RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE & ADDRESS |DR.SHANKAR BABU B.S. |

| | | |

| | |DEPARTMENT OF PSYCHIATRY, |

| | |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, |

| | |UNIVERSITY ROAD,DERALAKATTE, |

| | |MANGALORE-574160 |

| | |KARNATAKA |

| | | |

| | |S/O B.S.SRINIVAS |

| | |UMA PROVISION STORES,CHELUR ROAD, |

| |PERMANENT ADDRESS |CHINTAMANI |

| | |KARNATAKA-563125 |

|2. |NAME OF THE INSTITUTION |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, |

| | |DERALAKATTE, MANGALORE - 574160 |

|3. |COURSE OF THE STUDY & SUBJECT |M .D.(HOM) |

| | |HOMOEOPATHIC PSYCHIATRY |

|4. |DATE OF ADMISSION TO THE COURSE |17.06.09 |

|5. |TITLE OF THE TOPIC |

| |“ AN ENDEAVOR IN UNFOLDING THE ESSENCE OF UNIPOLAR MOOD DISORDER IN GERIATRIC AGE GROUP AND IT’S HOMOEOPATHIC |

| |MANAGEMENT.” |

|6. |BRIEF RESUME OF THE INTENDED WORK |

| |6.1 Need For The Study: |

| |Uni-polar mood disorder is a type of mood disorder characterized by severe and debilitating depressive episodes of Clinical |

| |Depression or Major Depression. Like its sister disorder (Bipolar Disorder) which consists of cycles of maniac (high) and |

| |depressive (low) symptoms, Unipolar Disorder does not.8 |

| | |

| |Uni-polar mood disorder or depression is the leading cause of disability as measured by YLDs(Years lost due to disability) and the|

| |4th leading contributor to the global burden of the disease(DALYs-Disability Adjusted Life Years)in 2000.By the year 2020 |

| |depression is projected to reach 2nd place of the ranking of DALYs calculated for all ages, both sexes.7 |

| | |

| |In 1950 very elderly age group made up 13% of the over 65 age group in more developed countries but by 2050 projected to make up |

| |32%.Similarly in developing and less developed countries in 1950 it was 8% which is projected to be 20% by 2050.7 |

| | |

| | |

| |Life expectancy in india has increased from 32years in 1947 to 65 and above(national health policy-2002).Geriatric patients with |

| |DEPRESSION attending psychiatric clinics have increased in the last decades which is really a matter of concern for health |

| |professionals, social scientists and planners.8 |

| | |

| |Majority of the times depression remains undiagnosed and untreated in geriatric age group because of the wrong belief that it is a|

| |part of normal aging.7 Thus this study is an attempt to understand more clearly about depression, its causative factors and its |

| |homeopathic management in geriatric age group. |

| | |

| |6.2 Review of the Literature: |

| |HISTORY: |

| |People have recorded instances of depression since antiquity.About 400BC,Hippocrates used the terms mania and melancholia to |

| |describe mental disturbance. |

| |Around 30AD,the roman physician Celsus described melancholia(from greek melan “black”and chloe “bile”in his work De re medicina as|

| |a caused by black bile depression).5 |

| | |

| |The 11th century physician Avicenna described melancholia as a depressive type of mood disorder in which the person may become |

| |suspicious and develop certain types of phobias. |

| | |

| |The term depression was derived from the Latin verb deprimere, "to press down" From the 14th century, "to depress" meant to |

| |subjugate or to bring down in spirits. It was used in 1665 in English author Richard Baker's Chronicle to refer to someone having |

| |"a great depression of spirit".8 |

| | |

| |During the 18th century, German physician Johann Christian Heinroth, however, argued melancholia was a disturbance of the soul due|

| |to moral conflict within the patient.In 1854,Jules falret described a condition called folie circulaire, in which patients |

| |experience alternating moods of depression and mania. |

| | |

| |Kraeplin also described a depression that came to be known as involutional melancholia,which has since come to be viewed as a form|

| |of mood disorder that begins in late adulthood.8 |

| | |

| | |

| |EPIDEMIOLOGY: |

| | |

| |Incidence and Prevalence: |

| | |

| |Prevalence of unipolar disorder or depression is 10% for those >65 years,with 2-3% being severe.Rates of depression differ |

