A case report on the impact of homoeopathic intervention in psychosis

INTRODUCTION

Psychosis is defined as a mental disorder in which the thoughts, affective response, ability to recognise reality, and ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality; the classical characteristics of psychosis are impaired reality testing, hallucinations, delusions, and illusions.^[1]

Moreno-Küstner et al. suggests that the descriptive results of the pooled median global prevalence of psychotic disorders were 4.6/1000 persons, while the median point and 12-month prevalence was 3.89 and 4.03/1000 persons, respectively, and the median lifetime prevalence was 7.49/1000 persons.^[2]

A study conducted in Kerala suggests that the prevalence of psychosis was 0.7%.^[3] As per National Mental Health Survey (NMHS) 2015–2016, the age group between 40 and 49 years was predominantly affected. The gender prevalence of psychotic disorders was nearly similar (lifetime: male: 1.5%; female: 1.3%; current: male: 0.5% and female: 0.4%). Residents from urban metros had a greater prevalence across the different disorders. Data from the NMHS reveal that mental disorders were significantly higher in households with lesser income, poor education and limited employment.^[4]

Psychotic disorders are associated with substantial premature mortality,^[5,6] morbidity^[7], and a large social and financial burden.^[8] The economic cost of care for a person with a mental disorder, mainly as out-of-pocket expenditure, reveals a huge burden, while the hidden and intangible costs are difficult to monetise.^[4] Socioeconomic deprivation, inequality, and instability are also associated with increased incidence.^[9,10]

Antipsychotics are considered the first-line agents for acute and maintenance therapy of psychotic disorders. It can be of great benefit in a range of psychiatric disorders, including schizophrenia and bipolar disorder, but all are associated with a wide range of potential adverse effects. These can impair quality of life, cause stigma, lead to poor adherence to medication, cause physical morbidity, and, in extreme cases, be fatal.^[11] Second-generation antipsychotics (SGAs) or atypical antipsychotics were considered to be more effective and safer than typical or first-generation antipsychotics (FGAs).^[12-15] Many studies have concluded that olanzapine, risperidone, clozapine, and pooled SGAs caused significantly less extrapyramidal side effects akathisia than FGAs but showed larger weight gain and caused metabolic syndromes than FGA comparators.^[16-18]

Thus, the limitations of existing antipsychotic drugs to alleviate all of the pathologic dimensions of the illness (i.e., negative symptoms, cognitive deficits, and social disabilities) have produced awareness that no single treatment may be sufficient. There is a need for an alternative treatment that will do more good than harm or one that can be used adjunctively with antipsychotic drugs.

The Brief Psychiatric Rating Scale (BPRS) is one of the most frequently used instruments for evaluating psychopathology in patients with psychotic disorders. It was developed in the early 1960s by John E.Overall and Donald R Gorham, using factor analysis. It is designed to assess the severity of psychotic states, with the aim of providing clinicians a way to quickly assess changes in the patient’s mental status. Each of the 18 items is designed to represent a discrete symptom area. Items are rated on a 7-point Likert scale, from 1 = ‘not present’ to 7 = ‘extremely severe,’ with scores ranging from 18 to 126 (achieved through summing the item scores).^[19]

Homoeopathy is a therapeutic method that has proved useful in many psychiatric conditions involving psychosis. There are published papers that show the usefulness of homoeopathy as a stand-alone treatment as well as an add-on treatment, which shows marked improvement.^[20-22]

We report a case involving a woman of age 62 years who was diagnosed with psychosis not otherwise specified (NOS). The outcome was assessed with the help of BPRS scale in every follow-up visit.

The patient visited the psychiatry outpatient department (OPD) of a tertiary care hospital in Kerala with complaints that met the criteria of psychosis on the basis of the International Classification of Diseases, Tenth Revision (ICD-10) Diagnostic Criteria for Research.

