Schizophrenia and Homeopathy

                                              Schizophrenia

Definition:

    This is a form of mental illness characterized by an abnormal emotional reaction associated with deterioration in personality. 

     Schizophrenia has puzzled physicians, philosophers, and the general public for centuries. The systematic study of schizophrenia, however, is but a century old. A clinical syndrome with a profound influence on public health, schizophrenia has been called “arguably the worst disease affecting mankind, even AIDS not excepted”. 
      To understand what schizophrenia is, it is important to have a brief look at the history of the evolution of the concept of schizophrenia.

HISTORICAL BACKGROUND:

Although earlier descriptions of schizophrenia-like illness are recorded in literature (such as in Ayurveda; Morel’s description of defense precoce; Kahlbaum’s description of catatonia; Hecker’s description of hebephrenia), the scientific c study of the disorder began with the description of dementia praecox by Emil Kraepelin.

Emil Kraepelin
   In 1896, Emil Kraepelin differentiated the major psychiatric illnesses into two clinical types: Dementia praecox, and Manic-depressive illness. Under dementia praecox, he brought to get her the various psychiatric illnesses (such as paranoia, catatonia, and hebephrenia), which were earlier thought to be distinct illnesses.

Eugen Bleuler
     Eugen Bleuler (1911), while renaming dementia praecox as schizophrenia (meaning mental splitting), recognized that this disorder did not always have a poor prognosis as described by Kraepelin. He also recognized that schizophrenia consisted of a group of disorders rather than being a distinct entity. Therefore,

he used the term, a group of schizophrenias.

Kurt Schneider: 
   Kurt Schneider (1959) described symptoms which, though not specific to schizophrenia, were of great help in making a clinical diagnosis of schizophrenia. These are popularly called as Schneider’s first rank symptoms of schizophrenia (FRS or SFRS). 

Aetiology: 

Not definitely known. The following factors are important:

Genetic: There is 40% risk of developing this disease when both parents are affected and 50% chance of developing this disease in monozygotic twins. 
Intra-uterine brain damage. 
Dopamine pathway: It has been found that Dopamine agonist aggravates the condition; if dopamine agonist is withdrawn a rebound phenomenon develops, the efficiency of the therapeutic weapons is directly dependent on their dopamine receptor blocking capacity in the brain and post-mortem studies have revealed increased dopamine binding sites in these individuals. However, it is also believed that there may be dysfunction of the limbic system of the dominant hemisphere. These patients are unable to handle the amount and speed of incoming perceptual stimuli. 
Miscellaneous: Disturbances in MAO function or transmethylation. 

Predisposing factors:
Heredity: There is a strong evidence that relatives of schizophrenic patients inherit this disease very often. The mode of inheritance is a matter of controversy. 
Physical constitution: This disease has a biological affinity for a narrow type of physique, namely athletic and dysplastic type.
Personality: Most of the patients have a schizoid personality. These patients are unsocial, shy, oversensitive having very few interests. 

EPIDEMIOLOGY:

  According to the World (Mental) Health Report 2001, about 24 million people worldwide suffer from schizophrenia. The point prevalence of schizophrenia is about 0.5-1%. Schizophrenia is prevalent across racial, sociocultural and national boundaries, with a few exceptions in the prevalence rates some isolated communities.
The incidence of schizophrenia is believed to be about 0.5 per 1000. The onset of schizophrenia occurs usually later in women and often runs a relatively more benign course, as compared to men.

First Rank Symptoms (SFRS) of Schizophrenia: 

1. Audible thoughts: Voices speaking out thoughts aloud or ‘ thought echo’.
2. Voices heard arguing: Two or more hallucinatory voices discussing the subject in the third person.
3. Voices commenting on one’s action.
4. Thought withdrawal: Thoughts cease and subject experiences them as removed by an external force.
5. Thought insertion: Experience of thoughts imposed by some external force on person’s passive mind.
6. Thought diffusion or broadcasting: Experience of thoughts escaping the confines of self and as being experienced by others around.
7. ‘ Made’ feelings or affect.
8. ‘Made’ impulses.
9. ‘Made’ volition or acts: In ‘made’ affect, impulses and volitions, the person experiences feelings, impulses or acts which are imposed by some external force. In ‘made’ volition, for example, one’s own acts are experienced as being under the control of
some external force.
10. Somatic passivity: Bodily sensations, especially
sensory symptoms, are experienced as imposed on the body by some external force.
11. Delusional perception: Normal perception has a private and illogical meaning.