| |depending on setting:0.5-1.5% in the community,5-10% of clinical outpatients,10-15% of clinical inpatients,15-30% of those in |

| |residential and nursing homes. The mean age of onset ,from a number of studies is in the late 20’s.Because people who have one |

| |episode of depression may have more in the future,the first time a young person becomes depressed is important both as a personal |

| |and public health concern.7 |

| | |

| | |

| |CLASSIFICATION: |

| |INTERNATIONAL CLASSIFICATION OF MENTAL AND BEHAVIORAL DISORDERS (ICD – 10) |

| | |

| |In ICD-10, under MOOD(affective) disorders F30-F39,unipolar disorder or depression is discussed under F32-the depressive episode..|

| | |

| |F32 DEPRESSIVE EPISODE1 |

| | |

| |F32.0 –MILD DEPRESSIVE EPISODE |

| |{F32.0-without and F32.01 with somatic syndrome} |

| |F32.1- MODERATE DEPRESSIVE EPISODE |

| |{F32.10-without somatic syndrome and F32.11 with somatic syndrome} |

| |F32.2-SEVERE DEPRESSIVE EPISODE WITHOUT PSYCOTIC SYMPTOMS |

| |F32.3- SEVERE DEPRESSIVE EPISODE WITH PSYCOTIC SYMPTOMS |

| |F32.8-OTHER DEPRESSIVE EPISODES |

| |F32.9-DEPRESSIVE EPISODE,UNSPECIFIED.1 |

| | |

| |DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDER (DSM) CLASSIFICATION : |

| | |

| |In DSM- IV TR (fourth edition, text revision), it has been included under Axis I. |

| |Depressive disorders:- |

| |1.MILD DEPRESSIVE EPISODE-296.21 |

| |2.MODERATE DEPRESSIVE EPISODE-296.22 |

| |3.SEVERE DEPRESSIVE EPISODE WITHOUT PSYCOTIC SYMPTOMS-296.23 |

| |4.SEVERE DEPRESSIVE EPISODE WITH PSYCOTIC SYMPTOMS-296.24.2 |

| | |

| |ETIOLOGY: |

| |1.Biochemical factors: |

| |Many studies have reported abnormalities in biogenic amine trans metabolities such as |

| | |

| |5-hydroxyindolacteic acid, homovanillic acid in blood, urine and cerebrospinal fluid of patients with mood disorders.6 |

| | |

| |2.Genetic factors: |

| |Genetic data strongly indicate that a significant genetic factor is involved in the development of a mood disorder, Prevelance |

| |rates in first degree relatives of mood disorder are-25%in bipolar disorders ,20% in unipolar disorders.6 |

| | |

| |3. Neuroendocrinal factors: |

| |The abnormal regulation of neuroendocrine axis may result from abnormal functioning of biogenic amine-containing neurons.The |

| |major endocrine axis of interest in mood disorders are adrenal,thyroid and growth hormone axis.6 |

| | |

| |4.Social factors: |

| |In explaining why people of low socio-economic status (i.e. low levels of income, employment,and education) are at demonstrably |

| |higher risk of depression,2 main arguments exist; Social causation stress associated with such problems leads to depression.6 |

| | |

| |5.Age &Development factors: |

| |Even though all age groups have been affected, more commonly seen in late adulthood and geriatric age group (above 65 years) many |

| |of the times it remains undiagnosed. Some studies have shown that developmental conflicts, childhood trauma & abuse have been |

| |frequently associated with the vulnerable temperaments.6 |

| | |

| |CLINICAL FEATURES:- |

| |1.Inability to concentrate or make decisions. |

| |2.Apathetic or flat emotional behavior |

| |3.Irritability, nervousness, anxiety |

| | |

| |4.Decreased energy, feeling persistently fatigued |

| |5.Sadness, hopelessness, low self-esteem, feelings of worthlessness |

| |6.Withdrawal from social and family activities |

| |7.Decreased sexual desire and activity |

| |8.Suicidal thoughts, talk of suicide or planning for suicide attempt |

| |9.Disturbance in eating or sleep habits, trouble falling asleep or staying asleep, or sleeping excessively.8 |