Consent was obtained from the caregiver. Case taking was done followed by analysis and evaluation of the symptoms with framing of the totality of the symptoms. Synthesis repertory was preferred, and using Radar Opus software, repertorisation was done. Medicine was selected after referring to Materia Medica, based on the very prominent presenting complaints and generals of the patient. A single medicine was prescribed, as and when required with a minimum dose. Assessment of the symptom severity was done by BPRS with the help of the Consultant Psychiatrist of the Institution. The BPRS was assessed every month. The assessment of BPRS is shown in Table 1. The Modified Naranjo Criteria for Homoeopathy– Causal Attribution Inventory was used for assessing the likelihood of a causal relationship between a homoeopathic intervention and clinical outcome. It is shown in Table 2. The strength of association between the medicine and outcome was assessed by the following criteria: definite: ≥9; probable 5–8; possible 1–4 and doubtful ≤ 0.^[23]

After improvement started, the patient was put on a placebo. Repetition of medicine was done according to the principles of homoeopathy.

CASE REPORT

A woman of age 62 years came with complaints of sleeplessness, self-talking, fearfulness, hearing voices of neighbors and undue suspicions that people were talking about her, weeping spells, and frequent hurling of abuses at neighbors. She was showing increased religiosity and also had a poor appetite for a month.

DISCUSSION

Through years of hard work and experience, Hahnemann in Organon of Medicine has laid down the pivotal guidelines for the treatment and management of mental diseases in aphorisms 210–230.^[25] The causative factor for this case is explained under the aphorism 221. To get complete recovery, the patient must be treated with homoeopathic anti-psoric drugs for long periods. However, since the patient was treated with conventional medicines for a long period, we could not get the exact picture. Hence, with the available presenting symptoms, repertorial totality was erected. A few disease symptoms were also added for repertorisation. This was done to confirm that individualistic medicine is similar to the disease as well. The remedy was selected after consultation with Homoeopathic Materia Medica. Repertorisation chart is shown in Figure 1. Lachesis came up first in the repertory chart, followed by Hyoscyamus niger and Veratrum album.

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Figure 1:

Repertorial chart.

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The prominent features such as paranoia, restlessness, fear, sleeplessness, increased religiosity, loquacity, and hot thermal state were sustained for prescribing Lachesis. Even though H. niger is also suspicious and talkative. The important characteristics and symptoms such as obscenity, foolish talk as well as behaviour and great hilarity were not present in the patient. More boost up for prescription of V. album symptoms such as obsession in religiosity and punctuality, quarrelsome rigid and haughty expression, cutting and tearing mania, howling, screaming, preaching, and uncertain fear of death were not present.^[26,27]

The case is of long-standing duration with marked psychotic symptoms and abnormal behaviour. The disease had affected her familial and social interpersonal relationships and functioning. After the homoeopathic intervention, she feels symptomatic relief as well as there is improvement in the social and familial relationships also.

During the course of treatment, the anti-psychotic medication which the patient had been taking for years was tapered. Complete withdrawal from conventional medicine was possible within six months of add-on homoeopathic intervention. BPRS was used to assess the outcome of the homoeopathic intervention by comparing the reading before and after the intervention. A BPRS score of 55 at baseline was reduced to a score of 18 with homoeopathic intervention. The patient reported slight exacerbation of the symptoms at the 9^th month of follow-up, which was managed with homoeopathic intervention alone. The patient is religiously coming to the OPD for monthly follow-ups.

CONCLUSION

The case report is aimed to show that homoeopathy can enhance the quality of life, and reduce the financial burden as well as mental discomfort of patients suffering from psychotic disorders, without the aid of conventional medication.

The present case report evidently suggests the successful treatment of psychosis and improving quality of life, and restoration of the well-being of the patient with the help of individualised homoeopathic medicine. This case has highlighted the importance of a holistic approach in the treatment considering the individuality of a patient and the use of repertorisation for the remedy selection, and not just disease symptoms. However, it would not be appropriate to generalise the usefulness of homoeopathy in cases of psychosis on the basis of a single case report. Therefore, rigorous observational and high-quality randomised control studies with larger sample sizes are suggested to ascertain the result obtained in the present case report.