CLINICAL FEATURES:  Schizophrenia is characterized by disturbances in thought and verbal behavior, perception, affect, motor behavior and relationship to the external world. The diagnosis is entirely clinical and is based on the following clinical features, none of which are pathognomonic if present alone.
 Thought and Speech Disorders:
    Autistic thinking is one of the most classical features of schizophrenia. Here thinking is governed by private and illogical rules. The patient may consider two things identical because they have identical predicates or properties ( von Domarus Law).
Loosening of associations is a pattern of spontaneous speech in which things said in juxtaposition lack a meaningful relationship or there is idiosyncratic shifting from one frame of reference to another. The speech is often described as being ‘disjointed’.Thought blocking is a characteristic feature of schizophrenia, although it can also be seen in complex partial seizures (temporal lobe epilepsy). There is a sudden interruption of a stream of speech before the thought is completed. After a pause, the subject cannot recall what he had meant to say. This may at times be associated with thought withdrawal.
  A patient with schizophrenia may show complete mutism (with no speech production), poverty of speech (decreased speech produc tion), poverty of ideation (speech amount is adequate but content conveys little information), echolalia (repetition or echoing by the
patient of the words or phrases of examiner), perseveration
(persistent repetition of words beyond their relevance), or verbigeration (senseless repetition of same words or phrases over and over again). These are disorders of verbal behavior or speech.

Delusions: A are false unshakable beliefs which are
not in keeping with patient’s socio-cultural and educational
background. These are of two types: primary
and secondary.
1. Primary delusions arise de novo and cannot be explained on the basis of other experiences or perceptions.2. Secondary delusions are the commonest type of delusions seen in clinical practice and are not diagnostic of schizophrenia as these can also be seen in other psychoses. Secondary delusions can be explained as arising from other abnormal experiences.

The commonly seen delusions in schizophrenia include:
1. Delusions of persecution (being persecuted against, e.g. ‘people are against me’).
2. Delusions of reference (being referred to by others; e.g. ‘people are talking about me’).
3. Delusions of grandeur (exaggerated self-importance; e.g. ‘I am God almighty’).
4. Delusions of control (being controlled by an external force, known or unknown; e.g. ‘My neighbor is controlling me”).
5. Somatic (or hypochondriacal) delusions (e.g.‘there are insects crawling in my scalp’).

Disorders of Perception
   Hallucinations (perceptions without stimuli) are common
in schizophrenia. Auditory hallucinations are by
far the most frequent. These can be:
i. Elementary auditory hallucinations (i.e. hearing simple sounds rather than voices)
ii. ‘ Thought echo’ (‘ audible thoughts’)
iii. ‘Third person hallucinations’ (‘voices heard arguing’, discussing the patient in the third person)
iv. ‘Voices commenting on one’s action’. Only the ‘third person hallucinations’ are believed to be characteristic of schizophrenia. Visual hallucinations can also occur, usually along with auditory
hallucinations. The tactile, gustatory and olfactory types are less common.

Disorders of Motor Behaviour:
  There can be either a decrease (decreased spontaneity, inertia, stupor) or an increase in psychomotor activity (excitement, aggressiveness, restlessness, agitation). Mannerisms, grimacing, stereotypies (repetitive strange behavior), decreased self-care, and poor grooming is common features. Catatonic features are commonly seen in the catatonic subtype of schizophrenia (and are discussed in detail under that heading).

Types of Schizophrenia: 
1. Paranoid schizophrenia
2. Hebephrenic schizophrenia
3. Catatonic schizophrenia
4. Residual schizophrenia
5. Undifferentiated schizophrenia
6. Simple schizophrenia
7. Post-schizophrenic depression
8. Others
1. Paranoid schizophrenia: 
   Paranoid schizophrenia is characterized by the following clinical features, in addition to the general guidelines of schizophrenia described earlier:
1. Delusions of persecution, reference, grandeur (or ‘grandiosity’), control, or infidelity (or ‘jealousy’). The delusions are usually well-systematised (i.e. thematically well connected with each other).
2. The hallucinations usually have a persecutory orgrandiose content.
3. No prominent disturbances of affect, volition, speech, and/or motor behavior.

Disorganized (or Hebephrenic) Schizophrenia
Disorganized schizophrenia is characterized by the
following features, in addition to the general guidelines
of schizophrenia described earlier:
1. Marked thought disorder, incoherence and severe loosening of associations. Delusions and hallucinations are fragmentary and changeable.
2. Emotional disturbances (inappropriate affect, blunted affect, or senseless giggling), mannerisms, ‘ mirror-gazing’ (for long periods of time), disinhibited behavior, poor self-care, and hygiene,  markedly impair red social and occupational functioning, extreme social withdrawal and other oddities of behavior.

Catatonic Schizophrenia: 
 Catatonic schizophrenia (Cata: disturbed, tonic: tone) is characterized by a marked disturbance of motor behaviour, in addition to the general guidelines of schizo phrenia described earlier.

