Clinical Cases

Psoriatic Arthritis and Delusional State in a Woman of 58

Psoriatic Arthritis and Delusional State in a Woman of 58

Dr. Neelima Divecha presents a case of psoriatic arthritis and delusional state in a woman of 58. Superstitious fears, delusion of being pursued and joint pain helped in the selection of the simillimum.

Date – 28/11/14  – A female patient aged 58 years presented with skin complaints and joints pain. This is a known case of psoriasis and psoriatic arthritis.

Doctor (D) – What is happening?

Patient (P) – Doctor, see what they have done to me! They are harassing me. I have fear that they would kill me.

D – Who are they?

P – You will not be able to see them. I can only see them. They are always following me and stealing my money. When I eat, they eat from my dish. I always hear their voices. They are always talking about me. They have not left any way to harass me. They have done everything to me. They have pushed me down from higher floor; they have put me under the train and even made accidents with me.

But now I came under shelter of my guru. My guru has talked to them but they are not listening to my guru also. But I know that they will not be able to do anything bad to me because my guru is with me. All my hair they have taken and still they are taking away my hair. My hairfall is severe because of them.

Observation: Her skin is very dry and exfoliating in big scales all over her body. Skin of face is also very dry. Lips are also dry. Big scales of skin are hanging over on the elbows. Oedematous swelling on both feet and legs.

D – Any other complaints?

P – I have pain in all my joints. I feel chilly and then I feel pain in all my joints. Since I started my skin complaint, I started my joint pain also.

D – When is it aggravated? How do you get relief from it?

P – When I stand up after sitting, but it gets better after walking a few steps. When I get up in the morning, I get severe pain. But as I move and continue to do work, I feel better.

D – Since when do you have this swelling on your feet?

P – Since last 20-22 days, it is not going.

D – Since when do you have this skin compliant?

P – Since 2-3 years. It was occurring on-and-off, but since a few days it is severe. They are harassing me too much in this way. Doctor, please do something. They are not listening to my guru so I have to come to you. Doctor please slow down the fan otherwise my joints pain will get worse.

D – Any other factor that aggravates your pain?

P – Draft of air aggravates my pain.

D – Can you bear heat or cold?

P – I can’t bear cold too much. Cold air aggravates my joint pain.

D – Do you bathe in hot, cold or lukewarm water?

P – Hot water always.

D – How much do you perspire?

P – It is moderate, not too less, not too profuse.

D – In which part of the body?

P – Everywhere, all over the body.

D – How is your sleep?

P – Previously I was not getting sleep, but now my guru has given me mantra and if I chant that mantra, I get sleep.

D – Do you get dreams?

P – Whole day I see them only. How will I get dreams?

D – How is your appetite?

P – It is okay.

D – What would you like to eat? Tell me your food craving and desires.

P – I eat everything. All food is good.

D – Though, what do you like the most?

P – I like everything.

D – Any complaint about stool/urine?

P – No complaint.

D – Do you have fear of anything?

P – I fear of those people. I feel they would kill me.

D – When did your menses cease?

P – 13-14 years ago

D – Did you get any complaint at the time of cessation of menses?

P – No, nothing. At gap of 2-3 months it was coming in the end and then stopped.

D – Did you have any compliant before, during or after menses?

P – No, nothing.

D – How many children you have?

P – Three. One son, two daughters.

D – All deliveries were normal or operated?

P – My all deliveries were normal.

D – Any major sickness in the past?

P – Not at all.

D – Did your parents have any sickness?

P – My mother suffered from knee joint pain and my father suffered from high BP and he died of a heart attack.

D – How many siblings do you have?

P – Two brothers and one sister

D – Do they have any sickness?

P – My one brother suffers from high BP, the other from diabetes, and my sister suffers from arthritis, knee joint pain.

Observation: patient has applied sindoor (orange powder) everywhere on her body, especially the feet, forehead, legs.

Conversation with husband:

D – Tell me about her nature.

Husband (H) – she is doing puja always, worships all the time. All of us family members get troubled by her habits.

D – Which type of puja does she do?

H – With lemon mirchi, she will roam around in the house and then she will burn it. She goes on delirium – speaks continuously, “They came again, they stole my jewellery, they again came to eat with me and they are eating from my dish.” Previously, she was not like this. Since 3-4 years she is doing all this.

D – Since when did the skin compliant start?

H – Since 2-3 years.

D – Any sickness before that?

H – No, she was quite healthy.

D – Okay, don’t worry. I will do at my best and she will be fine with this treatment.

Analysis of the case:

Pt. is at delusion level- level 4

Areas which are strong and important to be considered are:

  1. Mind- Delusions
  2. General Modalities
  3. Local modalities

Symptoms considered:

  1. Superstitious
  2. Fear, superstitious
  3. Delusion pursued of being
  4. Delusions, imaginations, voices, hears.
  5. Joints pain agg by first motion or in beginning of motion
  6. Joints pain better by continued motion.
  7. Joints pain agg by cold air
  8. Oedematous swelling of feet
  9. Cold air agg.
  10. Skin, Psoriasis

RUBRICS SELECTED:-

  1. Mind, Superstitious
  2. Mind, Fear, Superstitious
  3. Mind, Delusions, Imaginations, Pursued of being
  4. Mind, Delusions, imaginations, Voices, Hears
  5. Extremities, Pain, Joints, Motion, agg, Beginning
  6. Extremities, Pain, Joints, Motion, amel, Continued
  7. Extremities, Pain, Air, Cold agg
  8. Generalities, Pain, Air, Cold agg
  9. Extremities, Swelling, Oedematous, Feet
  10. Skin, Eruption, Psoriasis

