Altered perception syndrome in children and homoeopathic approach

 Dr Amala A

ABSTRACT: Altered perception syndrome or schizophrenia is  a heterogeneous clinical syndrome with a range of cognitive, behavioral and emotional dysfunction. Based on the presenting complaint and Psychodynamic sphere of the patient, homoeopathic medicines are prescribed that proved to be effective in curing Schizophrenia.

         Key words: Homoeopathy, Schizophrenia, children.

         INTRODUCTION:

• Schizophrenia is a heterogeneous clinical syndrome with a range of cognitive, behavioral and emotional dysfunction.
• Prodromal symptoms often precede the active phase, in which individuals may express a variety of unusual or odd beliefs and may have unusual perceptual experiences; vague speech, unusual behavior but not  grossly disorganized.
• Socially active individuals become withdrawn.
• Individuals with schizophrenia have inappropriate dysphoric moods, disturbed sleep patterns, lack of interest in eating or food refusal.
• Depersonalization, derealization, somatic concerns, anxiety and phobias are common.
• In children, delusions and hallucinations may be less elaborate and visual hallucinations are more common.1

ETIOLOGY

• Numerous studies have demonstrated a substantial genetic predisposition for the disorder. In addition, family studies consistently show a higher risk in monozygotic twins compared with dizygotic twins and siblings. First-degree relatives of patients with schizophrenia have a 10-fold higher risk.
• The incidence in boys is slightly greater than in girls,and the age of onset tends to be later for girls.1

CLINICAL COURSE

• Schziophrenia typically develops between the late teens and mid 30’s ; the peak age at onset for the first psychotic episode is in the early to mid 20’s for males and in the late 20’s for females.
• The onset may be abrupt or insidious but the majority of individuals manifest a slow and gradual development with around one half of individuals complaining of depressive symptoms.
• The most significant changes involve requiring two or more of the core features of a psychotic disorder (delusion, hallucinations, disorganized speech, disorganized/catatonic behaviour, negative symptoms) to be present, with at least one of the first three “positive symptoms” also being present.
• If the psychotic symptoms persists for upto 6months, the condition is called schizophreniform disorder.
• In schizophrenia there are continuous signs of disturbance for atleast 6 months.
• Active symptoms must have been present for a significant portion of time during a 1 month period and there is failure in children to achieve the expected level of functioning.
• Childhood-onset schizophrenia is a rare disorder (<1 in 10,000 children) and usually indicates a more severe form of schizophrenia.
• The frequency increases between 13 and 18 years of age, typically with the initial presentation of psychotic features.

The symptoms of schizophrenia typically fall into four broad

Categories:

• Positive symptoms include hallucinations and delusions. Hallucinations are auditory or visual misperceptions that occur without external stimuli. Delusions are fixed false beliefs and can be bizarre or non-bizarre depending on cultural norms.

• Negative symptoms include a lack of motivation and social interactions and flat affect. Negative symptoms are most frequent in early childhood and later adolescence.

• Children with high intelligence often show more positive and fewer negative symptoms than children with low intelligence.
• Cognitive impairment is common and is perhaps the most important feature of schizophrenia, causing marked social and functional impairment.
• To meet criteria for diagnosing schizophrenia, clinical symptoms should be present for at least 6 months. If symptoms are present for less than 1 month, the condition is called a brief psychotic disorder. If symptoms are present for more than 1 month but less than 6 months, a diagnosis of schizophreniform disorder is made.
• Psychotic symptoms that do not meet full diagnostic criteria for schizophrenia but are clinically significant are diagnosed as an unspecified schizophrenia spectrum or other psychotic disorder.1

DMS -5 CRITERIA FOR SCHIZOPHRENIA

2 or more of the following are present for a significant period for 1month.

• Disorganised speech.
• Grossly disorganised or catatonic behaviour.
• Negative symptoms.
• Impaired level of functioning in the areas of work, interpersonal relations, or self care.1

DIFFERENTIAL DIAGNOSIS

1. a) Schizoaffective disorder is diagnosed when a person has clear symptoms of schizophrenia lasting at least 2 weeks and experiences a major mood episode (major depression/mania) during an uninterrupted period of the illness. These affective syndromes occur at other times, even when psychotic symptoms are present. This condition is very rare in children and has a lifetime prevalence that is much lower than schizophrenia (0.3% lifetime prevalence).

b)Psychotic disorder due to another medical condition describes psychotic symptoms that are judged to be the direct result of a general medical condition.