Excited Catatonia
This is characterized by the following feature res:
1. Increase in psychomotor activity, ranging from restlessness, agitation, excitement, aggressiveness too, at times, violent behavior (furore).
2. Increase in speech production, with increased spontaneity, the pressure of speech, loosening of associations
and frank incoherence.
Stuporous (or Retarded) Catatonia:
This is characterized by extreme retardation of psychomotor function.


Residual and Latent Schizophrenia:
Residual schizophrenia is similar to latent schizophrenia and symptoms are similar to prodromal symptoms of schizophrenia. The only difference is that residual schizophrenia is diagnosed after at least one episode has occurred.


Undifferentiated Schizophrenia:
This is a very common type of schizophrenia and is
diagnosed either:
1. When features of no subtype are fully present, or
2. When features of more than one subtype are exhibited,
and the general criteria for a diagnosis of schizophrenia are met.

Simple Schizophrenia:
Although called simple, it is one of the subtypes which
is the most difficult to diagnose. It is characterized
by an early onset (early 2nd decade), very insidious
and progressive course, the presence of characteristic
‘negative symptoms’ of residual schizophrenia (such
as marked social withdrawal, shallow emotional
The response, with a loss of initiative and drive,), vague
hypochondriacal features, a drift down the social
ladder, and living shabbily and wandering aimlessly.
Delusions and hallucinations are usually absent, and
if present they are short lasting and poorly systematized.

The prognosis is usually very poor.

Post-Schizophrenic Depression: 
Some schizophrenic patients develop depressive features within 12 months of an acute episode of schizophrenia. The depressive features develop in the presence of residual or active features of schizophrenia and are associated with an increased risk of suicide.
The depressive features can occur due to side-effect of antipsychotics, regaining insight after recovery, or just be an integral part of schizophrenia

Other Subtypes: 

Pseudoneurotic Schizophrenia
Oneiroid Schizophrenia
Van Gogh Syndrome

DIFFERENTIAL DIAGNOSIS:

   The first step in the differential diagnosis is to exclude psychoses with known organic causes, such as complex partial seizures, drug-induced psychoses (such as amphetamine-induced psychoses), metabolic disturbances, or cerebral space occupying lesions.
There would often be clinical features suggestive of underlying disorders in these conditions.
 The second step is to rule out a possibility of mood disorder (such as mania, depression, or mixed affective disorder) or schizo-affective disorder.
  The third step is to exclude the possibility of other nonorganic psychoses such as delusional disorders, or acute and transient psychotic disorders (ATPD). In addition to the main diagnosis, it is also important to look for co-morbid medical (such as diabetes,
hypertension) and/or psychiatric disorders (such as depression, anxiety, alcohol or drug misuse, or personality disorder) on a multi-axial diagnostic system. 

Homeopathic Medicines for Schizophrenia:

Anacardium Orientale:

  Anacardium Orientale is an important medicine that can be utilized in patients experiencing the auditory hallucinations. The patient requiring this medicine usually complains of hearing voices from far away that command him to do activities. He also hears voices of dead people. This medicine also works well in case of the symptoms of- excessive talkativeness coupled with the use of abusive words; suspicion at everything around him and anxiety while walking. He also feels as if someone is following him and talking about him. 

Cannabis Indica:

  Cannabis Indica is a wonderful homeopathic medicine where disorganized speech is present in Schizophrenia. The important symptoms making Cannabis Indica an ideal choice are –  persistent thoughts crowding the brain which make the patient forget while talking and preventing rational speech. The patient forgets the last said words and cannot recall them, and has the fear of becoming insane and exhibits uncontrollable laughter.

Stramonium:

  Homeopathic Medicine Stramonium is yet another useful cure for disorganized speech and the guiding symptoms are – continuos talking, incomprehensible speech, excessive praying, religious mania,  fear of darkness and the tendency to talk with spirits.

Hyoscyamus Niger:

  Hyoscyamus Niger this homeopathic remedy is useful for those cases of Schizophrenia where the main symptom is the delusion of persecution and the patient feels that others are making some plot against him. Another symptom which points to its use is-  suspicion and the patient’s perception that he will be poisoned, thus refusing to take anything offered, even medicine too; there is a mistrust that his friends are no longer his friends and he carries on the conversation with imaginary people. 

Lachesis:

 Is also very effective for treating the delusion of persecution and its use is called for where the symptoms of suspicion and jealousy without any reason are present. Other symptoms like aversion to mixing with the world and excessive talkativeness also warrant its use. 

Phosphorus:

 Phosphorus also ranks as a top medicine for curing the grandiose delusion. The patients for whom this medicine is usually recommended are those possessing an exaggerated idea of self-importance; over-sensitiveness to all external impressions; depression and indifferent behavior towards family and friends and have strange imaginations e.g.. that something is creeping out of every corner.

