Abstract: Acute psychosis is characterised by development of delirium, hallucinations and jumbled speech. There is acute onset of incomprehensible or incoherent speech preceded by stress. According to a survey more than 50 % of adults experience stress during social events like holidays, weddings etc. There are many risk factors for mental health that may be present in the working environment.
Acute Psychosis is a common psychiatric emergency that may present to health services other than mental health practitioners; co morbidities are common and increase with age. The term psychosis refers to inability to distinguish reality from fantasy: impaired reality testing, with creation of new reality as opposed to neurosis where reality testing is intact and the behaviour does not violate gross social norms. Typical presentation would be with incoherent speech without apparent awareness that the speech is not understandable and agitated, inattentive and disordered behaviour so often precipitated by stress. Stress could be from any life situation or event. It’s an unfortunate paradox that many of life’s most momentous occasions are both best and worst of times. The first effect of stress on the body is loss of sleep, headache, and muscle tension. Most risks relate to interactions between type of work, the organisational and managerial environment, the skills and competencies of the employees and the support available for the employees to carry out their work. Organisations also have added responsibility to support individuals with mental disorders in their continuing or returning to work. The following case of acute psychosis demonstrates the evolution of the mental disturbance originating in a work place in a competent H R Manager with acute work related stress of inadequate sleep coupled with joy of striking a providential real estate deal
A 40 year old female H R manager with a multinational company was brought to OPD on 25/6/2015 by her husband and father. Her family had taken DAMA (discharge against medical advice) from the psychiatric ward of a well known private hospital in Mumbai. She is an intelligent, able, and gifted person who has recently shifted her base from a different city to Mumbai due to her new job. Her husband is still running his business in their previous city. She is staying with her daughters and her mother-in-law.
Her job is very demanding and she has to travel frequently. During a recent trip she faced many difficulties. Before she could get over her jetlag, she had back to back business meetings and outings. This left her totally drained and exhausted and she could not sleep for three days in a row. On returning home she went to meet her real estate agent and was lucky to strike a deal for a dream project at a very reasonable rate. She was in an ecstatic state as a result of this bargain and was waiting to share the good news with her family and was again sleepless all night with pleasure.
She had to resume work immediately. Before she left for work, she had an interaction with her elder daughter which disturbed her. As a part of her HRD work, she had planned some questionnaires and interactive sessions for new recruiters. She had a sore throat, so she did not speak much, but was upset with her colleagues as they did not achieve their target and were poor in time management. While handling additional tasks of coordinating and training new recruits her creative side got carried away. This is when her behaviour seemed berserk and her colleagues found it difficult to handle her. She was clapping, banging the desk, had become irritable and was making irrelevant statements.
She was taken to a nearby nursing home. As it became difficult to handle her, she was later transferred to another hospital, with a special psychiatric ward. Her husband and father came to her rescue and brought her to Mumbadevi Homoeopathic Hospital for further treatment. She was diagnosed as a case of acute and transient polymorphic psychotic episode (Mania).
When she came to me, she looked absolutely groggy and lost due to the medications at the hospital. Her family was keen on discontinuing the allopathic drugs and having her treated with homoeopathy. She mentioned that she had no memory of the previous day at the hospital and had only faint memory of the day prior at her work.
I traced the events with help from her family and concluded that her mental state was due to underlying over exhaustion with loss of sleep and the excitement of grabbing a providential deal. It’s said that anything in excess is not healthy even if it is something desirable when occurring in moderation. Her alert and actively brilliant mind went berserk with abundant ideas. She was full of energy and was ecstatic with the joy of having struck an opportune deal. The euphoria which resulted from this went out of control when combined with lack of sleep. This is a classic example of a saying in Hindi,” Ati sarvatra varjetya”, meaning “anything in abundance is bad”.
There are four important remedies with complaints from joy and surprises in Kent’s Repertory. When we compare the remedies listed viz., Aconite, Opium, Pulsatilla and Coffea, we find that in Aconite the common presentation with any strong stimulus is a state of panic. Opium on the other end ends in a state of somnolence without any pain, while Pulsatilla continues to sway in the direction of the wind. What is characteristic of the pathology found in Coffea in the given case? There is a history of loss of sleep, overtaxed mind, abundant ideas and ecstasy from pleasant news.
When we study Coffea we find it indicated for complaints arising from surprises and excessive joy. The derangements, which may be short lasting, have their origin in excitement. Patients experience loss of sleep following a stimulating conversation, event or situation. Sleep is easily disturbed by noise, and sound. Even though they have less sleep, they don’t get exhausted. The power to think and debate is heightened and their memory is phenomenal. Affected individuals labour incessantly for some cause and then break down with insomnia thinking of a thousand things in bed. Easy comprehension is also result of heightened sensitivity. The pace is quite fast and they hurry in their endeavours and may get restless if their work is left unfinished. Also, they want their surroundings to be neat and tidy. They are very organized and particular, and can multitask and manage any office, organization or home with ease. This was exactly the case with this patient.
I prescribed Coffea 10 M, 3 powders to be taken at bedtime for three consecutive days and asked her to discontinue her anti psychotics, anxiolytics and mood stabilizers that were prescribed by the psychiatrist. I was concerned about possible relapse of the episode as well as her anxiety about possibly losing her job. On subsequent follow up there was a distinct improvement in the mental state. All allopathic medicines were discontinued
Coffea 10 M, 3 powders were repeated twice. She went for evaluation by a Psychiatrist on 7/8/2015 before resuming her job. She was evaluated fit to resume her duties and was given guidelines for checking any possibilities of relapse. Her Psychiatrist also suggested that she should continue with homoeopathic treatment. It is more than 2 years since the incident and Coffea has helped her on two occasions when she feared falling into a relapse. She was also suffering from long standing eczema on her feet which cleared completely. She recently changed her job to a bigger one with more responsibilities and work pressure. She seems to be doing fine and enjoying her office work as well as her family life.