Homoeopathic Management Of Anxiety And Fear – A Case Study
Authors- Dr Vibha Kumari, Research Officer (H)/S1. Clinical Verification Unit, Patna.
- Dr Manila Kumari. SRF, Clinical Verification Unit, Patna.
Anxiety disorders are the most prevalent and disabling psychiatric disorders and the incidence is increased in the current state of lifestyle. Homoeopathy is an established system of medicine with evidence base on effectiveness in mental health issues. There is no dearth of literature concerning the potential utility of homoeopathy in the management of psychological issues of anxiety and fear. This article is aimed to find out the relation of mind and body and to assess the usefulness of homoeopathic medicines in the management of anxiety and fear.
KEYWORDS: Anxiety, fear, homoeopathic management
ABBREVIATIONS: World Health Organization (WHO), years of healthy life lost due to disability (YLD), DSM – Diagnostic Statistical Manual of Mental Disorders (DSM), Beck Anxiety Inventory(BAI); Generalised Anxiety Disorder 7-item scale(GAD-7);Depression Anxiety Stress Scale(DASS); Hamilton Anxiety Rating Scale(HARS); Leibowitz Social Anxiety Scale(LSAS); Overall Anxiety Severity and Impairement Scale (OASIS); Hospital Anxiety and Depression Scale (HADS); Penn State Worry Questionnaire(PSWQ); Social PhobiaInventory(SPIN); Generalised Anxiety Disorder Questionnaire-IV (GADQ-IV), attention deficit hyperactivity disorder (ADHD), outpatient department (OPD)
Mind-body dualism is an example of a metaphysical stance that mind and body are two distinct substances, each with a different essential nature in which later had far reaching restrictive influence on the field of medicine, on its complete understanding of real health issues, and on developing effective interventions to deal with the same. According to Rene Descartes, of the 17th century, human beings consisted of two quite unlike substances which could not exist in unity. Mind is a non-extended, immaterial but thinking substance whereas body is an extended, material but unthinking substance.
Anxiety and depressive disorders are common mental disorders. Globally, it is estimated that 4.4 % of the global population suffers from depressive disorder, and 3.6% from anxiety disorder. Anxiety disorders are ranked as the sixth largest contributor to non-fatal health loss globally and appear in the top ten causes of YLD in all WHO regions. 
The word anxiety is derived from the Latin “anxietas” (to choke, throttle, trouble, and upset) and encompasses behavioral, affective and cognitive responses to the perception of danger. Anxiety is a normal human emotion. . Anxiety is a response to a threat that is unknown, vague, or conflictual. Most of the effects of anxiety are dread accompanied by somatic complaints that indicate a hyperactive autonomic nervous system. . It prepares the body to take actions in stressful situation by increasing alertness and physical symptoms like-nausea or loss of appetite, fatigue , changes in sleep pattern, palpitation, dizziness, breathlessness, aches and pain. Anxiety sometimes feels like a knot in the stomach, feeling of pressure in head, losing control or feeling overwhelmed. Psychological symptoms like- feeling of intense fear or worry, inability to relax,decreased libido, insomnia,difficult concentration, unwanted thoughts, agitation, etc. also develops. ,
It includes a)panic disorder, b) agoraphobia, c) specific phobia, d) social anxiety disorder or phobia and e) generalised anxiety disorder. Causes for this aren’t fully understood. Still few of the causes are those related to biologic one, psychoanalytic, learning theory and genetic studies have also been related..Caffeine consumption, medical conditions, over-the-counter medication; relationship problems; stress; conflict at work, school or home; Finances; substance abuse; disturbance in sleep pattern, etc. are a few of the common anxiety triggers which could be queried from the sufferer by the physician . The fifth edition of Diagnostic Statistical Manual of Mental Disorders(DSM-5) explains 11 diagnostic types of anxiety disorder.There is no any specific laboratory test for anxiety but few psychological tests are available like- a) Rorschach test; b) Thematic apperception test; c) Bender-Gestalt ; d) draw-a-person; e) Minnesota Multiphasic Personality Inventory-2. 
TREATMENT AND MANAGEMENT
Treatment of anxiety disorder involves both pharmacologic approach as well as psychotherapy(which includes behaviour therapy, cognitive therapy, group therapy)., and other intervention after considering the several factors like-patient’s history of treatment attempts; illness severity; co morbidities and also the local availability of treatment methods, costs etc. After performing systemic literature search for randomised controlled trials,it was illustrated that patient should receive “psychoeducation” about their diagnosis, probable etiology and the treatment approach. Lifestyle changes, yoga, breathing exercise and exercise may help the sufferer to cope with this. 