| |Some of the striking symptoms in geriatric age group depression are- 7 |

| |1.Psycomotor retardation-in 30% cases |

| |2.Cognitive impairment -in 70% cases |

| |3.Depressive delusions regarding poverty,physical illness,nihilistic in nature. |

| |4.Paraonia is more common.7 |

| |DIAGNOSTIC CRITERIAS |

| |1.The typical symptoms of unipolar mood disorders are person suffers from depressed mood ,loss of interest and enjoyment and |

| |reduced energy leading to increased fatiguability and diminished mon symptoms are reduced concentration, |

| |attention,self esteem & self confidence.Other symptoms like ideas of guilt,unworthiness,bleak,pessimistic views of future,acts of |

| |self harm ,suicide,disturbed sleep and diminished apetite are present.1 |

| | |

| |2.In case of mild depressive episode-2 of the typical symptoms and atleast 2 of the |

| |common symptoms described above should be present for a definite diagnosis. Minimum duration of the whole episode is about 2 |

| |weeks.1 |

| | |

| | |

| |3.In case of mild depressive episode without somatic syndrome-criteria for mild depressive episode has to be fulfilled and there |

| |are few or none of the somatic symptoms present.1 |

| | |

| |4. In case of mild depressive episode with somatic syndrome-criteria for mild depressive episode has to be fulfilled and there are|

| |Four or more of the somatic symptoms present.1 |

| | |

| |5.In case of moderate depressive episode-2 of the typical symptoms noted for mild depressive episode should be present,plus |

| |atleast 3 of the common symptoms should be present.Minimum duration of whole episode is 2 weeks.An individual will usually have |

| |considerable difficulty in continuing with socialwork or domestic activities.1 |

| | |

| |6.In case of severe depression –all the typical symptoms noted for mild and moderate depression should be present plus atleast |

| |four other common symptoms of severe intensity should be present.1 |

| | |

| |DIFFERENTIAL DIAGNOSIS: |

| | |

| |Other psychiatric disorders, stress - related disorder, bipolar disorder, anxiety disorder,adjustment disorder,phobias & mood |

| |disorder. |

| |Neurological disorders dementia, epilepsy, stroke, tumour, Parkinson’s disease. |

| |Endocrinedisorders-addisonsdisease, cushingsdisease, hyper/hypo thyroidism, premenstrual syndromes, neopausal syndromes, |

| |hypopituitarism. |

| |Schizophrenia (negative symptoms), personality disorders. |

| | |

| |HOMOEOPATHIC APPROACH : |

| |Homoeopathy is based on the totality of symptoms, not merely on the condition. Dr. Hahnemann classifies the mental diseases and |

| |gives brief guidelines of their treatment in 6th edition of organon of medicine (Aphorism 210 – 230).9,14 |

| | |

| |Hahnemann has classified mental disease under – |

| |“One sided disease” |

| |( |

| |Mental symptoms ( Physical symptoms |

| |( |

| |These are divided into 4 types- |

| |1.Somato – psychic diseases ( Aphorism 216) |

| |Treatment consists of selection of similimum on the basis of corporeal and mental symptoms in a person followed by an antipsoric |

| |remedy.14 |

| | |

| |2.Acute flurrying (Aphorism 221) |

| |Acute remedy is selected first on the basis of corporeal and mental symptoms followed by an antipsoric remedy, is the suggested |

| |way of the treatment.14 |

| | |

| |3.Mental diseases of doubtful origin (Aphorism 224) |

| |In these types of diseases, display of confidence, friendly exhortations and sensible advice is to be given to |

| |bring down the emotional upset, and if it does not help, a deep antipsoric remedy, has been suggested as the |

| |proposed mode of treatment.14 |

| | |

| |4.Psychosomatic disease (Aphorism 225) |

| |Treatment consists of display of confidence, friendly exhortations, sensible advice to bring down the emotional |

| |upset, and if it does not help , a deep antipsoric remedy is prescribed.14 |

| | |

| |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. |

| | |

| | |

| |In homoeopathic materia medica there are number of remedies for unipolar disorder but totality of an individual |

| |helps us to find out the similimum, the most commonly used remedies for unipolar disorder or depression are |

