Dr. Apurva Dixit(1), Dr. Pravishtha Awasthi(1)*, Dr. Bhupendra Arya(1), Dr. Navita Sharma(2) , Dr. Ashok Yadav(3)
(1. MD scholar, Department of Practice of Medicine, M.P.K.H.C.&R.C. a constituent college of HOMOEOPATHY UNIVERSITY, JAIPUR
2. .MD scholar, Department of Repertory, M.P.K.H.C.&R.C. a constituent college of HOMOEOPATHY UNIVERSITY, JAIPUR
3. Head, Department of Practice of Medicine, M.P.K.H.C.&R.C. a constituent college of HOMOEOPATHY UNIVERSITY, JAIPUR)
Abstract- Schizophrenia is the disorder of mental conditions which may be regard to intelligence, memory, emotion, behaviour, and judgement and increased psychological and motor activity. Reportedly, Schizophrenia is present in 0.85% of the global population. There is no absolute investigation for the disorder, and the diagnosis is clinical. As homoeopathy is based upon treating the person individually, different individuals may need different treatment with similar symptoms. Homoeopathy has been known to be treating mental illnesses since the Hahnemannian period. This article concludes the homoeopathic approach to various manifestations of Schizophrenia with a comparison between diagnostic and statistical manual of mental disorders (DSM) 4 and 5.
Keywords- Schizophrenia, Mental State Examination (MSE), Diagnostic and Statistical Manual of Mental Disorders (DSM), Homoeopathy.
Introduction– Schizophrenia is the disorder of mental conditions which may be regard to intelligence, memory, emotion, behaviour, and judgement and increased mental and motor activity. (1) It is a group of functional psychiatric disorders which is characterised by specific psychological symptoms leading to disorganisation of the personality of an individual. (2)
Epidemiology– Schizophrenia is present in 0.85% of the global population, with a lifetime prevalence of approximately 1% to 1.5%. According to estimates, children have a 10% risk of developing the illness from their affected parent, but this rises to 50 % if an identical twin is affected. The usual age of onset is mid-twenties. (2)
Aetiology– The exact cause of Schizophrenia is unknown, and there are various factors responsible for Schizophrenia (mental illness). These factors may include Genetic factors, Physiological changes in the body at the time of puberty /menstruation /old age, Head injury- Cerebro-vascular accidents (haemorrhage /embolism/thrombus), Deficiency disorders(vitamin/ protein/ mineral), Trauma, Chronic infection (T.B. / syphilis/HIV / leprosy), Excessive stress work, Physical defect, Prenatal disorder, Marriage, pregnancy and childbirth disorder, Educational disorder, Life changes, e.g. Loss of job/ money, Addiction – opium /alcohol/barbiturates/marijuana, Endocrinal disorders, Idiopathic (1)
Clinical presentation-Information about the medical and psychotic history of the family members, details about gravidity and early tender age, history of the excursion, and history of medications and any addiction are most important. This information is useful in removing other causes of psychiatric symptoms.
The patient often had an unusual childhood. In retrospect, family members may define the person with Schizophrenia as a physically incompetent and emotionally distant child. The child may have been curious and preferred to play only by himself or herself. The child may have been late to determine to walk and may have been a bed wetter.
A distinguishable change in personality and a declining in academics, social, and interpersonal behaviour mostly begin during middle-to-late teenage. Usually, 1–2 years go by between the initiation of these vague symptoms and the first appointment to a psychiatrist.The first psychiatric episode often occurs between the late teenage years and the mid-30s. (3)
Sign and Symptom-
- Positive symptom – positive refers to the active motor symptoms and are of most important in making the diagnosis for Schizophrenia.
- Hallucinations auditory in nature
- Broadcasting of any idea or insertion /withdrawal of thoughts
- Curbing feelings, impulses, echolalia or echopraxia
- Negative symptoms –
- Flattened or waxy affect
- Lack of social attention
- Poverty of speech
- Low self – care
- Other Symptoms –
Catatonia-refers to assuming of awkward postures for tedious periods. (4)
Mental Status Examination(MSE)
On a precise (MSE), the following conclusions may be contracted in a severely ill patient of Schizophrenia:
1) The patient may be unduly doubtful of the examiner or be socially different.
2) The patient may have a variety of awkward beliefs or delusions.
3) The patient mostly has a flat affect (i.e., a small range of his/her emotions).
4) The patient may accept the hallucinations or receive stimuli of hearing and seeing that are not credible to the examiner.