Assessment tools for anxiety
There are several anxiety screening tools that mental health professionals use.
Different assessment scales used to measure the anxiety are- Beck Anxiety Inventory(BAI); Generalised Anxiety Disorder 7-item scale(GAD-7);Depression Anxiety Stress Scale(DASS); Hamilton Anxiety Rating Scale(HARS); Leibowitz Social Anxiety Scale(LSAS); Overall Anxiety Severity and Impairement Scale (OASIS); Hospital Anxiety and Depression Scale (HADS); Penn State Worry Questionnaire(PSWQ); Social PhobiaInventory(SPIN); Generalised Anxiety Disorder Questionnaire-IV (GADQ-IV). 
Homoeopathy finds a wide variety of its application in mental disorders. Dr. Hahnemann has well explained the guidelines for managing mental disorders in aphorism 210 to 230. The homoeopathic simillimum is found out based on patient’s history and symptoms relating to body, mind and spirit; i.e.with a holistic view.
Despite over a century of scientific endeavour, effective conventional treatment options for anxiety are still lacking in conventional medicine. The study reflects the positive role of homoeopathic medicines in the management of different psychiatric disorder like- schizophrenia; dementia  ;ADHD , [13 ] ; autism ; depression  and others as it treats patient holistically taking mind and body into account.
A 40 years old female patient was brought by her family member in OPD of Clinical Verification Unit, Patna on May 13,2019.
The patient had nervousnesswith restlessness; sleeplessnessfor 2 months due to anxiety; headache on vertex with pain in eye which aggravates with mental exertion; breathlessness for 5 months which aggravates suddenly without any definite cause and ameliorated in open air, keeping door and windows open. Informant was her elder daughter and the information was fairly reliable.
History of present illness–
Complains started gradually since 5 months, after a dispute with her husband in which her husband beated her. Her husband was unemployed for last 2 years; he remained at home all the time and did not efficiently try to earn. She always motivated and pressurised him to get employment but he yelled at her, and this time, he beated her; which shattered the lady, and gradually the complaints appeared. She developed anxiety for her children’s future; became nervous and restless; afraid of death, as if something happened to her, then her children would suffer a lot.
Before the onset of complaints, she was a mild, cheerful, hardworking lady. But now, she was nervous, restless, anxious lady who did not care of things related to her husband.
She had poor appetite with frequent thirst of small quantities of water. She had a particular desire for sour but no specific intolerance.
She had irregular bowel movements, passes hard stools in 1-2 days interval, constipation; no deviation in urination. She hardly slept for 3-4 hours and even some night went without sleepwith anxiety.
The patient was average built, having an anxious look and poorly groomed. Nothing abnormal was detected on general physical examination.
Hospital Anxiety and Depression Scale (HADS):
The patient was fully conscious and cooperative. Her mood was subjectively sad but willing to undergo for questionnaire session. She felt tensed or wounded up most of the time; had frightened feeling badly and very often; a lot of time worrying thoughts went through her mind; very much restless and became panic very often. She was not at all cheerful; not quietly enjoyed things she used to, or didn’t see the funny side of things so much. She didn’t care much about her appearance; very often she felt she was slowed down.
Diagnosis and assessment–
The case was diagnosed as anxiety disorder (F41- as per ICD -10) by the consultant physician.
Assessment baseline and subsequent follow-ups visit were done with HADS. HADS score at baseline was 13 for depression and 19 for anxiety.
The totality of symptoms was erected and subjected to repertorisation with Kent’s Repertory. Based on the totality of symptoms , concomitant, repertorisation, reportorial analysis and consulting material medica ,; Arsenicum albumwas found to be the most simillimum medicine and was prescribed in 200 potency , single dose.The medicine was dispensed from the institutional pharmacy.
