Clinical Cases

A Clinical Case of Psychosis

Last modified on February 6th, 2018

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Diana Ravi Kumar
Written by Diana Ravi Kumar

Drs. Diana Ravikumar and Girish Navada present a clinical case of psychosis in a woman of 35.

Diana Ravikumar – with guidance of Girish Navada

Abstract

Psychosis is one of the most challenging disorders for the Homoeopathic psychiatrist. Psychotic patients are disconnected from reality which makes the situation worse. Treatment should be completed with the antipsoric remedy.

Key words : Psychosis, Homoeopathy, Anacardium, Stramonium, Veratrum alb, Lachesis.

Introduction

According to the American Psychiatric Glossary of the American Psychiatric Association, the term psychotic means grossly impaired reality testing. Psychotic has been retained as a convenient descriptive term, particularly in  F23, Acute Transient Psychotic Disorder. Its use does not involve assumptions about psychodynamic mechanisms, but simply indicates the presence of hallucinations, delusions, or a limited number of severe abnormalities of behaviour, such as gross excitement and over activity, marked psychomotor retardation and catatonic behaviour. Lack of insight (patient’s understanding of illness) is a failure to accept that one is ill, and is a characteristic of acute psychosis.

Case report

Ms. B, aged 35 years, Beedi rolling by occupation, educated up to 6th standard, unmarried, Hindu by religion. According to her mother she does not talk to anyone, sits alone in a corner, loss of interest in her routine, muttering to self, angered easily (shouts back as if someone is talking to her and beats herself when angry), throw things, beats mother, used to remove cloths for past 15years and symptoms increased since past two months. On observation during case taking she was restless, no eye maintained, no hygiene maintained, plica polonica present, muttering to self. She was under allopathic treatment when complaints are aggravated but never on regular medication. She stopped all medications three years back. She was admitted on 27/ 09/16.

Personal history: Patient is a non-vegetarian, poorly built and poorly nourished. Appetite is good (eats frequently little by little); Thirst is good (drinks frequently by sips) but thirst increased when angry.

Family history : Father – Alcohol Dependent Syndrome (Left home when she was a child)

Brother – Delusional Disorder

Uncle – Alcohol Dependent Syndrome

Major life event: When she was 20 years she was raped, but family members were not aware of this. They came to know about it when she was 6 months pregnant and she was aborted in the seventh month with consent.

Mental Status Examination

Conscious and alert

Eye not maintained

No speech

Blunted affect

Rapport not established

Insight absent.

Memory, judgement, orientation, thought process, perception couldn’t

evaluate.

First prescription (27/09/16)

Advice has been given to the mother to make the patient take baths and maintain hygiene. The matted hair has been removed and her head shaved.

Hyoscyamus (0) / 1P Angered easily, shouts back as if someone is talking to her and beats herself when angry, throw things, beats mother, used to remove cloths. On observation during case taking she was restless, muttering to self

No ii pills    4 – 4 – 4

Progress and Follow up

DateSymptomsPrescription
28/09/16Violent

Restlessness+, Sleep ↓

Muttering to self and beating herself

Drinking water frequently in sips

 

1.     Veratrum album 200/ 1P

2.     No ii pills    4 – 4 – 4

02/10/16Violent

Talking to herself (Words of religious spirituals)

Restlessness+, PMA↑

Slept for half an hour.

 

1.     Stramonium 200 / 1P

2.     No ii pills    4 – 4 – 4

03/10/16Loquacious

Talks about going home

Scolds mother talks sarcastically

Abusive and cursing

 

1.     Stramonium 1M / 1P

2.     No ii pills    4 – 4 – 4

 

04/10/16Violent

Self beating

Uses abusive  language

Easily offended

Restlessness+, Appetite ↑

 

1.     Anacardium 200 / 1P

2.     No ii pills    4 – 4 – 4

06/10/16Anger – Maniac episode

Restlessness+

Violent head movement

 

1.     Veratrum album 200/ 4 hourly or sos

2.     No ii pills    4 – 4 – 4

08/10/16Restlessness –  neck movement

Smiling

Eye maintained

Violent – eating by herself

Loud screaming

Singing song

 

1.     Veratrum album 1M / 1P

2.     No ii pills    4 – 4 – 4

11/10/16Loquacious,

Talking to herself – Muttering+

Restlessness+, PMA↑ with violent movement of legs

Abusive

Sleep ↓, thirst ↑

 

1.     Lachesis 200 / 1P

2.     No ii pills    4 – 4 – 4

14/10/16Loquacity reduced

Self Talking present

Restless

Sleep improved, Appetite N, Thirst N

 

1.     Lachesis (0) / 1P

2.     No. ii pills 4 -4 -4

She was discharged on 18/10/16 as there was no further violent episode and all generals were good. She followed a routine and maintained personal hygiene, started obeying her mother. She was advised to come for regular follow up every two weeks.

Follow Up

DateSymptomsPrescription
22/11/16Restlessness better

Anger reduced but angry when taken her for bathing

No self talking.

Eye maintained on calling name.

All generals good.

 

1.     Lachesis (0)/1P

2.     No. ii pills 4 -4 -4

06/12/16Restlessness better

Anger reduced but angry when taken her for bathing

No self talking.

Smiled when called.

All generals good.

 

1.     Lachesis (0)/1P

2.     No. ii pills 4 -4 -4

31/01/17Restlessness better

Communication improved.

No anger episodes.

Eye maintained.

All generals good.

 

1.     Lachesis (0)/1P

2.     No. ii pills 4 -4 -4

21/03/17

(Last follow up)

Restlessness better

Communication improved.

No anger episodes.

Answered properly to the examiner.

Hygiene maintained.

Eye maintained.

All generals good.

 

1.     Lachesis (0)/1P

2.     No. ii pills 4 -4 -4

Discussion

During the violent episodes the patient was treated initially with remedies like Veratrum, Stramonium and Anacardium based on the totality of that episode. Later Lachesis and Tarentula were the remedies and Lachesis was given as the simillimum.

Conclusion

Homoeopathy has a vast scope in treating psychotic diseases. The acute state should be managed with remedies like Aconite, Belladonna, Stramonium, Hyoscyamus, Mercury, ie, apsoric remedies based on the present totality followed by antipsoric ones so as to prevent the recurrence. However, the results from this single case report are by no means conclusive regarding the long term clinical effectiveness of homoeopathic remedies for psychosis.

About the author

Diana Ravi Kumar

Diana Ravi Kumar

Dr Diana Ravikumar, MD Part II (Homoeopathic Psychiatry), Father Muller Homoeopathic Medical College and Hospital, Deralakatte, Mangaluru.

About the author

Girish Navada

Dr Girish Navada U. K., Prof. and HOD, Department of Homoeopathic Psychiatry, Father Muller Homoeopathic Medical College, Deralakatte, Mangaluru.

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