1. c) Some of the most common precipitating illnesses in children are epilepsy, metabolic disorders, and autoimmune disorders. Substance/medication-induced psychotic disorders have psychotic symptoms related to substance intoxication/ withdrawal or following exposure to a medication. 2

INVESTIGATIONS

• The identification of schizophrenia should include a physical and neurological examination, MRI, electroencephalography (to rule out epilepsy, especially temporal lobe epilepsy), substance/drug screening, and metabolic screening for endocrinopathies.
• Evaluation to rule out Wilson disease and delirium is also indicated. Youth with post-traumatic stress disorder often have vivid recollections and nightmares related to abuse.
• Psychological testing can be helpful in identifying psychotic thought processes. 2

MANAGEMENT

• Treatment is based on a multimodal approach, including the use of antipsychotic medications. First-line drugs are atypical antipsychotics (e.g., risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, and paliperidone). Second-line medications are typical antipsychotics (e.g., haloperidol, thiothixene, chlorpromazine, trifluoperazine, loxapine, and molindone).
• Psychosocial treatments, including skills training, supportive psychotherapy, behaviour modification, and cognitive-behavioural therapy, are all appropriate and should be considered as needed for individual patients.
• Attention should be paid to psychoeducation for parents and the child about the disease and its treatments.
• School interventions are needed to ensure that any special learning needs are addressed. Schizophrenia and other psychotic disorders also carry a high risk for suicidality. Co-morbid depressive symptoms increase the risk for suicide. Regular re-evaluation of suicidal ideation is necessary throughout treatment. The course of illness for schizophrenia varies in exacerbations and remissions of psychotic symptoms.3

PROGNOSIS

The poorest prognosis is seen if the onset is at an age younger than 13 years, with poor premorbid function, when marked negative symptoms are present, and when a family history of schizophrenia exists.3

HOMOEOPATHIC MANAGEMENT

• Lachesis – Lachesis is the top recommended medicine for schizophrenia treatment. Specifically indicated for certain delusions. These include the patient’s delusion about having been poisoned by someone, being harmed, or being followed by enemies. There is suspicion to an extreme degree towards everything. The sensation of being under the control of some superhuman power is yet another unique feature . Another delusion could be there are robbers in the house. In some cases, there is a delusion that she is dead and people are preparing for her A wish to isolate themselves, aversion to work, and a marked loquacity . Disorganized speech and continuous talking marked by quick jumping from one subject to another unrelated subject. Repetition of the same words over and over again is also present in the speech.4

2. Anacardium Orientale – For Auditory Hallucinations

Anacardium Orientale is an important medicine for Schizophrenia where a person hears voices. The voices are mostly of spirits or dead people.  Hear the voices say that they are going to die soon.  Spirits call their names, and command them to follow them.  Voices inside them speak in abusive language.  Delusion as if the mind and body are separated and delusion of being double or having two wills. A very unique delusion that may be present is that on one shoulder an angel is sitting commanding and doing good things, and on the second shoulder a devil is sitting asking to commit bad things. Other accompanying features are extreme sadness, absent-mindedness, suspicion, indifferent behaviour, and lack of interest in anything. Forgetfulness, aversion to work, desire to swear and curse, and talking in phrases that make no sense are also some characteristic symptoms that may be present.  Feeling that everything is a dream, and nothing is real. 4

3. Hyoscyamus Niger – For Delusion Of Being Poisoned And Seeing Absent Persons

Hyoscyamus Niger is useful in cases where the patient thinks someone is going to poison them. In most cases, as a result, they avoid eating or drinking offered by others. There is also a suspicion that family members are keeping a watch over them all the time. Doing  things that appear foolish. Laughing loudly at everything is also distinctly present. An impulse to strike and bite others may also arise along with delusions. Excessive and hurried talking, and unintelligible muttering can also appear. One may make strange and funny gestures like a clown dancing. The next important symptom to use this medicine is when a patient says he is able to see people who are not actually present. 5

4. Stramonium – Where Patients Talk with Imaginary Spirits

Thinks that they can talk with spirits. Say that they are under the influence of these spirits. They may also say that they are in communication with God. They carry out conversations with imaginary people. A feeling of restlessness accompanies talking to spirits and imaginary people.  Delusions about the presence of multiple people in the room may also arise though none are there in reality. The patient sees people coming out of all corners of the chamber. Patients who hear voices that scold them. Belief  that he is going to die soon. As a consequence, they start to give directions for their funeral. A constant praying and recitation of religious rhymes also predominantly appear with the above features. 4

