ADHD with Bipolar Disorder in a Man of 31

On 3^rd of August 2019 a 31year old man was brought by his mother with complaints of sleeplessness, talking to himself and stammering. He looked hopeless and complained that he faces a lot of difficulty in concentration and doesn’t feel like doing anything. He just feels like eating, at times overeating. He looked obese, around 93Kgs.

Tiredness felt in the morning and he doesn’t wake up. He was an engineering student but dropped out and joined Bachelors in Commerce (a course offered to students after high school and intermediate studies). His reason for selecting the Commerce stream was that he wished to do business and never wanted to do a 9 am to 5 pm type of job. Presently he regrets this decision.

He’s was a chilly patient and hated the rainy season. He preferred summers and desired sweets. He feels afraid of crowds due to anxiety. At this point he was holding himself responsible for his failure in life. He had fear of not reaching his potential because of his laziness. He had regrets that during his school days he did not participate in inter-class debate competitions or learning a musical instrument.

He suffered a lack of confidence. The stammering made him feel like a loser and he felt stale within himself. At class ten he suffered from obsessive compulsive disorder. He was always a hyperactive child and enjoyed manipulating others and enjoyed watching others fight for the trouble he created.

He had suicidal thoughts of hanging himself, because in comparison to his classmates he could not achieve anything in life. He said that he should support his parents at this age but it is the reverse, and that he had achieved nothing. When he would quarrel with his father he would say ‘Die’ to him.

Details of Family History of illnesses:

Father suffers from bipolar disease

Mother has Renal calculi, fibro-adenoma of breast.

Sister has obsessive compulsive disorder

Paternal grandfather had asthma

Maternal grandmother suffered from mental illness

Maternal uncles suffered from mental illness, asthma

Anemnesis:

I used these Complete Repertory rubrics:

1) Delusion Imagination, wrong: he has done

2) Suicidal disposition

3) Fear in a crowd.

His strong family history of sycotic-syphilitic miasm along with depression and the self-reproaching behaviour led me to prescribe Aurum Met 200, 1 single dose.

Follow up after 45 days– He had already been put on mood regulating psychiatric medications as well as psychotic medications on advice of a psychiatrist. He complained of catching cold easily. He would still not resist eating ice-cream.

Feels better after smoking (addiction). Also, he said that he cannot express himself, doesn’t know what words to speak and that he is in a fight with himself. Also, he had developed a new fear of barking dogs. He could not tolerate correction. He had even raised his hand on his father. He liked to watch a lot of travelling videos. I decided to prescribe Tuberculinum 200, 1 single dose.

Follow up after 2 months – His mother complained that whatever he wants the parents have to give it immediately (bossy). He would punch the cupboard when angry.  He does many things but leaves things unfinished. He used to spend at least 8 hours a day on social media. He would break things unknowingly. His room was always messy. Now he wanted to drop out of commerce stream and join computers (changeable). He was angry with himself for not achieving or having purpose in his life. There were several conflicts with his father. When he gets angry, he is afraid of killing someone. I selected Sulphur 10M, 1 dose. Sulphur is a complementary medicine to Tuberculinum.

Follow up after 7 months– He was better for nearly for 6 months. He stopped the antidepressant medication within a month. However, three weeks back he tried to hang himself with a bedsheet but suddenly stopped himself saying ‘I have to prove myself to the world’.

He appeared very slim as he had reduced from 93kgs to 73kgs by running 10 kms every day. Even if he suffered cramps he wouldn’t stop. He would read many self help books to improve himself.

He stopped social media, as he wanted to live in the real world. He said that universities cannot provide any knowledge to him, and that he can learn simply by reading in his library. However, his concentration had diminished while reading and he had to read the same matter over and over again and still didn’t understand it.

The last 3 weeks he was crying a lot out of anger.  He loves to sit by himself alone. He said that his mind had twice the thoughts of a normal person and that made him very intuitive.  He said, “If anyone tries to offend me I will fuck him in such a way that the person won’t even realize who did it”.

He wanted to manipulate everyone. He wanted to play mind games to win the confidence of his parents so that they give him the car to drive. He was brought to homoeopathic treatment by his uncle who was sitting outside.

The patient told me “I can kill my uncle and feel nothing about it.” He had broken a chair at home 3 days ago. He complained of insomnia and tachycardia 150/m and said that the ADHD medications were responsible for it (researched by him).

He craved for a lot of coffee which calmed him down. There was such a rage on his face (almost like a hard-core criminal). He felt impulses to murder people as he went for his morning run. I prescribed him Nux Vomica 50 M, 1 dose based on inclination to suicide but lacks courage, insomnia and the violent anger. Nux vomica is the acute of Sulphur.

Follow up after 1 month– He appeared so calm and cool. No suicidal thoughts at all. He would not run 10 kms at 6am because now he began experiencing fatigue. Exercise which was not so important to maintain his mood anymore. On his own he stopped the ADHD medicines which corrected his tachycardia.

Now he can sleep earlier and wake up late in the morning. His mother was more relaxed since there was no aggressive behavior at home with his father. In fact, there were minimal quarrels. His mind did not have racing thoughts. No remedy was needed.

This case demonstrates how timely judicious use of antimiasmatic remedies in a certain sequence is essential to restore harmony. We began the treatment with the anti-syphilitic remedy Aurum Met because this case had a lot of deep miasmatic load clearly evident in his family history of illnesses.

This was followed by Tuberculinum since he was by nature very nasty, malicious due to discontentment, provocative and highly manipulative. Tuberculinum also covered his fear of animals (dogs) and desire for ice cream.

He also had addictive behavior with desire for things harmful to him. His  changeability of mind was seen in his academics. I further supported him with two  antipsoric remedies, Sulphur and Nux-Vomica based on indications.

Nux Vomica did the greatest good by calming him down, normalizing his sleep and cancelling the bad effects of medications which were arousing the mind of the patient instead of calming it down. Higher potencies were used in this case because the susceptibility was higher, the presence of ample of characteristics and on account of the violent nature of the disease.

Follow up after 3 months

Two months ago (August 2020) his mother who is a nurse suffered from Covid 19, his father and sister both got affected, except him. He is very stable in mind and says that he is fully self-sufficient and not needing any medical treatment. He advocates homoeopathic treatment to others. His mother recovered but his sister is not doing so well. He worries about her since she is showing some signs of mental illness. He has no active problem. He drives the car wherever his mother wishes to be taken and appears very fit.  No medicine given.