| |as follows- |

| | |

| |NATRUM MURIATICUM |

| |Pathology is introversion arising out of a feeling of great vulnerability to emotional injury. |

| |Sensitive, so feel hurt by slightest comment or gesture that might imply ridicule or rejection. |

| |They can become quite content in their isolation. Gradually, they come to the point of not needing contact with outside world. |

| |Anxiety,brooding about past grievances,migraines,back pain,and insomnia can also be experienced when the person is depressed.11 |

| | |

| |IGNATIA AMARA |

| |Supression of emotion after death ,separation of affair. |

| |Sensitive people who suffer grief or disappointment and try to keep the hurt inside may benefit from this remedy. |

| |Wanting not to cry or appear too vulnerable to others ,they may seem guarded,defensive,and moody.11 |

| | |

| |AURUM METALLICUM |

| |This remedy can be helpful to serious people,strongly focused on work and achievement ,who become depressed if they feel they have|

| |failed in some way. |

| |Feel them separate from world. |

| |Feel worthless and failure in life,suicidal thoughts.11 |

| | |

| |STAPHYSAGRIA |

| |Quiet,sensitive,emotional people who have difficulty standing up for themselves may benefit from this remedy. |

| |In staphysagria there is a kind of sweetness in the face of grief.11 |

| | |

| | |

| |SEPIA |

| | |

| |People who feel weary,irritable and indifferent to family members and worn out by the demands of everyday life may respond to this|

| |remedy. |

| |They want to be left alone and may respond in an angry or cutting way if anyone bothers them. |

| |Sepia patient has been broken down by his excessive excitability,becom fatigued,mentally dull and apathetic.11 |

| | |

| |CAUSTICUM |

| | |

| |A person who feels depressed because of grief and loss. |

| |Frequent crying or a feeling of mental dullness and forgetfulness. |

| |People who are deeply sympathetic towards others and have a strong sense of justice ,can be deeply discouraged or angry about the|

| |world.11 |

| | |

| |Other remedies for unipolar mood disorder are as follows: |

| |Ambr,Anac,Arg-nit,Ars,Calc,Caust,Cimic,Clem,Gels,Kali-phos,Nat-c, |

| |Lil-t,Verat,Sulph,Hell. |

| | |

| | |

| |OBJECTIVE OF THE STUDY: |

| | |

| |1.To study the effectiveness of homoeopathic remedies in the treatment of UNIPOLAR MOOD DISORDER or DEPRESSION IN GERIATRIC AGE |

| |GROUP. |

| | |

| |2.To study and to represent about various causative factors leading to the development of unipolar mood disorder in geriatric age |

| |. |

| | |

|7. |MATERIALS AND METHODS: |

| | |

| |7.1 Source of Data: |

| |A sample of 30 cases will be taken from OPD, IPD cases and peripheral clinic of Fr. Muller Homoeopathic Medical College, Mangalore|

| |as per inclusion criteria. |

| | |

| |7.2 Method of collection of data : |

| |The Materials used for the study: |

| | |

| |The data will be collected by purposive sample method and processed in a standardized case record. All case processing to be done |

| |in SCR pattern of recording. All the cases will be followed up for a minimum of 3 months duration. |

| |Every case will be analyzed with reference from Materia Medica, Repertory and therapeutics whenever required. |

| |Each case will be evaluated according to the scoring criteria, which includes the intensity of the symptoms before and after the |

| |treatment. |

| | |

| |Inclusion Criteria: |

| |The sample of both sexes of age group above 65 years . |

| |Diagnostic criteria are based mainly on clinical presentation. |

| | |

| |Exclusion Criteria: |

| |Cases of maniac episode. |

| |Other psychotic disorders. |

| | |

| |Research Hypothesis : |

| |Homoeopathic medicines are effective in treatment of unipolar mood disorder in geriatric age group. |

| | |

| |Null Hypothesis: |

| |There is no significant difference in the scoring criteria before and after the treatment. |

| |The significance in parameters will be tested by student‘t’ test for continuous numerical values. |

| | |

| |7.3 Does the study require any investigations to be conducted on patients, or other humans (or animals)? If so please describe |

