Concluded Case

?? Bipolar Affective Disorder

31 yrs, F, married, 2 kids, c/o reduced memory and concentration, at times depressed and at times anger outbursts since many years Past history reveals that the pt was taking allopathic drugs for ??? Schizophrenia ??? BPAD (Bipolar affective disorder Pt had auditory and visual hallucinations, delusion of reference (if 2 people talking to each other she believed that they were talking about her), doubts on everyone saying that they try to harm her or kill her, had suicidal ideations (once tried), running from home on few occasions, unnecessary money expenditure. Family history reveals that she had 2 mothers (own mother psychotic and stepmother had grudge on her in every aspect and used to abuse her regularly). She took allopathic medicines and got control in her symptoms, but as she had complications like drowsiness always, over weight her family members tapered the dose (without any advise from doctors) and slowly stopped the medication completely 2 months before. At the time of stopping medicines the pt had the c/o only reduced memory and concentration, reduced sleep, mood swings. Simultaneously they started Ayurvedic medicines as the husband knew some products of ayurveda as he is Distributor of Ayurvedic medicines in the locality. She was given Ashwagandha 1 bd, Brahmi 1 OD, Tagara 1 HS, Shilajit 1 OD, Stressnil 1 bd (without any doctors consultation) Present MSE (Mental status examination) is Appearance and behaviour - good, well dressed, eye to eye contact maintained, rapport good and maintained Conscious, oriented to time, place and person Memory - remote memory little bit affected as the pt was unable to recall her children's birthday. Both immediate and recent memory are intact Hallucinations and delusions- absent Speech - flow, rhythm are intact. No abnormalities observed Mood - Euthymic (subjective and objective) Insight - preserved Judgement - intact Now the pt is feeling comparatively better. Sleep ok, memory and concentration somewhat improved (as pt party says). I suggested to add Kalyanaka ghrita or Maha paishachika ghrita to those Ayurvedic medicines. Dear doctors, kindly share your views and opinions regarding the case and treatment

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Concluded answer

To arrive at a particular diagnosis for this case is difficult as the pt has mixed symptoms of Schizophrenia and BPAD. But anyway the patient is psychotic not neurotic and based on this we should plan for Antipsychotics. in Ayurveda, shodhana karma followed by shamanaushadhis will help. As the case is Vata and Pitta pradhana for snehapana either Dadimadya ghrita or Tiktaka ghrita or Brahmi ghrita given. After virechana shamanaushadhis like Maha Kalyanaka Ghrita (effective in conditions of hallucinations) Dhoopana karma (beneficial in delusions) with Haridra, Daruharidra, Hingu, Vacha, Guggulu done Manasamitra vati or Mentat DS Combination of Shveta Shankhapushpi churna, Brahmi churna, Sarpagandha churna, Gokshura churna Saraswatarishta with gold

All Answers

To arrive at a particular diagnosis for this case is difficult as the pt has mixed symptoms of Schizophrenia and BPAD. But anyway the patient is psychotic not neurotic and based on this we should plan for Antipsychotics. in Ayurveda, shodhana karma followed by shamanaushadhis will help. As the case is Vata and Pitta pradhana for snehapana either Dadimadya ghrita or Tiktaka ghrita or Brahmi ghrita given. After virechana shamanaushadhis like Maha Kalyanaka Ghrita (effective in conditions of hallucinations) Dhoopana karma (beneficial in delusions) with Haridra, Daruharidra, Hingu, Vacha, Guggulu done Manasamitra vati or Mentat DS Combination of Shveta Shankhapushpi churna, Brahmi churna, Sarpagandha churna, Gokshura churna Saraswatarishta with gold

Sir,other than the se medicines, Himalaya"s kal lithium capsules,tab mentaid, samritisagar ras,medhya churna, Brahmi vati helpful.. Panchkarma can help.. shirodhara, shirovirechan and Nasya karma can help...phadbindu tail ican help .

Thank you doctor
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I think this is the case of schizophrenia.. Nasya karma &Shirodhara 1...Smriti Sagar ras+Unmaad gajkesari+Mukta pisti with Brahmi avleha 2... Ashwagandha churna+Sarpgandha churna 3..Chandanasava +Saraswat Arista

Thank you doctor
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