RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. Name of the Candidate

and Address

[in block letters]

Permanent Address

Dr. NITIN TYAGI

DEPARTMENT OF PSYCHIATRY

FATHER MULLER HOMOEOPATHIC

MEDICAL COLLEGE AND HOSPITAL,

UNIVERSITY ROAD, DERALAKATTE

MANGALORE – 574160

S/O BRIJ MOHAN TYAGI

B-386 PATEL NAGAR II

GHAZIABAD – 201001 (U.P.)

2. Name of the Institution FATHER. MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,

DERALAKATTE,

MANGALORE – 574160.

3. Course of study and subject

M.D. (Hom.) PSYCHIATRY

4. Date of admission to Course

16.06.2008

5. TITLE OF THE TOPIC:

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“AN ATTEMPT TO UNDERSTAND THE ROLE OF HOMOEOPATHY IN MANAGEMENT OF ANXIETY DISORDERS THROUGH CLINICAL CASE STUDIES”.

6.

BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR THE STUDY:

Anxiety is the commonest presenting disorders in Psychiatry.

Everyone is anxious in one or the other way. Anxiety presents with

symptoms like excessive worry, persistent worry panic, fear of any

object/situation, obsessions, compulsions etc.

Anxiety is a normal phenomenon which is characterized by a

state of apprehension unease arising out of anticipation of danger. A

normal anxiety becomes pathological when it causes significant

subjective distress or impairment of functioning of an individual.

As many of the anxieties are often curable either by proper

councelling or with the help of medication or by both. So here we are

trying an attempt to show the efficacy of homoeopathy in the

treatment of anxiety disorders.

Anxiety has become very common now a days, due to busy –

fast life and affecting out younger generation, so we need to treat i t

in all possible ways. So here I shall try the dynamic way of treatment

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(ie “Homoeopathy”) of an anxious human mind.

6.2 REVIEW OF LITERATURE:

HISTORY:

Anxiety goes back to our very beginning. Greeks had words for

many conditions l ike mania, hysteria, malencholy but they had no

word for anxiety. They used word “Anesuchia” meaning “Not quiet”,

“Not calm”

The roman’s used the word “anxietas” which indicate a testing

state of fearfulness.

Latin “Angustia” (narrowness) and French “Angoisse”, German

“Angust” were the other word used similar to anxiety.

In 17 t h century English writer Richard Younge (1671) in his

Skettches mentioned anxiety conditions. Flecknoes wrote of “anxiety

states” describe an “irresolute person” that one trouble herself with

every thing”.

In 18 t h century Battie’s describe anxiety and madness with

their relations.

In 19 t h century Jules Angst mentioned a German physician Otto

Domerich who wrote about anxiety attacks and considered

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combination of anxiety and cardiopulmonary symptoms.

EPIDEMIOLOGY:

Incidence and Prevalence

Anxiety is a common complaint, every one is anxious in one or

other way but when anxiety becomes pathological, it is to be

considered seriously.

It is very difficult to consider the percentage of human

population suffering from anxiety because, the anxiety intermingled

with other syndromes and rarely single in clinical presentation. So

they should be well differentiated, especially in a co-morbid

presentation.

As anxiety disorders mainly affects the younger individuals, so

the study is important both as personal and public health concern.

Generalized anxiety disorders(GAD) – 3.8%

Obsessive compulsive disorders (OCD) – 9.2%

Panic disorders – 1.7% (life t ime prevalence)

to

3.5%

Social phobia – 2.4% to 13%

Specific phobia – 8.8% to 12.5%

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Post traumatic stress disorder – 7% (ICD – 10)

The prevalence of any of these anxiety disorders fluctuates so

the percentage of population suffering is difficult to mention.

Diagnostic and statist ical manual of mental diseases (DSM-IV) and

International classification of diseases (ICD-10) have given different

prevalence.

Classification of Anxiety Disorders:

International statist ical classification of diseases and related

health problems has described anxiety disorders under neurotic –

stress – related and somatoform disorders (from F40 to F48).

F40 – Phobic anxiety disorders

F41 – Other anxiety disorders

F41.0 – Panic disorders (episodic paroxysmal anxiety)

F41.1 – Generalized anxiety disorders

F42 – Obsessive compulsive disorders

F43 – Reaction to severe stress and adjustment disorders

F43.0 – Acute stress reaction

F43.1 – Post traumatic stress disorder

F43.2 – Adjustment disorders

Pre-disposing factors for anxiety disorders:

1. Genetic Factors: Panic, phobic, OCD are more common among

degree relatives of patients.

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2. Physical Disease: The possible physical causes which can

mimic l ike anxiety should be ruled out. Physical problem can

also co-exist with the anxiety.

3. Psychological trauma: Experience of a mental trauma may

cause or exaggerate the condition.

4. Absence of coping mechanism: Deficit in coping responses

coupled with a negatively distorted view of ability to cope can

cause anxiety to persist for long time.

5. Irrational thoughts, assumptions and cognitive processing

errors.