Superstitious —- 3—- Fear   —Same  Remedy—- Delusion—–3——Persecuted—–Same Remedy—Cold Weather —–3—Aggravates ——-Same  Rem—- Motion—–3—–Beginning—-3 Aggravates—-Same Remedy—–Continued—–3—-Motion—–Amel—–Same Remedy—-Edematous  Swelling—-3——Feet—-Same Remedy—-Joints—-3—-Pain

Rhus Tox Is Only Remedy

Treatment:

28/11/14  – Rhus Tox 1M 1 Dose –  Followed by LM 8 – Daily 1 dose

Follow-Up:  12/12/14— Skin complaints slightly better. Swelling of feet is reduced but not completely.  Joint pain is better than before but painful. Patient’s comments still suggest a superstitious mind. Pt. says- Who log ab bhi muje pareshan kar rahe hai. Me guruji ka bhi nahi sunte, lekin muje pata hai ki  mere guruji ke hote hue who log mera kuchh nahi bigad sakte.

Treatment: 

SL 4-4 pills 3 times a day for 15 days. Rhus Tox LM 8 dail,y once at night.

29/12/14 –  Swelling of feet is reduced 50-60%.  Joint pain is better by 60-70%.

Skin is better by 10 %.

State of patient’s mind: Sill superstitious but severity and intensity of feeling was reduced since last time.

Treatment: 

SL 4-4 pills 3 times a day for 15 days. Rhus Tox LM 8 daily once at night.

15/01/15-  Swelling of feet gone.  Joints pain is completely better.

Skin: Scaling of skin in big scales reduced to small scales.

Dryness of skin reduced 10-15%.

Observation:  Patient is not talking much of being pursued or harassed.

Treatment: 

SL 4-4 pills 3 times a day for 1 month.  Rhus Tox LM 8 daily once at night.

18/02/15:  No oedema, no joint pain.

Skin is better than before. Scaling is reduced. No big scales are seen.

Dryness of skin of face is reduced a lot. Cracks and dryness in palms reduced.

Treatment: 

SL 4-4 pills 3 times a day for 1 month. Rhus Tox LM 8 daily once at night.

25/03/15: Skin is better 40-50%.

Observation– She is no longer talking about someone pursuing or harassing her.

Pt.’s husband reports she is much better. At home also, previously she was doing much pooja and now it is reduced from before.

Treatment: 

SL 4-4 pills 3 times a day for 1 month.  Rhus Tox LM 8 daily once at night.

28/04/15:  Skin is better 65-70%.

No any other physical complaints.  No oedema and no joint pain.

Treatment: 

SL 4-4 pills 3 times a day for 1 month.  (LM potency is stopped as 70% improvement was there.)

03/06/15: Skin condition is 80% better.  Scaling is reduced a lot. Dryness of skin is reduced a lot.

Patient is feeling happy. She says – aaj mere guru ki wajah se unhone muje pareshan karna bandh kar diya hai. Ab me ghar me shanti se reh sakti hoon.        (Still patient has applied sindoor.)

No joints pain, no oedema.

Treatment:

SL 4-4 pills 3 times a day for 1 month.

10/07/15:  Better. Still improving.  Skin is better than before. We can say up to 90%.

Treatment:

SL 4-4 pills 3 times a day for 1 month.

16/08/15:  Pt. is much better.  Looking absolutely normal in appearance. Superstitious state of mind was there but its intensity was reduced a lot.

Treatment:  SL 4-4 pills 3 times a day for 2 months.

26/10/15: Absolutely fine. No complaints.

Treatment:  SL 4-4 pills 3 times a day for 2 months.

04/01/16 :  Patient herself did not come. Patient’s husband reported that she is fine. No complaints.

Treatment:  SL 4-4 pills 3 times a day for 2 months.

16/03/16: Patient’s husband reported that she is absolutely fine and told me to send the medicine through a courier.

 Treatment:  SL 4-4 pills 3 times a day for 2 months.

22/05/16:  Patient arrived with her husband at clinic.  She is absolutely fine.

No skin complaints, no oedema, no joints pain.

Treatment:  SL 4-4 pills 3 times a day for 2 months.

Patient is still under treatment and observation.

Note: Here we can see that oedema and joints pain got better first and then gradually skin complaint got better.  If we think about “Herring’s Law of Cure”, we can see it in this case. This appears to be an ideal cure.  ( See photos below)

                                                                        Before treatment

After treatment

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About the author

Neelima Divecha

Neelima Divecha

Dr. Neelima Divecha received her DHMS from C.D. Pachchigar College of Homoeopathy, in August 1993 and started a practice the next year. She has been practicing homeopathy for 24 years. In 2013 she joined the PG Hom London course and got the Best Thesis Award for “Scope of Homoeopathy in Non-Healing Ulcers” in which she created a “Pictorial Repertory of Non-Healing Ulcers”. In 2015-2016 she did a Fellowship course (F.C.A.H.) from the Other Song International Academy of Homoeopathy. In 2018, she attended the workshops of Dr. Amarsinha Nikam who runs a 100 bed hospital in Pune, treating advanced pathologies.

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