A Case Study On Generalized Anxiety Disorder Treated by Individualized Homoeopathic Medicine - homeopathy360

A Case Study On Generalized Anxiety Disorder Treated by Individualized Homoeopathic Medicine

ABSTRACT-

A case on Generalized anxiety disorder. The patient presented with the symptoms of Generalized anxiety order with a GAD-7 scale score 17. After a proper case taking the totality was formed and repertorization was done using synthesis repertory. Final prescription was made on the basis of homoeopathic principles.

KEYWORDS –

Synthesis repertory, Homoeopathy, GAD-7, GABA, Benzodiazepine, Synthesis repertory.

INTRODUCTION-

 Generalized Anxiety Disorder (GAD) is defined as an uncontrolled and a persistent worrying about a certain situation associated with some other somatic signs and symptoms, such as restlessness, muscle tension, impaired concentration, feeling “on edge”  and insomnia.[1] About one- third of anxiety patients have an organic etiology for their psychiatric symptoms but Generalized anxiety disorder can also present with somatic signs and symptoms without any diagnosable physical disease condition. Mental disorders are highly prevalent in medical practice. Among which 15-20% of patients are of Anxiety disorder making it the most prevalent psychiatric condition.    

ETIOLOGY-

Various causes of Generalized anxiety disorder include-

  1. Biological- If a person is suffering from any chronic physical ailment then he is more prone to suffer from GAD.
  2. Psychological– Sudden grief and mental shock can also lead to GAD.
    3.Social risk factors- Lack of proper social contact, peer pressure, lacking proper education, lack of social support etc. can also result in anxiety disorder.
  3. Family history – Individuals with family history of GAD are more prone to suffer from this psychiatric illness. [2]
    INCIDENCE– The prevalence of anxiety disorders in older adults, ranges from 3.2% to 14.2%.[3] Depression and anxiety were found to be the two most burdensome mental disorders in a study conducted by Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) in 2019.[4]
    PATHOPHYSIOLOGY– GAD is thought to result from aberrations in benzodiazepine receptor regulation.Animal models of anxiety identify several anxiogenic agents that are structurally distinct but have a similar physiologic effect of altering the binding of benzodiazepines to the gamma-aminobutyric acid (GABA); a receptor/chloride ion channel complex .Benzodiazepine are thought to bind two separate GABA – type I, which has a broad neuroanatomic distribution and type-II, which is concentrated in hippocampus, striatum, and neocortex.Pharmacological differences in sensitivity to benzodiazepine receptor subtypes are related to drug differences in sedation, memory impairment, and antianxiety efficacy.Serotonin also appears to have a role in the neurobiology of anxiety.Buspirone, a partial 5HT1A receptor agonist, and certain 5HT2A and 5HT2C receptor antagonists( e.g.,nefazodone) may have beneficial effects.[1]
    CLINICAL FEATURES – If a person is suffering from three or more of the below symptoms for at least 6 months then he is diagnosed as a GAD patient: Difficulty in concentration Feeling on edge’or Restlessness Getting easily tired Irritability Disturbed sleep Increased muscle tension
  4. Excessive anxiety and worry for at least six months
  5. Difficulty controlling the worrying.
  6. The anxiety results in significant distress or impairment in social life. The anxiety is not attributable to any physical cause [5]
    DIAGNOSIS– Generalized Anxiety Disorder (GAD)-7 Scale- Generalized anxiety disorder assessment (GAD-7) scale is a seven item instrument that is used to measure or assess the severity of Generalized Anxiety Disorder. Each item asks the individual to rate the severity of his or her symptoms. This easy-to-use self-administered patient questionnaire is used as a screening tool and severity measure for generalized anxiety disorder. The GAD-7 score is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of ‘not at all’, ‘several days’, ‘more than half the days’, and ‘nearly every day’, respectively, and adding together the scores for the seven questions. Scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate and severe anxiety, respectively. [6]
  7. TREATMENT– Allopathy treatment- A Short course of benzodiazepine is usually indicated.An optimistic approach by the physician that encourages the patient to clarify environmental precipitants, anticipate his or her reactions, and plan effective response strategies are essential elements of therapy.
    Homoeopathy treatment– A literature study identified 83 rubrics in the repertory of Homoeopathic Materia Medica corresponding to symptoms of social phobia. [7] Some important remedies for anxiety in our Homoeopathic Material Medica – [8] ACONITUM NAPELLUS- Physical and mental restlessness, fright, is the most characteristic manifestation of Aconite. A state of fear, anxiety; anguish of mind and body.
    ARSENICUM ALBUM – Fear, fright and worry. Changes place continually. Fears, of death, of being left alone. Great fear, with cold sweat. Thinks its useless to take medicine. Suicidal.ARGENTUM NITRICUM- Thinks his understanding will fail. Fearful and nervous; impulse to jump out of window. Faintish and tremulous. Melancholic; apprehensive of serious disease. Fears and anxieties and hidden irrational motives for actions.
  8. BELLADONNA– Patient lives in a world of his own, engrossed by spectres and visions and oblivious to surrounding realities. He is crazed by a flood of subjective visual impressions and fantastic illusions. Desire to escape.
    CALCAREA CARBONICA – Apprehension, worse towards evening; fears loss of reason, misfortune, contagious disease. Anxiety with palpitation. Averse to work or exertion.
    DIGITALIS PURPUREA- Despondency, fearful; anxious about the future. Dullness of sense. Every shock strikes in epigastrium.
    KALIUM PHOSPHORICUM – Anxiety, nervous dread, lethargy. Indisposition to meet people. Extreme lassitude and depression. Very nervous, irritable.
    LYCOPODIUM– Melancholy; afraid to be alone. Little things annoy him, extremely sensitive. Averse to undertaking new things. Loss of self- confidence. Constant fear of breaking down under stress. Apprehensive. Cannot bear to see anything new.
    PULSATILLA– Weeps easily. Timid, irresolute. Fears in evening to be alone, dark, ghost. Easily discouraged. Highly emotional.
    SULPHUR– Difficult thinking. Irritable. Averse to business; loafs too lazy to arouse himself. Sulphur subjects are always irritable, depressed, thin and weak, even with good appetite.
    VERATRUM ALBUM- Sullen indifference. Frenzy of excitement; shrieks, curses. Delusion of impending misfortune.