Platinum Metallicum:

 Platinum Metallicum is an excellent medicine for treating delusion of grandeur. The characteristic features calling for this medicine to be used are the superiority complex, where the person feels that everyone around him/her is inconsequential and of no value and only he/she is superior and important. 

Mentals, SCHIZOPHRENIA: 1anh,aur,bell,carc,cic,convo-s,cortico,halo,hyos,kers,levo,med,nux-v,op,psil,rauw,
Mentals, SCHIZOPHRENIA, catatonic: 1cic,convo-s,cortico,halo,rauw,reser,thala,thiop.
Mentals, SCHIZOPHRENIA, hebephrenia:1anh,halo,kres,reser,thala,thiop,thuj-l
Mentals, SCHIZOPHRENIA, paranoid: 2Bell,2Hyos,2Nux-v,
1med,op,rauw,stram,verat. 

Dr. Farooq Khan's Elite Clinic

Shop No. 6, Darul falah colony,

Kausa-mumbra. Thane 400612

Phone no: 022-25350699

WhatsApp: 8097166756

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Skype for online consultation: Khan.farooq0

Anxiety Neurosis and Homeopathy

                                                     ANXIETY NEUROSIS 

                                         

Definition: 
        This is the commonest form of psychoneurosis characterized by the lack of concentration, loss of interest and unforeseen fears due to adaptation to environmental stress.  

   . Anxiety is not the same as fear, which is a reaction to a real or perceived instant threat; whereas anxiety is the anticipation of future risk.Anxiety is nothing but a feeling of fear, uneasiness, and worry, usually comprehensive and nonspecific as an overreaction to a situation that is only automatically seen as threatening.

  Anxiety most of the times is accompanied by muscle tension, restlessness, weakness and unable to concentration. Anxiety can be a protective mechanism in some situations, but when if it is regular the person may suffer from an anxiety disorder.

     Anxiety is the commonest psychiatric symptom in clinical practice and anxiety disorders are one of the commonest psychiatric disorders in general population. Anxiety is a ‘normal’ phenomenon, which is characterized by a state of apprehension or unease arising out of anticipation of danger. Anxiety is often differentiated from fear, as fear is an apprehension in response to an external danger while in anxiety the danger is largely unknown (or internal).

 Normal anxiety becomes pathological when it causes significant subjective distress and/or impairment in the functioning of an individual.

Aetiology: 

Genetic: 

       Family history in 15% cases is present. 

Learning theory: 

       It is thought to be a fear response which by conditioning is attached to another stimulus. 

Psychodynamic theory: 

      There may be several stress types, e.g., familial, personal or of sexual nature which may play in the background. 
       
1. Emotional instability.

2. Constitutional, environmental and hereditary factors. 

3. Sexual background. 

Clinical Features: 

      Symptoms of anxiety always dominate. There may be fear of body and mind. Fear of bodily function (hypochondriasis)or of disease (Cynophobia) may be present. The patient may think that he may die or may commit suicide. He is afraid to walk in the street, in a vehicle, and may remain in the house day and night. There is insomnia and if there is sleep, it is often disturbed by nightmares. 

  There may be autonomic imbalance and due to this various visceral symptoms and signs may develop as given below: 

Gastrointestinal:

     Nausea, vomiting, hiccup, diarrhea, flatulence, water brash, epigastric pain, dysphagia, dryness of mouth and throat. 

Nervous: 

    Twitching, tremor, blurring of vision, giddiness, tinnitus, headache, insomnia. 

Genitourinary: 

    Frequency of micturition, seminal emission. Erectile impotence, loss of libido. 

Cardiovascular: 

    Palpitation, dyspnoea, precordial pain, fall of BP, etc, Sometimes these are seen in young soldiers and this is called Effort syndrome or Neurocirculatory asthenia(Da costa's syndrome)
        
Respiratory:

    Constriction of the chest, breathlessness, over breathing, hyperventilation syndrome, pain chest.

Cutaneous: 

     Pale cold skin, sweating of hand and feet and axillae. 

Others: 

    Headache, fear of open spaces. irritability, restlessness,  lack of concentration. 

Psychological Symptoms

A. Cognitive Symptoms: Poor concentration; Distractibility;
Hyperarousal; Vigilance or scanning; Negative automatic thoughts

B. Perceptual Symptoms: Derealisation; Depersonalisation

C. Affective Symptoms: Diffuse, unpleasant, and a vague sense of apprehension; Fearfulness; Inability to relax; Irritability; Feeling of impending doom (when severe)

D. Other Symptoms: Insomnia (initial); Increased

sensitivity to noise; Exaggerated startle response

HOMEOPATHY MEDICINES FOR ANXIETY DISORDERS:

Argentum Nitricum: 

      This is one of the most important medicines for anxiety related disorders. This drug that is prepared from the nitrate of silver. It specifically affects the mind causing neurotic effects. It also has curative effects on the affectations of the nervous system, digestive system, reproductive system, respiratory organs, musculoskeletal system, etc.