5) The patient may depict thought blocking, where long pauses occur before he/she answers a question.
6) The sequence of ideas and thoughts follows a logic which makes sense to the patient but not to the psychiatrist.
7) The patient has difficulty with ideal thinking, shown by an inability to understand trivial proverbs or idiosyncratic perception of them.
8) The speech can be circumstantial (i.e., the patient takes longer time and uses many words in responding to a question)
9) The patient may have little acknowledgement of his or her problems (i.e., anosognosia)
10) Orientation is mostly intact to time, place, and person.
11) A person with Schizophrenia may manifest strange and poorly recognised behaviours. These may include drinking water to the extreme of intoxication, staring at themselves in front of the mirror, opting stereotyped activities, and hurting themselves. Their sleep cycle can be disturbed. (3)
Differential Diagnosis – Delusional disorders, psychotic depression, manic episode, schizoaffective disorder, puerperal psychosis (2)
Diagnosis – The patient must have experienced at least 2 of the following symptoms:
- Delusion, Hallucination, Disorganised speech, Catatonic attitude, Negative symptoms
A minimum of one symptom must be the present either delusions, hallucinations or disorganised speech.
- Uninterrupted signs of disturbance must be present for at least 24 weeks, during which the patient must observe at least four weeks of active symptoms along with either social or occupational deterioration troubles occurring for a significant amount of time.
- These problems must not contribute to another condition.
Schizophrenia is described into Criterion A of ICD-10 in code f-20 into five types as paranoid, disorganised, catatonic, undifferentiated and residual in the diagnostic and statistical manual of mental diseases (DSM)-4 whereas all five subcategories have been dropped in DSM-5.(3)
Following are the subcategories through which Schizophrenia is easily identifiable:
(a) Paranoid Schizophrenia – A type in which there is a preoccupation with one or more delusions or frequent auditory hallucinations.
(b) Disorganised Schizophrenia – A type where all of the symptoms are prominent such as disorganised speech, disorderly behaviour, flat or inappropriate affect
(c). Catatonic Schizophrenia – A type where the clinical presentation is qualified by at least two of the given symptoms
- Motoric immobility as evident through catalepsy (including waxy flexibility) or stupor
- Excess motor activity (that is purposeless and not influenced by external stimuli
- Extreme negativism (a motiveless resistance to instructions, or maintenance of a rigid posture against multiple attempts to be moved) or mutism
- Unusual voluntary movement as evidenced by posturing (voluntary supposition of inappropriate postures), repeated movements, prominent manner, or prominent frowning
- Repetition of same speech or movements consecutively.
(d). Undifferentiated Schizophrenia – When a person exhibits behaviours, which contain two or more of the other categories of Schizophrenia, containing symptoms such as Delusions, Hallucinations, Disorganised speech or behaviour, and Catatonic behaviour.
(e). Residual Schizophrenia – A type where there is either an absence of prominent delusions, hallucination, disorganised speech and actions, or catatonic behaviour or there is simultaneous evidence of the disturbance, as observed by the existence of negative symptoms, or two or more symptoms related to Schizophrenia, present in the least form (e.g., unusual perceptual experiences, odd beliefs). (3)
Prognosis – The prognosis does not entirely depend upon the manifestation of the symptoms and the response to the treatment. A permanent withdrawal without any relapse does seldomly happens, and about 10% of the schizophrenic patients tend to commit suicide. (2)
Complications – Addiction, Depression, Anxiety, Obsessive-compulsive manifestations, Violence (2)
Common rubrics from different repertories-
I. Repertory Of Homoeopathic Materia Medica By Robin Murphy (5)
MIND- SCHIZOPHRENIA -63 drugs
anac., lach. (2th grade)
aur., hyos., stram. (3rd grade)
II. Kent’s Comparative Repertory Of The Homoeopathic Materia Medica (6)
APATHY- INDIFFERENCE-147 DRUGS
apis, carb-v, chin, crot-c, hell, lil-t, mez, nat-c, nat-m, nat- p, onos, op, ph-ac, phos, plat, puls, sep, staph.
calc, hell, hyos, ign, mang, mur-ac, plat, puls, stann.
arg-n, bell, cann-i,cocc, hyos, ign, lach, petr, ph-ac, sabad, stram, sulph
INDIFFERENCE – 146 DRUGS
apis, carbo-v, chin, crot-c, hell, lil-t, mez, nat-c, nat-m, nat-p, onos, ph-ac, phos, plat,puls, sepia, staph
MELANCHOLIA – DESPAIR (RUBRIC) 93 DRUGS
Ars, aur, calc, coff, hel, ign, psor
COMPANY AVERSION- 96 DRUGS
anac, bar-c, carb-an, cham, cic, gels, ign, nat-m, nux-v
SENSITIVE- 111 DRUGS
Arg-n, bell, bor, chin, chiin-a, chin-s, coff, gels, ign, lyc, lyss, nat-m, nit-ac, nux-v, phos, plb, puls, ran-b, sil, sulph, ther, valer.
