Diana Ravikumar – with guidance of Girish Navada
Abstract
Psychosis is one of the most challenging disorders for the Homoeopathic psychiatrist. Psychotic patients are disconnected from reality which makes the situation worse. Treatment should be completed with the antipsoric remedy.
Key words : Psychosis, Homoeopathy, Anacardium, Stramonium, Veratrum alb, Lachesis.
Introduction
According to the American Psychiatric Glossary of the American Psychiatric Association, the term psychotic means grossly impaired reality testing. Psychotic has been retained as a convenient descriptive term, particularly in F23, Acute Transient Psychotic Disorder. Its use does not involve assumptions about psychodynamic mechanisms, but simply indicates the presence of hallucinations, delusions, or a limited number of severe abnormalities of behaviour, such as gross excitement and over activity, marked psychomotor retardation and catatonic behaviour. Lack of insight (patient’s understanding of illness) is a failure to accept that one is ill, and is a characteristic of acute psychosis.
Case report
Ms. B, aged 35 years, Beedi rolling by occupation, educated up to 6th standard, unmarried, Hindu by religion. According to her mother she does not talk to anyone, sits alone in a corner, loss of interest in her routine, muttering to self, angered easily (shouts back as if someone is talking to her and beats herself when angry), throw things, beats mother, used to remove cloths for past 15years and symptoms increased since past two months. On observation during case taking she was restless, no eye contact maintained, no hygiene maintained, plica polonica present, muttering to self. She was under allopathic treatment when complaints are aggravated but never on regular medication. She stopped all medications three years back. She was admitted on 27/ 09/16.
Personal history: Patient is a non-vegetarian, poorly built and poorly nourished. Appetite is good (eats frequently little by little); Thirst is good (drinks frequently by sips) but thirst increased when angry.
Family history : Father – Alcohol Dependent Syndrome (Left home when she was a child)
Brother – Delusional Disorder
Uncle – Alcohol Dependent Syndrome
Major life event: When she was 20 years she was raped, but family members were not aware of this. They came to know about it when she was 6 months pregnant and she was aborted in the seventh month with consent.
Mental Status Examination
Conscious and alert
Eye contact not maintained
No speech
Blunted affect
Rapport not established
Insight absent.
Memory, judgement, orientation, thought process, perception couldn’t
evaluate.
First prescription (27/09/16)
Advice has been given to the mother to make the patient take baths and maintain hygiene. The matted hair has been removed and her head shaved.
Hyoscyamus (0) / 1P Angered easily, shouts back as if someone is talking to her and beats herself when angry, throw things, beats mother, used to remove cloths. On observation during case taking she was restless, muttering to self
No ii pills 4 – 4 – 4
Progress and Follow up
| Date | Symptoms | Prescription |
| 28/09/16 | Violent
Restlessness+, Sleep ↓ Muttering to self and beating herself Drinking water frequently in sips |
1. Veratrum album 200/ 1P 2. No ii pills 4 – 4 – 4 |
| 02/10/16 | Violent
Talking to herself (Words of religious spirituals) Restlessness+, PMA↑ Slept for half an hour. |
1. Stramonium 200 / 1P 2. No ii pills 4 – 4 – 4 |
| 03/10/16 | Loquacious
Talks about going home Scolds mother talks sarcastically Abusive and cursing |
1. Stramonium 1M / 1P 2. No ii pills 4 – 4 – 4
|
| 04/10/16 | Violent
Self beating Uses abusive language Easily offended Restlessness+, Appetite ↑ |
1. Anacardium 200 / 1P 2. No ii pills 4 – 4 – 4 |
| 06/10/16 | Anger – Maniac episode
Restlessness+ Violent head movement |
1. Veratrum album 200/ 4 hourly or sos 2. No ii pills 4 – 4 – 4 |
| 08/10/16 | Restlessness – neck movement
Smiling Eye contact maintained Violent – eating by herself Loud screaming Singing song |
1. Veratrum album 1M / 1P 2. No ii pills 4 – 4 – 4 |
| 11/10/16 | Loquacious,
Talking to herself – Muttering+ Restlessness+, PMA↑ with violent movement of legs Abusive Sleep ↓, thirst ↑ |
1. Lachesis 200 / 1P 2. No ii pills 4 – 4 – 4 |
| 14/10/16 | Loquacity reduced
Self Talking present Restless Sleep improved, Appetite N, Thirst N |
1. Lachesis (0) / 1P 2. No. ii pills 4 -4 -4 |
She was discharged on 18/10/16 as there was no further violent episode and all generals were good. She followed a routine and maintained personal hygiene, started obeying her mother. She was advised to come for regular follow up every two weeks.
Follow Up
| Date | Symptoms | Prescription |
| 22/11/16 | Restlessness better
Anger reduced but angry when taken her for bathing No self talking. Eye contact maintained on calling name. All generals good. |
1. Lachesis (0)/1P 2. No. ii pills 4 -4 -4 |
| 06/12/16 | Restlessness better
Anger reduced but angry when taken her for bathing No self talking. Smiled when called. All generals good. |
1. Lachesis (0)/1P 2. No. ii pills 4 -4 -4 |
| 31/01/17 | Restlessness better
Communication improved. No anger episodes. Eye contact maintained. All generals good. |
1. Lachesis (0)/1P 2. No. ii pills 4 -4 -4 |
| 21/03/17
(Last follow up) |
Restlessness better
Communication improved. No anger episodes. Answered properly to the examiner. Hygiene maintained. Eye contact maintained. All generals good. |
1. Lachesis (0)/1P 2. No. ii pills 4 -4 -4 |
Discussion
During the violent episodes the patient was treated initially with remedies like Veratrum, Stramonium and Anacardium based on the totality of that episode. Later Lachesis and Tarentula were the remedies and Lachesis was given as the simillimum.
Conclusion
Homoeopathy has a vast scope in treating psychotic diseases. The acute state should be managed with remedies like Aconite, Belladonna, Stramonium, Hyoscyamus, Mercury, ie, apsoric remedies based on the present totality followed by antipsoric ones so as to prevent the recurrence. However, the results from this single case report are by no means conclusive regarding the long term clinical effectiveness of homoeopathic remedies for psychosis.