     The patient is very nervous and impulsive by nature; extremely hurried in whatever he does. He dreads situations that may cause him anxiety and tries to avoid getting into such situations. Multiple phobias such as fear of darkness, evil, fear of heights, tall buildings, of passing certain places, etc. anticipatory anxiety which causes diarrhea before any important event or function. Intense apprehension and worry about trifling matters. 

Aconite:

  when symptoms are of Sudden onset of fever, with chilliness, throbbing pulses, and great restlessness-from anxiety. A remedy of cold, dry weather, bitter winds (opp. to Gels).

Bryonia:

     White tongue: thirst for much cold fluid. ( Phos) From every movement, every noise, attacked with dry heat (rev. of Nux, Gels., etc.) Wants two lies quite still, and be let alone. Especially with pleurisy, or pleuro-pneumonia. Headaches and pain all better for pressure, and worse for movement. ( Eup. per.)_ The anxiety, dreams, and delirium of Bry. are of business; in delirium, he "wants to go home," Pains in the head from coughing. Irritable.

Graphites:

   Best anxiety homeopathic remedy for children.

 There is a queer contradiction in the GRAPHITES children. With the uncertainty and hesitation, laziness and general physical sluggishness, there is always an element of anxiety in the children. Graphites Homeopathic constitution they always tend to look on the hopeless side of things; if they are going to a new school, they dread it.

Lycopodium clavatum:

     Lycopodium is prepared from the spores of a fungus called as club moss. It is an inert substance until it undergoes the process of potentization to reveal its latent curative powers. Lycopodium is a deep acting, constitutional remedy having a very wide sphere of action. It positively affects the mental sphere, general nutrition, urinary system, gastrointestinal system, reproductive system, lungs, skin, etc.

Natrum Muriaticum: 

      This in a wonderful example of a drug prepared from an inert substance like common salt. After undergoing the process of Potentization, the inner healing powers of common salt are brought to the surface and thus is borne a deep-acting constitutional remedy. Natrum muriaticum is one of the most commonly used medicines in homeopathy It can be used for a wide range of disease processes and has a very broad spectrum of action.Natrum muriaticum is an excellent remedy for diseases affecting the general nutrition of the body and for anemia, fevers, thyroid affections, etc. Not only the physical ailments but also the psychic affections come under the domain of this wonderful drug.

Silicea (Silica):

     It is one of the splendid acts of homeopathy that substances labeled as inert can also be used efficiently to treat a large variety of disorders. Silica is the example of one such substance, which is chemically inert in its natural form, but after undergoing the process of potentization it gets transformed into a wonderful, deep acting remedy. Silica is in a true sense called as polychrest remedy as it has a broad spectrum of action, useful for a wide range of disease processes. In fact, this remedy has helped Homeopaths world over to treat so-called surgical conditions gently without requiring the knife.

Syphilinum:

    This is a drug that is prepared from the syphilitic virus by the process of potentization. It belongs to a group of homeopathic drugs called as Nosodes which are prepared from disease products or diseased tissues. The remedy prescribed does not contain the original drug substance in the material form but it contains only the dynamic powers of that substance. This is achieved through the process of potentization in homeopathy

Syphillinum is a deep acting, polychrest remedy affecting multiple systems of the body.

It positively influences the mind, sensorium, skin, gastrointestinal tract, genito-urinary system, nerves, bones, etc. It is a very helpful remedy to combat hereditary syphilitic tendencies in patients.

Repertorial approach:

Complete repertory:

Mentals, ALIMENTS from anxiety: 3Sil, 1 Aur, 1Calc, calc-p,                          carc, cimic, hyos, kali-p, lyc, nit-ac, ph-ac, pic-ac, samb,                   staph

Mentals, ALIMENTS from anxiety prolonged: 1Carc, 1pic-ac. 