IDEAS DEFICIENCY OF- 73 DRUGS
Hel, lyc, op, ph-ac, phos, staph.
SUICIDAL THOUGHTS- 14 DRUGS
aur, nat-s, psor.
RESTLESSESS- 252 DRUGS
acon, anac, arg-n, ars, ars-i, bapt, bell, calc, calc-p, camp, cimci, coloc,cupr, cupr-ar, ferr, ferr-ar, hyos, lyc, merc, plb, puls, rhus-t, sep, sil, stram, sulph, tarent, zinc.
SUSPICIOUS- 75 DRUGS
acon, ars, bar-c, cann-i, caust, cench, cic, dig, kali-ar, lach, lyc, puls, rhus-t, sec-cor, stram, sulph.
Homoeopathic Medicines with Common Symptoms of Schizophrenia-
1. Argentum Nitricum – For Mental Excitability and Impulsiveness
The central idea is of the weakness of the mental sphere, which is most applicable when a task appears and is contributed with nervousness and impulsiveness. Thus, such a compound makes the patient act on inserted thought no matter how irrational it seems to others. For example, mutilating himself or jumping out of the window just to experience what and how it would be like to experience it.
2. Arsenicum Album – For Paranoia and Vulnerability
The patient is insecure and has anxiety about health thinking he is going to die of any trivial factor. It may appear different to others, but an arsenic patient can get impulsive or jumps into the well or bush only to escape from the harm that he is afraid that any stranger may do to him/her. Still, there is a great desire of company and fear of being alone too.
3.Calcarea Carbonicum – For Supernatural Beliefs
In children of age 6-12 years, there is an insertion of thoughts of supernatural beliefs such as, ‘what is god?’, ‘How do angels behave?’, ‘What happens after death? Such beliefs undoubtedly depend upon the family background of the child, and they are being carried out to an extent where the child be waiting for the angels to come and take him/her to paradise. A healthy family and childhood history of unfortunate events is present. There is the fear of the unknown with insanity.
5.Cannabis Indica – For Disorganised Behaviour
A Cannabis Indica patient has no definitive start and end of their talks. Their conversations are not verifiable as they are not grounded indeed. They were switching from one idea to another with no relation between the former and latter, as if the previous conversation does not exist.
6. Medorrhinum- For Fear Of Being Followed by Someone
the patient has fixed ideas for everything along with withdrawn social behaviour but Medorrhinum has” the pendulum” effect for two extremes. The characteristics feature is that the patient feels that someone is following him/her. They keep on turning back to check it although no one is there. Repeats the same activity again and again due to fixed thoughts running continuously in his/her mind.
7. Platina – For Sensory Hallucinations
The delusion of grandiosity precedes the theme of Platina. Being emotionally haughty the patient experiences physical sensations and delusions, describing her internal conflicts. She observes as if her body parts have enlarged or the rest of the world has shrunken, there may be numbness around the body parts, especially the lips, or the delusion that their face has been distorted. (7)
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3. Schizophrenia Clinical Presentation: History, Physical Examination, Complications [Internet].https://emedicine.medscape.com/article/288259-clinical
4. Sharpe M.C., Lawrie S.M. Davidson’s Principles and Practice of Medicine. 22nd ed. LONDON: CHURCHILL LIVINGSTONE ELSEVIER; 2014.
5. Table 3.22, DSM-IV to DSM-5 Schizophrenia Comparison – Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health – NCBI Bookshelf [Internet]. Ncbi.nlm.nih.gov. 2020 [cited 3 April 2020]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t22/
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6. Kent J. Repertory of the homeopathic materia medica. 6th ed. New Delhi: B. Jain; 2002.
7. Vitholkas G. Essence of Materia Medica. 2nd ed. New Delhi: B. Jain Publishers(P) LTD; 2013.