PERSONAL DATA-

NAME – Amit Gupta

REG NO.- 42375

AGE –36 years

GENDER– Male

RELIGION– Hindu

OCCUPATION– Private job; engineer

ADDRESS– Vineet khand, Gomti nagar, Lucknow

PRESENT COMPLAINT-

  • Anticipation, fear with palpitation since 20 years.
  • Restlessness with crowding of negative thoughts in mind
  • Feeling of being dirty everytime.
  • Overthinking about past and future. Diagnosed as GAD by allopaths in 2008
  • Despair of recovery with indifference to everything.

PAST HISTORY-

GADdiagnosed since 18 years of age.

FAMILY HISTORY-

  • Father- Asthma
  • Mother – Heart attack
  • Sister – nothing specific
  • Brother – nothing specific

  PHYSICAL GENERALS-

  • APPETITE –  Normal
  • THIRST – Approx 3-4 liters per day
  • DESIRE – Nothing specific, everything seems tasteless
  • AVERSION – Nothing specific
  • STOOL – Constipated, unsatisfactory
  • URINE – Normal, 4-5 times/day
  • PERSPIRATION – Profuse on whole body
  • THERMAL – Hot
  • TONGUE – Clean
  • SLEEP – Disturbed due to overcrowding of thoughts
  • DREAMS – Nothing specific
  • INTOLERANCE– Sun exposure

MENTAL GENERALS-

  • Disposition to Contradict.
  • Always feels that he is dirty.
  • Disgusting feeling.
  • Hopeless about recovery which aggravates at night.
  • Jealous nature since childhood
  • Competitive since school time
  • Negative thoughts about what has happened in past and about future.
  • Was an average student in studies.
  • Duality in thoughts.
  • Indifference to everything

ANALYSIS OF SYMPTOMS

COMMON SYMPTOMS:

  • Anticipation with palpitation.

      UNCOMMON SYMPTOMS:

  •  Disposition to contradict.
  •  Delusion that he is dirty.
  •  Despair about recovery.
  • Constantly thinking about past and future.
  •  Crowding of negative thoughts in mind.
  •  Indifference towards his work.
  •  Competitiveness.
  • Jealousy.
  • Night aggravation.

