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Sunday 26 February 2017

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Dopamine pathway: It has been found that Dopamine agonist aggravates the condition; if dopamine agonist is withdrawn a rebound phenomenon develops, the efficiency of the therapeutic weapons is directly dependent on their dopamine receptor blocking capacity in the brain and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. 





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1 comment:

  1. I’m so appreciative for this type of platform, it gives us all opportunity to openly share our experiences without fear of shame. It is no longer a news that there is permanent cure to schizophrenia. My daughter was diagnosed of schizophrenia 15 years ago, over those time, I spent more time in hospital than out of hospital without much improvement. It was difficult and humbling, she had a major breakthrough only with CONSUMMO treatment. we're so proud that we've done it all to save her, She now think more clearly. She has grown as a person in all facets of life. She more compassionate, intelligent, wise, sociable, and actionable! For more detail on Consummo, kindly visit this blog: curetoschizophrenia.blogspot.com, And if you have used this medicine, I will advice you create an awareness to help others, because, every family that has a mentally ill patient needs help. Thank you.

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