Abstract
Stroke is the major cause of death and disability.post stroke depression (PSD) is one of the most common complications after stroke. After shock the people may experience with emotional and behavioral changes. According to epidemiological studies, nearly 30% of stroke patients develop depression, either in the early or last stages after stroke. Their behaviour depends on the part of the brain which is affected and depends on severity of the injury. Homoeopathy has a good scope among these conditions.
Keywords: post stroke depression, homoeopathy, Kent’s Repertory.
Abbreviations: PSD (post stroke depression), DSM(diagnostic and statistical manual of
mental disorders), OPD (out-patient department), mm Hg (millimetre of mercury).
Introduction
Acute stroke is characterised by the rapid appearance (usually over minutes) of a focal deficit of brain function, most commonly a hemiplegia with or without signs of focal higher cerebral function (such as aphasia), hemisensory loss, visual field defect or brain-stem defict. [1]
Post stroke depression is prominent and persistent mood disturbance characterized by depressed mood and / or anhedonia (lack of interest or lack of pleasure) in all or almost activities. These symptoms define the DSM-V criteria of depressive disorder due to stroke.[2]
It is often caused by biochemical changes in the brain. When the brain gets injured, the survivor may not able to feel the positive emotions.
Sub Types
- With major depressive – like episode, with depressive feature, and with mixed feature like loss of energy, decreased concentration, psychomotor retardation and there may be some reduction in somatic symptoms such as appetite and insomnia [2].
DSM –IV diagnostic criteria for major depression
- Persistent sad, anxious or empty mood
- Feeling hopelessness ,pessimism,guilt,worthlessness or helplessness
- Restlessness and irritability
- Loss of interest or pleasure in hobbies and activities
- Decreased energy and fatigue, and feeling “slow down”
- Difficult in concentrating, remembering and making decisions
- Insomnia ,early morning awakening or oversleeping
- Appetite and/or weight changes
- Thought of death, or suicidal attempts
- Responding with little or no emotion.
If five or more of these symptoms persist for longer than two weeks, the survivor may be having post stroke depression.
Suicidal tendency
The absolute risk of suicide after stroke is low but the relative risk is two times higher in general population. 12 % of people have suicidal ideation and 1.3 % of stroke survivors attempt suicide. The important risk factors for the persons with suicidal thoughts are current or past depression, recurrent stroke, disability and cognitive impairment. [2] .
Rehabilitation of stroke patients
There is a life and hope after stroke. The rehabilitation will help to build the capability, strength and confidence to the patients It help to bring the patient back to their normal life. For the first three months after a stroke, the brain is much like a new brain. It is ready to learn, ready to make new connections. This ability of our brain to adjust is known as neuroplasticiy which plays a vital role in recovery. It takes about three months for the brain to return in to the normal state. [3] Social support and support from the caregivers are very important in this condition.
Rehabilitation of patient with stroke can be done with various psychotherapies and with the help of homoeopathic medicines in case of depression after stroke. Homoeopathy is a system of medicine which approaches the sick by not considering the single disease entity but its holistic approach. Homoeopathy helps the patients to back their normal life with a positive attitude.
Case study
- Introduction of the case
A male, aged 60 years of average height and moderate build came along with companion attended the OPD. The patient having the complaint of weakness and tired feeling since 6 months, lack of interest for doing works since 6 months. He had stroke 6 moths back after that he developed these complaints. The complaint represented by his family member.
Presenting complaints
Weakness and tried feeling since 6 months
Lack of interest for doing work since 6 months
Past history
There is a past history of stroke 6 months back took allopathic treatment. Patient having hypertension about 6 years. Under allopathic treatment.
Family history
Father- diabetes mellitus, hypertension
Mother- Mother died due to myocardial infarction
Brother- myocardial infarction-survived
Physical generals
Appearance: Medium complexion .His appetite is decrease. He has desire for sweets. Thirst is normal with clean and moist tongue. Tired feeling want to sleep always and dreams of falling off. . Thermal reaction: chilly patient .Bowel and bladder habit is regular and satisfied.
Mental generals
He was a jovial person and always busy in doing some or the other work. After the attack of stroke, he developed the complaints of lack of interest in doing work and wanted to sit alone which ameliorated his complaints. Fear of death. Made mistakes while writing.
On examination, his blood pressure was 140/100 mm Hg. On systemic and local examination nothing specific abnormality observed. After the analysis and evaluation of totality symptoms were selected.