| |briefly. |

| |No, the study doesn’t require any investigation. |

| | |

| |7.4 Has ethical clearance been obtained from your institution in case of 7.3? |

| |Yes, enclosed. |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|8. |LIST OF REFERENCES: |

| |1.ICD-10: International classification of mental and behavioral disorders.(Pg 119-124) |

| | |

| |2.DSM - IV TR, Diagnostic and Statistical Manual of Mental disorders, 4th ed., text revision. |

| | |

| |3.AHUJA NIRAJ –A short Text book of psychiatry 6th edition. New Delhi. Jaypee publishers (P) LTd.(pg:74-89) |

| | |

| |4.Vyas J.N, Niraj Ahuja. Textbook of Postgraduate Psychiatry. Vol. 1, 2nd Ed. New Delhi: Jaypee Brothers Medical Publishers (P) |

| |Ltd. 1999.(pg:187-213) |

| | |

| |5.Sadock Benjamin James, Sadock Virginia Alcott. Kaplan and Sadock’s Synopsis of Psychiatry, behavioral Sciences / Clinical |

| |Psychiatry. 10 ed. Philadelphia: Lippincott Williams & Wilkins.(pg:527 -562) |

| | |

| |6.Sadock Benjamin James, Sadock Virginia Alcott. Kaplan and Sadock’s Comprehensive textbook of Psychiatry. Vol. 1, 8th ed. |

| |Philadelphia: Lippincott Williams & Wilkins, 2005,( pg:1559 -1717) |

| | |

| |7.Oxford Handbook Of Psychiatry,first Indian edition -2005,Oxford University Press(pg-469-494) |

| | |

| |8.en.wiki/depression. |

| | |

| |9. Hahnemann Samuel. Organon of Medicine, 6th ed. Trans. William Boericke. Reprinrt ed. Delhi: B. Jain Publishers (P.) Ltd. 2002, |

| | |

| |10. Schmidt Pierre. The Art of Interrogation. 1st Ed. New Delhi: B. Jain Publishers (p) Ltd. |

| | |

| |11.Vithoulkas George. The essence of Materia Medica. Reprint Ed. New Delhi: B. Jain Publishers (P) Ltd. 1996. |

| | |

| |12.Allen H. C. Keynotes and Characteristics with Comparisons with Bowel Nosodes. Reprint ed. New Delhi: B. Jain publishers (P) |

| |Ltd. 2002. |

| | |

| |13. Kent James Tyler. Lectures on Materia Medica. Low priced ed. New Delhi: B. Jain publishers (P) Ltd. 2002. |

| | |

| |14.Sarkar B.K. Organon Of Medicine 9th edition .New Delhi-Birla publications.(pg-413to418) |

| | |

| |15. Arumugam V. K. Human mind and homoeopathy, new approach to selection of remedy and pattern of 174 remedies. Economy ed. |

| |Chennai: Hahnemann publication, 2003, |

| | |

| |16.Dr.Andre Saine.Teachings.Vol I&II-Psychiatric patients and Pure classical homoeopathy. New Delhi: B. Jain publishers (P) |

| |Ltd.2006. |

|9. |SIGNATURE OF CANDIDATE | |

|10. |REMARKS OF THE GUIDE | |

|11. |NAME & DESIGNATION OF |DR JACINTHA MONTEIRO |

| |(IN BLOCK LETTERS) |B.H.M.S, M.D. (HOM), |

| |11.1 GUIDE |ASSISTANT PROFESSOR, |

| | |DEPARTMENT OF PSYCHIATRY, |

| | |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, |

| | |DERALAKATTE, MANGALORE. |

| |11.2 SIGNATURE | |

| |11.3 CO-GUIDE | |

| |11.4 SIGNATURE | |

| |11.5 HEAD OF THE DEPARTMENT |DR JACINTHA MONTEIRO |

| | |B.H.M.S, M.D. (HOM), |

| | |ASSISTANT PROFESSOR, |

| | |DEPARTMENT OF PSYCHIATRY, |

| | |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, |

| | |DERALAKATTE, MANGALORE. |

| |11.6 SIGNATURE | |

|12. |12.1 REMARKS OF THE | |

| |CHAIRMAN& PRINCIPAL | |

| |12.2 SIGNATURE | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download