Precipitating factors for anxiety:

1. Physical problems or toxic substances.

2. Severe external stressors

3. Long term stress

4. Chronic health problems.

Clinical Features:

Symptoms of GAD

- Tremors, twitchings, muscular tension, backache, headache,

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feeling of constriction of chest, fatigue, parasthesia.

- Palpitations, dry mouth, dysphagia, flatulence, diarrhoea.

- Shortness of breath, tachypnoea.

- Urinary frequency, loss of erection, menstrual disturbance.

- Flushes, apprehension, difficulty in concentration, irri tability.

- Insomnia, lack of appetite, loss of libido.

Panic Disorders:

- Palpitation, shortness of breath, sweating, choking sensation,

parasthesia, tremors, dizziness, fear that he is going to die.

Phobic Disorders:

- Agoraphobia, social phobias, specific phobias.

- Irrational fear of objects, si tuation etc.

OCD:

- Obsession in form of thoughts, ruminations, doubts, impulses

eg – having or not locked the door, posted a letter.

- Compulsions like washing frequently, checking, cleanliness,

etc.

Post traumatic stress disorders:

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- Hyperarousal.

- Intrussions

- Avoidance

Acute stress disorders:

- Anxiety

- Depression

- Both anxiety and depression

- Sweating

- Palpitation

- Trembling

- Restlessness

- Insomnia.

Diagnostic Criteria:

GAD:

i . Anxiety and worry in excess occurring more days than not

for atleast 6 months.

ii. Person finds difficult to control the worry.

iii . Symptoms at least 3 or more of following

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- Restlessness

- Easily fatigued

- Difficulty in concentrating mind.

- Irritabili ty

- Muscle tension

- Sleep disturbance

iv. Features excluding all other anxiety and mental, physical

diseases.

PANIC DISORDERS

- Recurrent panic attacks

- At least one of the attack has been followed by 1 month (or

more) of one (or more) of following –

(a) Persistent concern about having additional attack

(b) Worry about implication of attack and its consequences

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(c) Significant changes in behavior related to attack.

(d) Absence of agoraphobia.

(e) Not due to drug abuse/medications, other medical conditions.

(f) Panic attack not better accounted for by other phobias, OCD,

Post traumatic stress disorders, etc.

PHOBIC DISORDERS

- Social Phobia

(a) Persistent fear for performance situation.

(b) Exposure to social situation provokes anxiety.

(c) Recognition that fear is excessive and unreasonable.

(d) Avoidance of si tuation is present.

(e) Excluding other medical / drug abuse conditions.

SPECIFIC PHOBIA

(a) Marked persistent fear, excessive, reasonable caused by

presence or anticipation.

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(b) Exposure to phobic stimulus causes immediate anxiety

response.

(c) Person recognizes that the fear is excessive and unreasonable.

(d) Phobic situation is avoided.

OCD

(a) Recurrent thoughts, impulses, images.

(b) Person attempts to suppress them

(c) Person knows that these are the produce of his own mind.

Compulsions:

(a) Repeated behaviors (like washing, checking)

(b) Behavior is due to or aimed to preventing or reducing distress.

Differential Diagnosis:

GAD

(a) Bipolar mood disorders.

(b) Schizophrenia.

(c) Adjustment disorders

(d) Substance related disorders.

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Panic Disorders

(a) GAD

(b) Depressive disorders

(c) Somatoform disorders

(d) Hyper and Hypothyroidism.

(e) Mitral valve prolapse

(f) Arrythmias

(g) Epilepsy

Phobic Disorders

(a) GAD

(b) Depression disorders

(c) Panic disorders

(d) Delusional disorders

OCD

(a) Schizophrenia

(b) Depression

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(c) Phobia

HOMOEOPATHIC APPROACH

Homoeopathy is based on the totality of symptoms, not merely on

the condition. Hahnemann has classified mental diseases into – under

–

“One sided disease”

Mental symptoms Physical symptoms

These are divided into 4 types

1. Somato-psychic diseases (Apho 216) in these diseases corporeal

symptoms decline with derangementt of mind

Treatment – Considering both physical and mental totality and

selecting a similimum

2 . Acute flurrying internal psora due to fright, vexation, liquor.

Treatment – Considering corporeal and mind symptom in a person, an

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acute remedy is given.

3. Mental disease of doubtful origin (Aphorism – 224) really arose

from corporeal affection or did not rather result from fault of

education, bad practice, corrupt model.

Treatment – Display of confidence, friendly exhortations, sensible

advice will bring down the emotional upset, if it does not work,

antipsoric medicine is given.

4. Psychosomatic Diseases (Apho 225) – Emotional disturbances

like continued anxiety, worry, vexation and frequent occurance of

great fear / freight in course of time leads to physical diseases.

Treatment – In this disease display of confidence, friendly

exhortation, sensible advice will bring down his emotional upset. If

it does not help the person, deep antipsoric medicine is given.

Homoeopathy considers that health is intimately connected to

understanding the mind in general. Mind and body are dynamically

interconnected. Some psychological symptoms arise from

physiological process and vice versa. So we consider the patient as a

whole.