Analysis of case
| Uncommon symptoms Common symptoms | ||
| Mental generals | Physical generals | |
| Fear of death Makes mistakes while writing Desire to sit alone | Chilly patient Desires sweets Appetite diminished Sleepiness Dreams of falling | Weakness and tired feeling Lack of interest in doing work |
Evaluation of case
| Uncommon symptoms Common symptoms | ||
| Mental generals | Physical generals | |
| Fear of death 3+ Makes mistakes while writing3+ Desire to sit alone 2+ | Chilly patient 1+ Desires sweets 3+ Appetite diminished 2+ Sleepiness 3+ Dreams of falling 3+ | Weakness and tired feeling 3+ Lack of interest in doing work 1+ |
Selection of repertory
Kent’s Repertory was selected for the repertorisation because the symptoms of the mind were prominent in the case and they are the most important symptoms in the remedy and the sick.[4] So more importance was given to the generals and uncommon particulars, which characterise a person and his disease. In Kent’s Repertory, Kent has classified the symptoms in to general, particular and common to understand a person, part and disease respectively.
Repertorial result
The repertorisation done with Kent’s Repertory [6][figure 1]. Lycopodium clavatum, Sulphur, Sepia officinalis came out to be the leading drugs in the case.
Lycopodium clavatum – 16/7
Sulphur – 15/8
Sepia officinalis -14/8
Analysis of repertorial result and prescription
He was an intelligent multi talented person from the study of the patient and reference to the materia medica. Lycopodium clavatum is adapted to functional power weakening, with failure of digestive power and more suitable to old persons. Loss of self confidence, weakness of memory, confused thoughts; spells or Wright wrong words markedly present in Lycopodium clavatum(6) .from the study of the patient and reference to the materia medica and Lycopodium clavatum covers the rubrics So Lycopodium clavatum 200 was prescribed. Detailed follow up is being summarised in the table 1.
Repertorial chart [figure 1 ]
Prescription
Lycopodium clavatum 200/1 dose
Pills (3-0-3)/ 15 days
Follow up[Table 1]
| DATE OF VISIT | Symptoms | Prescribed medicine with potency and doses |
| O7.08.2019 | Base line presentation | Lycopodium clavatum 200 /1 DOSE PILLS (3-0-3)/15 days |
| 22.08.2019 | There is no marked change in the presenting complaints. The tiredness and weakness present. Fear of death. Appetite :Slightly increased, Thirst : normal Sleepiness slightly reduced. Bowel and bladder habit: Regular and satisfied BP:140/100 mm of Hg | PILLS (3-0-3)/ 15 DAYS |
| 05.09.2019 | Patient felt better. Weakness and tired feeling reduced. He started doing small works. Started sit with the family members. Appetite: Improved Sleepiness reduced. Other generals are normal BP:140/100 mm of Hg | PILLS (3-0-3)/ 15 DAYS |
| 20.09.2019 | Although there is a steady improvement of complaint but the weakness and tiredness are still present. Appetite: Normal, Thirst :Normal Sleepiness reduced. Other generals are Normal BP:130/90 mm of Hg | Lycopodium clavatum 1 M / 1 DOSE PILLS (3-0-3)/ 15 DAYS |
| 05.10.2019 | Patient felt better. Complaints reduced and started doing his works and started spending time with family. Fear of death reduced. Appetite :Good, Sleep: normal sound sleep and No specific dreams. Other generals are normal BP:130/80 mm of Hg | PILLS ( 3-0-3)/15 DAYS |
| 21.10.2019 | No new complaints. Patient felt better. Generals are normal BP:130/80 mm of Hg | PILLS ( 3-0-3)/15 DAYS |
Conclusion
Homoeopathic medicines are very effective in case of post stroke depression and help to improve the person’s quality of life. Kent’s Repertory is the best and much authenticated repertory which helps to treat constitutionally.
REFERENCES
- Walker BR. Colledge NR. Ralston SH. Penman ID. Edited By, Davidson’s Principles And Practice Of Medicine,22 rd edition
- Brainin M. Hesis WD. Text Book Of Stroke Medicine ,Third Edition ,Cambridge University Press
- American Stroke Association. About Stroke. Copyright 2020 American Heart Association. Available from: https://www.stroke.org/en/about-stroke
- Kent J.T, A.M, M.D Kent Lectures On Homeopathic Philosophy B.Jain Publications(P) Ltd 2012
- Kent J.T, A.M, M.D. Repertory Of The Homoeopathic Materiamedica B, Jain Publishers
- Boericke W. Pocket manual of Homoeopathic materia medica.New Delhi,B.Jain publishers(P)Ltd,revised edition
About Author:
Dr J.SENTHILKUMAR, B.H.M.S, M.D (HOM) 1, Dr BLESSY CHACKO 2
- Professor, PG Guide, Head of Department, Department of Repertory, Vinayaka Mission’s Homoeopathic Medical College & Hospital,
A Constituent college of VMRF-Deemed to be University, Salem, Tamilnadu.
- Post Graduate Student, Department of Repertory, Vinayaka Mission’s Homoeopathic Medical College & Hospital, Salem.
