Understanding the rubric delirium and the first grade remedies of Kent’s repertory

Dr Nishkala P S

ABSTRACT
Delirium is defined by the acute onset of fluctuating cognitive impairment and a disturbance of consciousness and it remains as a major cause of morbidity and mortality. Despite increased efforts targeting awareness of this condition, it often goes unrecognized in the face of evidence that it is usually the cognitive manifestation of serious underlying medical or neurologic illness. In this article an attempt is made to understand the meaning of the rubric “delirium” and also differentiate the 1^st grade remedies from Kent’s repertory.

KEY WORDS: Delirium, Kent’s Repertory.

INTRODUCTION
Delirium, a term used to describe an acute confusional state, is a transient global disorder of attention, with clouding of consciousness. Onset is usually rapid. Often goes unrecognised despite clear evidence that it is usually the cognitive manifestation of serious underlying medical or neurologic condition.

Its common causes include toxins prescription medications like narcotics and benzodiazepines, Drugs of abuse: alcohol intoxication and alcohol withdrawal Poisons: inhalants, carbon monoxide, pesticides, metabolic conditions and electrolyte disturbances, vitamin deficiencies, dehydration and malnutrition, anaemia, systemic infections etc

A multitude of terms are used to describe patients with delirium, including encephalopathy, acute brain failure, acute confusional state, and postoperative or intensive care unit (ICU) psychosis. Delirium has many clinical manifestations, but is defined as a relatively acute decline in cognition that fluctuates over hours or days. The hallmark of delirium is a deficit of attention, although all cognitive domains—including memory, executive function, visuospatial tasks, and language—are variably involved. Associated symptoms that may be present in some cases include altered sleep-wake cycles, perceptual disturbances such as hallucinations or delusions; affect changes, and autonomic findings that include heart rate and blood pressure instability.

The rubric delirium in Kent’s repertory has 17 1^st grade remedies- 3 marks

• Agaricus muscarius
• Arsenicum album
• Arum triphyllum
• Belladonna
• Bryonia alba
• Cannabis indica
• Chelidonium majus
• Hyoscyamus niger
• Lachesis mutus
• Lycopodium clavatum
• Nitricum acidum
• Opium
• Rhus toxicodendron
• Secale cornutum
• Stramonium
• Veratrum album
• Veratrum viride

AGARICUS MUSCARIUS
Delirium characterised by singing, shouting, and muttering; rhymes and prophesies. Begins with paroxysm of yawning.

Four phases of cerebral excitement

1. Slight stimulation- shown by increased cheerfulness, courage, loquacity, exalted fancy.
2. More decided intoxication- great mental excitement and incoherent talking, immoderate gaiety alternates with melancholy. Perception of relative size of objects is lost. Physical strength is increased.
3. Condition of furious or raging delirium, screaming, raving, wants to injure himself etc
4. Mental depression, languor,  indifference, confusion, disinclination to work etc

ARSENICUM ALBUM
Delirium – with great flow of ideas. Great anguish and restlessness. Changes place continually. Fears, of death, of being left alone. Suicidal, Thinks it’s useless to take medicine. Hallucinations of smell and sight. Despair drives him from place to place. General sensibility increased.

Violence; self torture, pulls her hair, bites her nails, tears his own body. Delirium tremens. Suspicious, Irritable; increasingly. Fixed ideas, hallucinations

ARUM TRIPHYLLUM
Excessively cross and stubborn, nervous.  Persistently boring into nose, or picking at lips, fingers, at one spot until it is sore or bleeds, especially children

BELLADONNA
Patient lives in a world of his own, engrossed by spectres and visions and oblivious to surrounding realities. He is acutely alive and crazed by a flood of subjective visual impressions and fantastic illusions. Hallucinations; sees monsters, hideous faces. Delirium; frightful images; furious; rages, bites, strikes; desire to escape.

Loss of consciousness, disinclined to talk, perversity with tears. Acuteness of all senses. Changeableness.

BRYONIA ALBA
Exceedingly irritable; everything puts him out of humour. Delirium; wants to go home; talks of business.

Taciturn, wants to be let alone. Desire for things which are rejected when offered. Apprehension and dread for future. Despair of being cured, with fear of death. Nightly delirium about the events of the day. Thoughtless, forgetful. Unusual peevish irritability and wrathful violence. Despondent and doubtful of salvation.

CANNABIS INDICA
Excessive loquacity; exuberance of spirits. Time seems too long. Anxious depression; constant fear of becoming insane. Mania must constantly move. Very forgetful; cannot finish sentence. Is lost in delicious thought. Uncontrollable laughter.

Delirium tremens. Clairvoyance. Emotional excitement; rapid change of mood. Cannot realize her identity. Hears; voices, bells, music. Moaning and crying.

CHELIDONIUM MAJUS
Aversion to mental exertion or conversation. Despondent. Anxieties as if she had committed a crime; fear of getting crazy. Feels like crying with ill humour or without any reason. Restless

HYOSCYAMUS NIGER
Very suspicious. Talkative, obscene, lascivious mania, uncovers body, great hilarity, inclined to laugh at everything. Delirium, with attempt to run away. Low muttering speech; constant carphologia, deep stupor.

Many bewildering aberrations. Laughs, sings, talks, babbles, quarrels. Erotic, exposes genitals; sings amorous songs. Fears; being along; being pursued; of water; being poisoned, being bitten etc. restless, jumps out of bed, wants to escape. Rage; with desire to strike, bite, fight, insult, scold and kill.