|[Kent ] [Mind]Fastidious:||2||0||0||0||2||0||0||0|
|[Kent ] [Mind]Restlessness, nervousness:||3||3||3||3||2||2||3||2|
|[Kent ] [Mind]Fear (see Anxiety):Death, of:||3||1||2||2||2||2||1||2|
|[Kent ] [Mind]Anxiety:Children:About his:||0||0||0||0||0||0||0||0|
|[Kent ] [Stomach]Appetite:Diminished:||1||1||1||1||1||0||1||2|
|[Kent ] [Stomach]Thirst:Smallquantities,for:Often:||3||2||1||2||0||1||0||0|
|[Kent ] [Stomach]Desires:Sour,acids,etc.:||2||2||2||1||0||2||2||2|
|[Kent ] [Stool]Hard:||2||3||2||2||3||2||3||3|
|[Kent ] [Rectum]Constipation (see inactivity):Alternate days,agg:||0||0||0||0||0||0||0||0|
|[Kent ] [Sleep]Sleeplessness:Anxiety,from:||3||1||0||1||1||0||0||0|
|[Kent ] [Respiration]Difficult:Open:Wants doors and windows:||0||3||3||0||0||3||0||3|
|[Kent ] [Mind]Starting, startled:Sleep:From sleep:||2||2||2||3||2||2||2||0|
|[Kent ] [Head]Pain,headache in general:Vertex:Mental exertion:||0||0||0||0||2||0||2||0|
|[Kent ] [Head]Pain,headache in general:Vertex:Extendingto:Eyes:||0||0||0||0||0||0||0||0|
Arsenicum album- 21/9
Pulsatilla nigricans- 16/8
No homoeopathic aggravation was found after the administration of Arsenicum album 200. In the subsequent follow up visits, there was marked improvement in her mental symptoms ; physical symptoms and her presenting complaints. Following the Kentian rule of second prescription , the remedy was allowed to continue its beneficial action with the prescription of Rubrum200. Arsenicum album 200 was repeated as there was standstill condition and its higher potency was prescribed as the improvement slowed down. The patient didn’t go through any conventional treatment during this period.
The HADS score for depression was 13 and for anxiety was 19 at the baseline and it turned to 3 for depression and 4 for anxiety at the end of 3 months.
|Date||Observation||Prescription||Assessment of scale|
|29/05/2019||Breathlessness –relief. Anxiety- present Restlessness- present Headache – no episode after medication. Appetite- diminished Stool- Hard, regular. Sleep- sleeplessness||Rubrum 30/ 7 doses||D-12 15|
|03/06/2019||Restlessness relief, only at night. Anxiety- same Appetite- slight better Breathlessness- better Headache- no episodes Sleeplessness Stool- hard; semi solid, regular No improvement further||Arsenicum album 200/2 doses||D-10 15|
|17/6/2019||Restlessness relief Anxiety- same Breathlessness- better Sleep- slight improvement Appetite- diminished yet Headache- no episodes Not much improvement from last visit.||Arsenicum album 1M/1 Dose||D-9 14|
|22/07/2019||Restlessness relief Anxiety- better Breathlessness- only after a long walk Sleep- better Appetite- better Headache- appeared for two days with pain in eye.||Rubrum 200/14 doses||D-7 8|
|05/08/2019||Patient much better. Restlessness- no such Anxiety- much better Breathlessness- sometimes only Headache- no episodes Sleep- better, 5-6 hours at night. Stool- regular Appetite- good||Rubrum200/14 doses||D-3 A-4|
- *D- Depression score
- *A – Anxiety score
Anxiety disorder has to be differentiated from depressive disorder; schizophrenia; bipolar disorder; atypical psychosis; adjustment disorder with anxiety; cognitive disorder; some substance related disorder like intoxication with caffeine, coccaine, amphetamines, etc. which exhibit symptoms of anxiety. Efficacy of homoeopathy in central nervous system disorder like anxiety neurosis has been eplicited with the use of Turnera aphrodisiaca 
A case series of five cases on phobic disorder explaining the preliminary evidence for the usefulness of homoeopathy in phobic disorders has been published which concluded with need of randomised controlled trial to establish the effectiveness of homoeopathy in phobic disorders on more scientific basis.
Homoeopathy is established system of medicine which is extending its potential relevance to mental health issue also, but has limited database .Convincing results are reported with few studiesbut its effectiveness in certain psychiatric disorders are yet to be explored. Anxiety disorders are most common psychiatric disorder that reduces the quality of life of an individual. Homoeopathy can be well utilized as alternative medicine for such cases with effective cure.
Declaration of patient’s consent
An informed consent was obtained from the patient and her daughter. The patient’s identity is not disclosed in any form based on ethical guidelines.
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Dr Vibha Kumari, Research Officer (H)/S1. Clinical Verification Unit, Patna.
Dr Manila Kumari. SRF, Clinical Verification Unit, Patna.