safety, there are no rules that limit a serving size or the amount of a nutrient in any form of dietary supplements. Therefore, the supplement industry has become a billion dollar business that markets supplements without proper dosing or evidence based on research.
This decision is made by the manufacturer and does not require FDA review or approval. By law, manufacturers may make three types of claims for their dietary supplement products:
1. health claims,
2. structure/function claims, and
3. nutrient content claims.
If a dietary supplement label includes structure/function claim, it must state in a "disclaimer" that FDA has not evaluated this claim. The disclaimer must also state that this product is not intended to "diagnose, treat,
cure or prevent any disease," because only a drug can legally make such a claim. Hence, in order to increase research on these products, the National Center for Complementary and Alternative Medicine (NCCAM) was formed at the National Institute on Health in Washington, D.C. Integrative and Functional Physicians rely on research in order to make recommendations for supplements. However, one should make ask if a physician is certified in these fields before deciding to use a particular physician.
National Center for Complementary and Integrative Medicine(NCCIM) emphasizes symptom reduction, not treatment
Strategic Objectives for NCCIM are:
Advance research on CAM pharmacological and dietary interventions and approaches.
Advance research on mind/body and manipulative/manual CAM interventions.
Increase understanding of “real-world” patterns and outcomes of CAM use and its evidence-based integration into practice and care.
Improve the capacity of the field to carry out rigorous research.
Develop and disseminate objective, evidence-based information regarding the role of CAM interventions for the public and health care providers
What is Personalized Medicine?
As noted by the Federal Drug Administration, the term "personalized medicine" is often described as providing "the right patient with the right drug at the right dose at the right time." More broadly, "personalized medicine" may be thought of as the tailoring of medical treatment to the individual characteristics, needs, and preferences of a patient during all stages of care, including prevention, diagnosis, treatment, and follow-up. Functional Psychiatry just expands this definition to find the pre-disease state reasons for having any disease rather than just treating the chronic disease state. In this way we can either prevent the disease from re-emerging or stop the progression.
What is mindfulness or meditation?
Mindfulness or meditation is used to teach the brain to not be distracted by the external environment or our
own thoughts. So, for instance, if you are focusing on your breath, each time a thought jumps into your head or you hear a noise, you focus back on your breathe. There are many types but all of them decrease cortisol and adrenalin (associated with fight and flight) and decreases inflammation associated with PTSD, anxiety, TBI and depression. The best studied in terms of turning on the default mode (which turns off when your brain is completely at rest) is Transcendental Meditation.
What is the Gut-Brain- Axis?
Any changes id the normal bacteria in the gut is called "dysbiosis". This causes an inflammatory response in the gut which signals the vagal nerve. This causes cortisol and adrenalin to increase, prevents the normal production of healthy neurotransmitters in the brain to be produced and causes white blood cells called microglia to produce more inflammatory responses. The inflammation that is due to chronic stress can lead to an increase risk for dementia, depression, worsening of PTSD and TBI.. The antibodies produced can lead to diabetes, high blood pressure, cardiac disease and autoimmune diseases like rheumatoid arthritis and inflammatory bowel disease.
Looking at lifestyle and how it produces inflammation in the gut is important in functional medicine. Factors that can cause inflammation in the gut are seen below.
Processed foods and high fat foods
Lack of sleep
Antibiotics and medications like anti-acids
History of physical or sexual abuse
Any infection of the GI tract
What is cognitive behavior therapy?
This is a type of therapy used to confront distorted thoughts from our past or present that changes our perception of ourselves or events.
What is Neurofeedback?
1. Neurofeedback involves putting a cap on the head that has 19 electrode channels. These channels record a patient's EEG or brain waves with eyes opened and eyes closed.
2. Then these brainwaves are compared to a normal data base. If the patient's brainwaves are 2 or more standard deviations above or below the mean of the normal data base and these brainwaves are found in the area of the brain
that matches the patient's symptoms, these areas are targeted. This is called a quantitative EEG (qEEG).
3. The patient comes back and the cap is placed back on. Then the patient is watching a monitor which may have something like a car on a race track. Every time the right brain waves occur by chance, the car will move on the
5. The patient learns how to move the car and thus change the brain waves each time the car moves.
6. Once this is done, the time the patient has to keep the car moving is extended until the brain waves turn back to normal.
(For more detail and the science behind Neurofeedback,, see NEUROFEEDBACK Specific under FAQs category)
IS ALL NEUROFEEDBACK ALIKE?
LORETA neurofeedback unscrambles brain wave frequencies beneath every electrode and matches these specific
brain waves to deeper structures in the brain which allows for specificity and localization similar to that of
functional MRI methods.
Neurofeedback use to take 40 -80 sessions with traditional Surface qEEG neurofeedback. However, LORETA neurofeedback takes fewer sessions because it reaches deeper structures.
The new Research Domain Criteria set up by the National Institute of Mental Health targets dysfunctional circuits.
Since LORETA neurofeedback targets deeper structures and is simialr to functional MRI neurofeedback, it is ideal for use under these criteria.
WHAT CREDENTIALS SHOULD A CLINICIAN HAVE TO DO NEUROFEEDBACK?
The FDA has approved many machines (amplifiers) for use for neurofeedback because there is little harm that occurs from these machines. These machines and software programs can be bought and used by many people. It is wise to ask the clinician whether they have training in neuroscience. It may be wise to ask if a clinician is board certified by the
Biofeedback Certification International Alliance (BCIA) or supervised by someone who is. If you are interested in LORETA neurofeedback, ask if this is the system they use.
Also, a clinician should do a thorough bio-psycho-social evaluation with information from multiple sources before doing neurofeedback. Many conditions like seizures and thyroid problems can look like ADHD and neurofeedback would not be appropriate in those patient's. Those medical conditions need to be treated first.
In addition, LORETA neurofeedback should never be used as a stand alone intervention. Other problems like
learning disorders should be tested for and appropriate interventions at the school level should also be addressed. Many
other factors need to be explored before neurofeedback can occur and this is addressed in a thorough bio-psycho-social evaluation.
Why was Complementary, Alternative and Integrative Medicine not incorporated into Western Medical Schools?
Acupuncture arrives in the West, with the strongest influence in France in 1800’s and in U.S. by way of William Osler, M.D.(father of medicine) who began using in late 1800s.
However, in 1910 the Flexner Report on medical education was commissioned by the Carnegie Foundation for the advancement of teaching. This resulted in restrictions of what could be taught in medical schools and the focus became acute care.
Great depression followed and Medicare was created which developed the concept that a “war against disease” would be established.
President Roosevelt allotted money for research and medical education placed basic sciences above clinical care.
The discovery of penicillin led to the “magic bullet” mentality for fixing everything. This led to the huge growth in hospitals and money spent to fix everything.
Managed care was created to slim down costs.
Hence a reduction in services and payments for services occurred and devaluation of time spent with the practitioner occurred.
Many therapies were simply eliminated from managed care (acupuncture, neurofeedback, homeopathy, etc.)
What was forgotten was the question as to why diseases occurred-if someone had HBP-what were they eating, were they exercising, how did they respond to stress)