Mentals, ANXIETY: 3Acon, 3Arg-n, 3Ars, 3Ars-i, 3Ars-s-f,3Aur,3Aur-s, 3Bell, 3Bism,3Bry, 3Cact,3Calc, 3 Calc-ar, 3Calc-p, 3Calc-s, 3Camph, 3Cann-i, 3Carb-v, 3Carbn-s, 3Carc, 3Caust, 3Chin,3Con, 3Dig, 3Iod, 3Kali-ar, 3Kali-c, 3Kali-p, 3Kali-s, 3Lyc, 3Merc-c, 3Mez, 3Nat-ar, 3Nat-c, 3Nit-ac, 3Phos, 3Psor, 3Puls, 3Rhus-t, 3Sec, 3Sulph, 3Verat

Mentals, ANXIETY future, about: 3Bry, 3Calc, 3Chin-s, 3Cic, 3Phos, 3Spong, 

Mentals, ANXIETY health, about: 3Kali-ar, 3Nit-ac, 3Phel, 2Arg, 2Calad, 2calc, 2calc-p, 2chin-ar, 2lyc, 2ph-ac, 2phos,2puls, 2Sep

Mentals, ANXIETY family, about: 3Rhus-t, 2Ars, 2Caust, 2Spig

Mentals, ANXIETY alone, when: 3Ars, 3Phos, 2Dros, 2Kali-br, 2Mez, 2Rhus-t

Mentals, ANXIETY sleep before: 2Mag-c. 2Rhus-t, 2Sulph

Mentals, ANXIETY sleep falling asleep, on: 2calc, 2caust,2lach,                                                                               2lyc, 2puls.

Mentals, ANXIETY sleep during: 3Ars, 2Bell,2cocc, 2graph, 2kali-c, 2kali-i, 2lyc, 2merc-c, 2nat-c, 2nat-m, 2nit-ac, 2phos, 2spong. 

Mentals, ANXIETY sleep disturbed, with: 2acon,2ars,2bell, 2carb-v, 2cast, 2caust, 2chin, 2cocc, 2 ferr, 2graph, 2hep, 2hyos, 2ign, 2kali-c,2mag-c

Mentals, ANXIETYsleep preventing: 3Ars, 3Chin, 3Rhus-t, 3Sep

Mentals, ANXIETY sleeplesness, with: 2Acon, 3Ars, 3Cocc, 3Verat
Kent repertory:

MIND, ANXIETY: 3 Aco, 3Arg-n, 3Ars, 3Ars-i, 3Aur, 3Bell, 3Bism,3Bry, 3Cact, 3Calc, 3Calc-p, 3Calc-s, 3Camph, 3Cann-i, 3Carb-s, 3Carb-v, 3Caust, 3Chin, 3Con, 3Dig, 3Iod, 3Kali, 3Lyc, 3Mez, 3Nat-c, 3Nit-ac, 3Phos, 3Psor, 3Puls, 3Rhus-t, 3Sec, 3Sulph, 3Sec, 3Sulph, 3Verat

MIND, ANXIETY, conscience, of (as if guilty of a crime): 3Alum, 3Ars, 3Aur, 3Chel, 3Dig, 3Psor. 2 am-c,2carb-c, 2cocc, 2con, 2ferr, 2graph, 2hyos, 2ign, 2med, 2merc, 2nat-m, nux-v, 2rhus-t, 2sil, 2sulph, 2thuj, 2verat, 2zinc. 

MIND, ANXIETY, crowd, in a: 2acon, 2ambr, 2petr, 1bell, 1lyc, 1plat, 1stram. 

MIND, ANXIETY, expected of him, when anything is: 2ars

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IBS (Mucous colitis)

                                                      Irritable Bowel Syndrome 
                           (IBS, Mucous colitis, Spastic colitis)

      It is an idiopathic disorder including chronic recurrent variable gastrointestinal symptoms mainly, which cannot be explained by the anatomical or biochemical abnormality. This is an extremely common condition which is seen common in adults
(25%). 

There are four variants of IBS:

·         IBS-A (alternating constipation and diarrhea).

·        IBS-C (primarily constipation)

·         IBS-D (primarily diarrhea)

·         IBS-M (a mixture of constipation and diarrhea).

Pathogenesis:

   Though the exact explanation is far from clear the following factors are mostly responsible: 

Abnormal intestinal motility:

  Myoelectrical and motor abnormalities have been found in the small and large gut but whether these are primary or secondary to psychic stress is difficult to assess. 

Increased visceral nociception:

  Visceral pain threashold is low on these subjects and hence the low volume of colonic gas may produce symptoms of abdominal distension and pain. 

Psychosocial stress:

  More than 50% of cases of this disease will have anxiety, depression or somatization, These will ultimately influence the development of symptoms. 

Clinical Features:

  Onset is acute to chronic: 


Age: Younge adults but the disease runs throughout life. Four important symptoms should be present to make a diagnosis of IBS. 

1. Bloating of distension of abdomen,
2.Diffuse abdominal pain which is relieved after an adequate bowel movement. 
3Incresed frequency of stool with the onset of pain, and
4.Loose stool with the onset of pain. 