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Homoeopaths / biologists says organisms respond to stress in ways

that primarily fascilitate survival. Mental state of the individual is

vital for the person’s survival as it governs the ability to respond to

stressful or life threatening situations.

Some of the homoeopathic remedies of anxiety disorders

Aconite – Remedy for panic attacks, coming suddenly. There is

immense anxiety accompanied by strong palpitations, shortness of

breath, flushing of the face. Restlessness, unquenchable thirst etc.

Argentums nitricum – Anxiety developing before a big event l ike

public speech, social engagement etc. emotional upset, fear,

dizziness, diarrhea craving for sweets and salts.

Arsenic Album – Anxious about health, fastidious, panic attack of

mid night with restless, anxious moves, obscessions and compulsions

with irritabil ity. Thirst for frequent small drinks. Sleepiness but

insomnia.

Calcarea carb – Chilly pts, easily fatigued agitated by worry or bad

news, dead of disaster, fear of height, claustrophobia. Increased

perspiration, dizziness, nausea, night sweats, anxiety of health etc.

Lycopodium – Anxiety from mental stress. Suffers from lack of

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confidence, they can feel anxiety and fear of failure, when they take

on responsibili ty, shaking of head without an apparent course,

irritabil ity, claustrophobia breaking down under stress

Note : Natrum mur, gelsemium, kali phos, ignatia, phosporus

pulsati lla, si licea can also be used according to symptoms totality

6.3 OBJECTIVES OF THE STUDY

1. To study the effectiveness of homoeopathic medicines in

the treatment of anxiety disorders.

2. To study the role of miasms in the development of

anxiety disorders.

MATERIALS AND METHODS:

7.1 Source of Data:

The subjects will be selected from OPD’s and peripheral

centres of Father Muller Homoeopathic Medical College, Mangalore

A minimum of 30 cases will be selected randomly as per the

inclusion criteria and will be followed for a minimum period of 3

months duration

7.2 Method of Collection of Data:

The materials used for the study

The data will be collected by purposive sample methods and

processed in the standardized case record.

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Every case will be analyzed with reference from materia medica,

repertory therapeutics, whenever, required.

Each case will be evaluated according to scoring criteria, which

includes the intensity of the symptoms before and after the treatment

INCLUSION CRITERIA :

• The sample of both sexes of 5-65 age groups

• Diagnostic criteria is based mainly on clinical presentation

Exclusion Criteria:

• Other psychotic disorders

• Manic episodes

• OCD’s with psychotic symptoms etc

Research hypothesis

Homoeopathic medicines are effective in the treatment of anxiety

disorders.

Null hypothesis

There is no significant difference in the scoring criteria before

and after the treatment

Does the study requires any interventions to be conducted on

patients or other humans

No, the study does not require any investigations

Has ethical clearance been obtained from your institutions in case

of ABOVE.

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- Yes, enclosed

8. LIST OF REFERENCES:

1. ICD -10- International classification of mental and behavioral

disorders.(P 319-321)

2. AHUJA NIRAJ –A short Text book of psychiatry 6th edition.

New Delhi. Jaypee publishers (P) LTd

3. DAN. J, STEIN,, ERIC HOLLANDER,Text book of anxiety

disorders, American pychiatric publishing (P-3-10)

4. SARKAR.B.K, organon of medicine

5. HAHNEMANN SAMUEL,Organon of medicine 6th edition,

Delhi, Indian book and periodical publisehrs (P) Ltd.

6. VITHOULKAS GEORGE 2007. The essence of materia medica.

B. Jain Publishers

7. www.similina com.

8. www.hpathy com.

9. DHAWALE M.L – Principle and practice of homoeopahtic 3rd

edition 2000, Institute of clinical research Bombay

10. LUIS DETNI MD, Mental symptoms in homoeopathy, 2007,

Reed Elsevier Pvt. Ltd. New Delhi.

11. GALLAVARDIN JEAN PIERRE , Psychism and homeopathy,

3rd edition , Ist edition 1982 World homoeopahtic links, New

Delhi.

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12. TALCOTT HAINES SELDEN ,Mental diseae and their modern

treatmetn indian edition, B.Jain Publishers.

13. HAROLD MD, KAPLAN I BENJAMIN SADDOCK J Synopsis

of psychiatry, 7th edition, B.I Wawerly (pvt.) l td. New Delhi

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9. Signature of the candidate

10. Remarks of the guide

11. Name and Designation of

(in block letters)

11.1 Guide

DR. JACINTHA MONTERIO

M.D. (Hom)

ASSISTANT PROFESSOR

DEPARTMENT OF PSYCHIATRY FATHER. MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,

DERALAKATTE, MANGALORE.

11.2 Signature

11.3 Head of the Department DR. JACINTHA MONTERIO

M.D. (Hom)

ASSISTANT PROFESSOR

DEPARTMENT OF PSYCHIATRY FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,

DERALAKATTE, MANGALORE

11.4 Signature

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12. 12. 1 Remarks of the Chairman and Principal

12.2 Signature

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