TOTALITY OF SYMPTOMS

  • Anticipation with palpitation.
  • Disposition to contradict.
  •  Delusions that he is dirty.
  •  Despair about recovery.
  • Constantly thinking about past and future.
  •  Crowding of negative thoughts in mind.
  •  Indifference towards his work.
  •  Night aggravation

MIASMATIC ANALYSIS

SYMPTOMS PSORA SYPHILIS SYCOSIS
Anticipation with fear and palpitation   +    
Disposition to contradict   +   +
Delusions that he is dirty   + +  
Despair about recovery.   +   +
Constantly thinking about past and future.   +    
Crowding of negative thoughts in mind   ++ +  
Indifference towards his work.   ++ +  
Night aggravation     +  

RUBRICS TAKEN[9]

1.MIND – CONTRADICTION – DISPOSITION TO CONTRADICT

2. MIND- DELUSIONS- DIRTY- HE IS

3.MIND- DESPAIR- RECOVERY, OF

4.MIND- DWELLS-PAST DISAGREEABLE OCCURENCES, ON

5.MIND- THOUGHTS- PERSISTENT

6.MIND- INDIFFERENCE- EVERYTHING, TO

REPERTORIAL SHEET

Synthesis repertory was used for repertorization.

PRESCRIPTION

SYPHILLINUM 200/ 3 DOSES

SAC LAC 30 TDS

FOLLOW UP

S.NO. DATE SYMPTOMS PRESCRIPTION
1. 17/5/2022   Anticipation with negative thoughts Anxiety about future with palpitation Insomnia Disgust feeling Despair about recovery Indifference to everything Crowding of negative thoughts in mind. Syphillinum 200/3 doses SL 30 tds  
2. 28/05/2022   Slight relief in all complaints   Syphillinum 1M/ 3 doses SL 30 tds  
3. 11/06/2022   Mental positivity with feeling of confidence   Sac lac 30/tds  
4. 22/06/2022   Slight weaknessMentally confident Avena sativa Q 10 Drops TDS  
5. 02/08/2022   Anticipation reduced No palpitations Mentally feeling confident Sleep normal   Sac lac 30 tds  

GAD SCORES BEFORE AND AFTER TREATMENT

CONCLUSION-

Homoeopathy has a great scope in the treatment of psychiatric disorders including anxiety. Our material medica is flooded with medicines which have a great effect on our mental plane. If a medicine is choosen on the basis of symptom similarity then it has the power to cure any type of psychiatric illness.

REFERENCES-

1. Fauci,Braunwald, Isselbacher, Wilson, Martin, Kasper, Hauser,Longo.Harrison’s principles of internal medicine.14th edition, The Mc Graw Hill Companies, Inc. United States of America p- 2486 2488

2. Chattopadhyay K, Singh AP. Anxiety and its impact on quality of life among urban elderly population in India: An exploratory study. Indian J Res Homoeopathy 2016;10:133-41.

3. Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG.Anxiety disorders in older adults: A comprehensive review. Depress Anxiety 2010;27:190-211.

4. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of mental disorders in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Psychiatry (in press).

5. Munir S, Takov V. Generalized Anxiety Disorder. 2022 Oct 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28722900.

6. Spitzer RL, Kroenke K, Williams JB, et al; A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7.

7. Davidson J, Gaylord S. Meeting of minds in psychiatry and homeopathy:An example in social phobia. Altern Ther Health Med 1995;1:36-43.

8.Boericke W.Pocket manual of homoeopathic material medica and repertory.[51st impression],B.Jain Publishers (P) Ltd, New Delhi, India (2011).

9.Schroyens F.Synthesis Repertorium Homoeopathicum Syntheticum 9.1ed.B.Jain Publishers Ltd.2008

About the author

Dr Devika Chaturvedi

P.G scholar at State National Homoeopathic Medical College and Hospital, Lucknow

About the author

Dr Zubair Khan

P.G Scholar at State National Homoeopathic Medical College and Hospital, Lucknow

About the author

DrRamPrasad Yadav

P.G Scholar State National Homoeopathic Medical College and Hospital