  More than 90% of the patients will have these symptoms though in different proportions and these symptoms must be present for at least 3-6 months before a diagnosis is made. Bloating of the abdomen is a very important symptom though this is not alway clinically evidenced. Abdominal pain is diffuse, cramps, intermittent and mostly located in the lower abdomen. Constipation, loose stool, frequent stool or even alternate constipation and loose stool all commonly seen. But whatever may be the character of stool mucus is always present, so the character of stool mucus is always present, so the other name is "Mucous colitis". 
   Fever, weight loss, blood in stool or nocturnal diarrhea will not be present and should arouse suspicion for the presence of organic disease. Similarly, when these symptoms start at later life organic cause in the background should be suspected. On examination, nothing remarkable should be suspected. On examination, nothing remarkable is found but slight abdominal tenderness may be present. As there is anxiety in the background anxious facies may also be present. But all organic causes should be searched during clinical examination.  

diagnostic criteria:

   Abdominal distension (bloating).

      Diffuse lower abdominal pain noticed, particularly in the lower left quadrant. Pain is usually reported as a constant dull ache with occasional episodes of acute sharp pain. Eating may precipitate this pain and it’s often relieved by defecation. For diagnostic purposes, the pain described here should have been present for at least 3 days per month during the previous 3 months.

·         Altered bowel habits, consisting of constipation, diarrhea, or an alternation between the two, including defecation urgency, particularly after a meal.

Special Investigations: 

  Blood, stool and biochemical examinations reveal no abnormality. The endoscopic examination also reveals normal features. 

The orthodox medical management of IBS commonly consists of the use of dietary fiber, polycarbophil compounds, anticholinergics, antispasmodics, antidepressants, a FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) exclusion diet, as well as a lactose and fructose exclusion diet.

Natural medicine practitioners commonly advise clients with IBS to use probiotics, glutamine, psyllium, melatonin, curcumin, Vitamin D, Aloe vera, peppermint oil, Brahmi, Cat’s claw, Artichoke leaf or Slippery elm, and similar dietary restrictions to those referred to above.

The homeopathic treatment of a person with IBS is typically based on the use of a homeopathic medicine that’s been selected on the basis of a similarity between the signs and symptoms of the client, and the homeopathic proving symptoms of the medicine. This medicine selection process, otherwise known as homeopathic repertorization, is designed to guide the prescriber to a very specific medicine prescription yet it often brings up one or more of a recurring group of medicines, and a brief discussion of each of these medicines follows.

homeopathic therapeutics:

Sulphur

Sulphur is often useful in cases where the person suffers from diarrhea with an urgent need to pass stools soon after waking in the morning, often at around 5 a.m. A difficulty in passing stools may occur at other times of the day, with hyperacidity, abdominal colic after drinking, offensive flatulence and offensive belching, often reported. There may be anal and other pruritis, with most symptoms having a burning character. Dry skin and red orifices may also be present. The person requiring Sulphur will typically desire sweet foods, have adverse reactions to milk, be irritable, forgetful, experience back pain and appear to have bad posture. Most ailments are inclined to relapse. Symptoms are worse when standing for prolonged periods, and better from lying on the right side or drawing in the legs.

Colocynthis

The Colocynthis type of person often appears to be angry or irritable. In this instance, diarrhea, abdominal distension, and severe cramping or cutting lower abdominal pain that’s relieved by pressure or bending double, may be noted. A bitter taste in the mouth may be reported, along with great hunger, muscular cramping (particularly of the calves), twitching, gallbladder disturbances and back pain. Symptoms are worse from suppressed anger or irritability, a bowel movement, from eating fruit or drinking water, anger or irritation, and better from hard pressure and warmth.

Argentum nitricum

A watery, flatulent, offensive, diarrhea which occurs immediately after eating or drinking, or which is associated with emotion, is usually seen here. Anxiety or ailments from mental exertion are often associated with these issues and the sufferer may have a marked desire for sweet food. The person may appear to be nervous, fearful, forgetful, hurried and impulsive. Nausea, vomiting of mucoid materials, belching, abdominal distention, lower left quadrant abdominal pain, flatulence, a sense of an epigastric “lump”, and bloating may be found, and disorders of blood sugar may be present. One of the characteristics here is that pains increase and decrease slowly. Symptoms are worse from warmth, cold or sweet food or at night, and are better from pressure, cold and belching.

Lycopodium

In this case, constipation and diarrhea are frequently alternating. There may be indigestion, heartburn, borborygmi, nausea, as well as abdominal pain and distension that’s worse at the end of, and immediately after, eating. The abdominal pain and distension are not relieved by the passage of flatus. Pain tend to travel from right to left and come and go suddenly. There’s often a sense of heaviness in the abdomen after eating and a dislike of tight clothing. The person is usually thirstless with a dry mouth and halitosis and may appear to be sensitive, apprehensive and forgetful. There may be a history of liver or kidney disorders, poor circulation and digestive weakness, a desire for hot food and drink as well as sweet foods, and the appetite may be increased to the point where the person may remark on having to get out of bed in the middle of the night to eat. Symptoms are worse on the right side, from heat, between the hours of 4 and 8 p.m., and from consuming beans, cabbage or onions. Symptom improvement may occur with rubbing the abdomen, consuming warm drinks, exposure to cold, or being uncovered.