LACHESIS MUTUS
Great loquacity, restless and uneasy, jealousy. Suspicious, nightly delusion of fire. Religious insanity. Derangement of the time sense.

Compelling delusions; thinks she is under super human control thinks she is dead and preparations are being made for her funeral; thinks herself pursued, hated and despised. Persistent erotic ideas.

Nocturnal delirium with much talking, or with murmuring. Delirium; tremens; from over- watching, over-fatigue, loss of fluids, over-study. Fears; going to sleep; lying down. Crawls on the floor; spits often; hides, laughs or is angry during spasms.

LYCOPODIUM CLAVATUM
Extremely sensitive. Weak memory, confused thoughts; spells or writes wrong words and syllables. Failing brain- power.

Fearsome; dread of men; presence of new persons, of everything, even ringing of doorbell. Anxious thoughts as if about to die. Distrustful, suspicious. Anthropophobia, with anxiety at the approach of man, yet fears to be alone.

NITRICUM ACIDUM
Irritable, hateful, vindictive. Profane, cursing, using vulgar language. Quarrelsome delirium; talks to spirits in other tongue. Confusion, thoughts vanish, after exertion of mind. Anxiety about his disease, fear of cholera, of death. Easily frightened. Attacks of rage with imprecation and swearing.

OPIUM
Vivid imagination and increased courage with stupefaction and dullness of all senses. Heightened power of imagination even to ecstasy. Phantasy illusions and caricatures before eyes. Insanity and delirium with hideous or ecstatic visions, alternating with somnolence, especially of drunkards. Cheerfulness with joyous mood. Fearless and audacious. Loquacious delirium with open eyes and a red face. Easily frightened. Delirium tremens with terror. Carphologia. Deceptive; vision, taste, touch, perversion of all senses. Delirium with frightful visions, of mice, scorpions etc.

RHUS TOXICODENDRON
Extreme restlessness with continued change of position. Delirium, with fear of being poisoned. Sensorium becomes cloudy,Confusion.  Great apprehension at night cannot remain in bed.

Low mild delirium; incoherent talk, answers correctly but slowly, or hastily or reluctantly. Thoughts of suicide, wants to drown himself.

SECALE CORNUTUM
Madness, inclination to bite or drown himself. Maniacal fear; tears or depressed by fear. Laughs, claps her hand over head, and seems beside herself. Weakened power of thinking. Illusion of fancy, of the senses. Unconscious or anxious, often passing into raving delirium. Insanity with rage and mania to bite. Dejection with fear of death.

STRAMONIUM
Devout, earnest, beseeching and ceaseless talking. Loquacious, garrulous, laughing, singing, swearing, praying, rhyming. Sees ghosts, hears voices, talks with spirits. Rapid changes from joy to sadness. Violent and lewd. Delusions about his identity. Religious mania. Cannot bear solitude or darkness. Sight of water or anything glittering brings on spasms. Delirium tremens. Delirium with desire to escape. Talks in foreign tongue. Lascivious talk. Wants to kill people or himself.

VERATRUM ALBUM
Melancholy, with stupor and mania. Frenzy of excitement; shrieks, curses. Delusions of impending misfortunes. Mania with desire to cut and tear things. Attacks of pain, with delirium driving to madness. Cursing, howling at night.

Delirium; early; with violence, loquacity or lewdness; during pain.

Mental confusion, deliria of insanities, mostly mute, religious or with pride. With lasciviousness and obscene talk, with laughing, whistling and spinning. Howling and lamenting in a hoarse voice. Nightly anguish and despair. Transient attacks of unconsciousness. Transient loss of memory.

VERATRUM VIRIDE
Delirium; furious, screams, howls, strikes, incessant muttering. Quarrelsome. Loquacity, with exaltation of ideas. Carphologia. Fear; of seeing her physician; of being poisoned. Suspicious. Delirium with wild staring eyes and restless hands.

CONCLUSION
Repertory is a useful tool, as it helps us to arrive at a final group of medicines, but the final prescription should be made by referring the materia medica. In order to put the repertories at best use the arrangement and meaning of the rubrics must be understood and how the remedies under a same rubric differ from each other must be understood. 

REFERENCES

1. Jhanwar Venugopal. Delirium, dementia and other cognitive disorders. In Munjal YP(ed).API Textbook of medicine, 10/e, Vol 2 2015. Jaypee Brothers Medical Publishers(P)Ltd.New Delhi 
2. Longo, Fauci, Kasper, Hauser, Jameson, Lascalzo. Harrison’s Principles of Internal Medicine.18^th. USA: McGraw Hill Company
3. Kent J. Repertory of the homoeopathic materia medica. New Delhi: B Jain Publisher; 1961
4. Boericke William, Pocket manual of Homoeopathic Materia Medica and Repertory, 9/e, New Delhi, Jain Publishers, 2012
5. Clarke J. A Dictionary of Practical materia medica 1^st /e, New Delhi, Jain Publishers, 2012
6. Phatak S. Materia medica of homoeopathic medicines.2^nd ed.New Delhi:B.Jainpublishers;1999
7. Boger CM.Boenninghausen’s characteristics Materia medica and repertory with word index. New Delhi Jain publishers;2007

Dr Nishkala P S
Department of Case taking and Repertory
Under the guidance of Dr Munir Ahmed R
Government Homoeopathic Medical College and Hospital,Bengaluru