5. Platina – For Schizophrenia Accompanied By Delusions Of Grandiosity

Platina is a high-grade homeopathic medicine for Schizophrenia with delusions of grandiosity.  Platina think of themselves as superior to others, and of great value to humanity. They believe that they are better than everyone else, and that all others are insignificant in comparison. Even the closest family members seem to be of no value and inferior to them. They exhibit great pride and are extremely critical of others. 4

6. Baryta Carb – For Suspicion That A Person Is Being Talked About

Baryta Carb is helpful in treating Schizophrenia where sufferers have a high suspicion that other people are talking about them. There is also a feeling that they are being made fun of and people are always laughing at them. Other symptoms that accompany are difficulty in concentration and confusion of the mind. Childish behaviour is also common. 5

7. Plumbum Met – For Delusions Of Conspiracies Of Being Murdered

Plumbum Met is administered for Schizophrenia among those suffering from delusions of others conspiring to murder them. These individuals think everyone around them is a murderer and their life is in danger. Sadness, melancholy, restlessness, anxiety, aversion to talking, and absent-mindedness also prevail. 4

8. Thuja Occidentalis – For Sensation Of Being Under Superhuman Control

Person  feels as if he is under the control of some superhuman power.  Vacant look with staring eyes and may talk in a hasty way or use the wrong words while talking. They are also sad, irritable, and suffer from insomnia. They are usually unable to manage daily life tasks. 5

9. Calcarea Carb – For Delusions Of Being Followed By Someone All The Time

Calcarea Carb is administered for Schizophrenia with a delusion of being followed by someone all the time. Along with this, there is the fear that something bad is going to happen. Fear of misfortune and of losing reasonableness in one’s life is also present. Anxiety, high irritability without any reason, and the constant fear of death also appear. 4

10. Kali Bromatum – Persistent Sleeplessness Attends Delusions

Kali Bromatum is a medicine for Schizophrenia where there is persistent insomnia accompanied by delusions. The delusions are of varying kinds. They mainly include delusions of conspiracy, and of persecution (as if someone is conspiring against them or pursuing them). Symptoms of depression, which include profound melancholy, indifference to life, and uncontrollable weeping.  Such patients fear talking to people. 5

11. Cannabis Indica – For Disorganized Speech

Cannabis Indica is a very useful medicine for Schizophrenia with the presence of disorganized and incoherent speech, with the tendency to stammer. Begins speaking but is unable to complete a sentence. They forget words while talking. A lot of ideas tend to crowd their brain, and they get lost in thought and/or are unable to fix their attention on one subject. Uncontrollable laughter may arise when the patient laughs at every word spoken to him. They even laugh at serious matters. They, however, have the persistent fear of becoming insane. 5

12. Medorrhinum – When Nothing Seems Real

Medorrhinum is a medicine for Schizophrenia when nothing seems real, and the person feels everything is a dream. This is accompanied by feelings of anxiety and of always being in a hurry. Patients are also impulsive, and cruel and tend to use abusive language. As night approaches they are overwhelmed by the fear of someone following them. Delusions of people looking at them from behind the furniture. Apart from the above symptoms, sudden mood changes may also be present. A very characteristic feature is that patients constantly think that they have done some unpardonable sin and are going to hell, so they keep praying. 4

13. Aurum Met – To Manage Depression

This medicine is of great value to manage depression in such cases.  Intense sadness, and hopelessness along with predominating suicidal thoughts. They feel as if life is a burden, and the future is all dark. They indulge in self-criticism. There is a desire to die, and such people constantly talk of self-destruction and suicide. 5

CONCLUSION: Homoeopathy is the safest and best mode of treatment for Altered Perception Disorder in Paediatric age group.

BIBLIOGRAPHY:

• Nelson text book of paediarics, edition, Elseiver,Edition 8^th, pg 70-75
• Gupta Piyush, PG text book of Paediatrics, 2^nd edition, Jaypee brothers publications, pg no 854-860
• AIP text book of paediatrics, Jaypee brothers publishers, 5^th edition,pg 330-335.
• Clark Henry John, Condensed Homoeopathic Materia Medica and Repertory , B. Jain Publishers. Revised Ed, pg 58, 59, 97,83,67, 62
• ND Murphy Robin , Homoeopathic medical Repertory , Indian book periodal publishers, 1^st Ed pg 34, 42, 47, 53, 57, 64, 72Author: Dr.Amala.A(M.D –Part 2).

Department Of Paediatrics.
Father Muller Homoeopathic Medical College, Deralakatte, Mangaluru- 575018

Under The Guidance Of: Dr Jyoshna Shivaprasad.
Professor And H.O.D, Paediatrics. Father Muller Homoeopathic Medical College