Nux vomica

Nux vomica can be useful for those reporting constipation with the passage of small quantities of stool, colicky abdominal pain that occurs an hour after eating, flatulence, cramping, heartburn, bitter belching, and abdominal distension that occurs after eating. There may be insomnia, a history of liver congestion, overeating, stress, or overwork. The person in question may appear to be irritable, chilly, impatient, and sensitive to light, odors, and noise. There’s often a desire for alcohol, coffee, cigarettes, spicy foods, and stimulants generally. Symptoms are worse from eating, from stress, anger, alcohol, stimulants and spicy foods. Symptoms are improved by strong pressure, from a nap, from consuming hot drinks and passing flatus.

Natrum carbonicum

The pointers to Nat carb include indigestion, heartburn, belching, abdominal distension, flatulent diarrhea, dairy intolerance and a bitter taste in the mouth. There’s often a sudden desire to pass stool and the sufferer may express a craving for potatoes and sweet foods. The person may present as mentally and physically weak, sensitive, and depressed. Symptoms are worse from milk, sitting, mental exertion or a change in the weather, and better from physical movement.

Natrum muriaticum

The usefulness of Nat Mur is often indicated by constipation with straining to evacuate the bowel, dry, crumbling stools, indigestion, heartburn, abdominal cutting or cramping pain, abdominal distension, fatigue, dry mucous membranes, hiccoughs and a hypersensitivity to external stimuli. The person may be excessively thirsty, with a dry mouth and a salty or bitter taste, and have a desire for salty or starchy foods. Feeling of incomplete evacuation may be described.  There may be a history of fluid retention or endocrine disorders. The person may appear to be quiet, shy, sensitive, irritable or depressed. Symptoms may be worse mid-morning, lying down and from mental exertion. Symptom improvement may arise from lying on the right side, tight clothing, exposure to open air or cold bathing.

Aloe

The need for Aloe may be indicated by the presence of uncontrolled flatulent diarrhea which is worse after eating or drinking, an accelerated gastrointestinal transit time, abdominal pain particularly around the umbilicus, bloating, nausea, belching, a bitter or sour taste in the mouth, and flatulence after eating. The abdominal pain often occurs before and during a bowel movement but diminishes after the event. A bearing down sensation in the rectum may be reported and there may be a feeling of a loss of muscular power in the anus. The stool is often watery or mucoid. There may be a history of liver congestion and fatigue. Symptoms may be worse in the early morning and from eating or drinking, and better from cold.

China:

  China will frequently be of use where there is a thin liquid diarrhea of undigested food, fatigue, vomiting of undigested food, abdominal distension, flatulence and belching, borborygmi, and darting, flatulent colicky abdominal pain. The digestive processes in this instance are often quite slow. Symptoms are periodic and there may be a bitter taste in the mouth. Symptoms are worse from fruit, beer or tea, at night and after eating, and from a light touch. Symptoms are better from warmth, hard pressure or bending double.

Repertorial approach:

Complete repertory:

Abdomen, DISTENSION,General: 3Acon, 3Aloe,3Arg-n,3Ars,3Calc, 3Carb-v.3Carbn-s,3Chin, 3 Cic, 3Cocc,3Colch,3Graph, 3Hep, 3Kali-c,3Lach, 3Lyc, 3Mag-c,3Merc,3Nat-c,3Nat-p, 3Ph-ac, 3Phos, 3Ptel, 3Raph, 3Sulph, 3Ter. 

Abdomen, PAIN, general eating agg-after: 3Graph, 3Staph,3Verat, 2All-c, Alum, ars, calc-p, carb-v, cham, chin, cocc, coloch, coloc, ferr, gran, kali-c, kali-p, lyc, mag-c, nat-c, nat-m, nux-m, nux-v, ph-ac, phos, pitu-a, psor, puls, rhod, Rhus-t, sars, stann, stront-c, sul-ac, sulph, thuj, zinc.


Rectum, CONSTIPATION, alternating with diarrhea: 3Ant-c, 3Chel, 3Nit-ac,3Nux-v, 3Olnd, 3Op, 3Podo, 2abrot, arg-n, ars, aur, aur-i, aur-s, bry, carb-ac, cord-n, cimic, cob, coll, con, cupr, dig, ferr-i, hep, hydr, ign, iod, kali-c, lac-d, lach, lact, lyc, manc, mang, nat-m, nat-s, nux-m, phos, plb, ptel, puls, ruta, sulph, tab, tub. 

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