Case taking in mental diseases

By
Soumya mathew

Homeobook
 A mental disorder or mental illness is
a psychological pattern, potentially
reflected in behavior, that is generally
associated with distress or disability,
and which is not considered part
of normal development of a
person's culture.
 Mental disorders are generally defined
by a combination of how a
person feels, acts, thinks or perceives
Homeobook
• Casetaking in mentalcases helps to
develop a good working relation ship
termed as rapport with the patient.
• Good rapport is essential to gather
data particularly in sensitive areas of
patient’s life .
• the interview further motivates the
patient and aids curative process

Homeobook
General instructions for
interviewing mental patients
 Adopt an unhurried and relaxed pose
throughout the interview.
 Maintain eye contact with the patient
 listen attentively to what the patient says.Do
not assume a bored ,indifferent or sceptical
attitude.
 Encourage patients in his narration by
making occasional facilitatory remark or by
non verbal expression of assurance and
concern.
Homeobook
 Avoid interruption and distraction as much as
possible.
 To patients with furious mania we must
oppose calm intrepidity and cool.
 firm resolution to doleful,
 To querulous lamentation, a mute display of
commiseration in looks and gestures

Homeobook
 To senseless chattering patient ,a silence not
wholly inattentive
 To disgusting and abominable conduct ,
conversation of a similar character,ie total
inattention.
 Avoid unduly prolonging the interview
.Interview should not ordinarly stretched
beyond 40-50 minutes.In special situations
interviews will have to be cut much shorter
Homeobook
 All kinds of external
disturbing
influences on their
senses and
disposition should
be if possible
removed.

Homeobook
 We must merely endeavour to prevent the
destruction and injury of surrounding objects,
without reproaching the patient for his acts,
and everything must be arranged in such a
way that the necessity for any corporeal
punishments and tortures whatever may be
avoided.

Homeobook
 contradiction, eager explanations, rude
corrections and invectives, as also weak,
timorous yielding, are quite out of place with
such patients; they are equally pernicious
modes of treating mental and emotional
maladies.

Homeobook
 The treatment of the
violent insane maniac
and melancholic can
take place only in an
institution specially
arranged for their
treatment but not
within the family circle
of the patient.
Homeobook
Types of interview
 Broadly three methods are there
 In the free type interviewer assumes the role
of a listener without trying to direct the
course of the interview.
 If there are pauses ,the interviewer repeats
last words of patient
 once the patient starts talking he keeps him
going, occassionaly asking him to elaborate a
particular detail.
Homeobook
 Second type called the direct interview the
physcian deciding on grounds which he wants
to cover, asks more direct questions
 It is uncomfortable to patient and puts him on
guard.
 also some areas are left untouched which
though important to the patient are missed
by the interviewer.
 the patient has only passive role and may not
be an active participant.
Homeobook
 In the third type called the structured
interview or the questionnaire method the
interviewer prepares a set of standard
questions which are administerd to all his
patients alike generally in the same order.
 this method is disturbing to patient.
 It does not reveal all information which
patient otherwise volunteer.

Homeobook
CLASSIFICATION AND TREATMENT OF MENTAL
DISEASE ACCORDING TO DR.HAHNEMANN

• Aph.210-230
• According to concept of our master
Dr.samuel Hahnemann, mental diseases are
one sided diseases because they display only
one or two principal symptoms which obscure
almost all the other.

Homeobook
 These are of psoric origin and more difficult
to cure in consequence of this onesidedness
,all their other morbid symptoms disappear
before the single great prominent symptoms.

Homeobook
 Mental disease do not constitute a class of
disease sharply seperatly from all others
,since in all other so called corporeal disease
the condition of disposition of mind is always
altered.
 for eg:those who were patient when well
often becomes obstinate,violent,hasty,or
even intolerant ,capricious,desponding when
ill.

Homeobook
 Those formerly chaste and modest often
become lascivious &shameless.
 A clear headed person become obtuse of
intellect
 weakminded person become more prudent
and thought ful
 a man slow to make up his mind sometimes
acquire great presence of mind and quickness
to resolve etc.
Homeobook
 We should consider mental symptoms along
with other symptoms for selecting the
correct remedy and to enable a conformable
cure

Homeobook
4 types of mental diseases are there.
 In 1st type symptoms of derangement of
mind and disposition ,peculiar to them are
increased while the corporeal symptoms
decline (more or less rapidly ) till at the length
they attain the most striking onesidedness
This type of disease precedes with a history
of physical symptoms which later transform
into symptoms of mind.

Homeobook
 The cases are not rare in which a so-called
corporeal disease that threatens to be fatal
becomes transformed into insanity, into a kind of
melancholia or into mania by a rapid increase of
the psychical symptoms that were previously
present, whereupon the corporeal symptoms
lose all their danger, improve almost to perfect
health, or rather they decrease to such a degree
that their obscured presence can only be
detected by the observation of a physician gifted
with perseverance and penetration.

Homeobook
 In this manner they become transformed into a
one-sided and, as it were, a local disease, in
which the symptom of the mental disturbance,
which was at first but slight, increases so as to be
the chief symptom, and in a great measure
occupies the place of the corporeal symptoms,
whose intensity it subdues in a palliative manner
 in short, the affections of the grosser corporeal
organs become, as it were, transferred and
conducted to the almost spiritual, mental and
emotional organs.
Homeobook
 In such cases complete history taking is
imperative in order to acquaint oneself with
the whole phenomenon of the corporeal
symptoms and the predominating state of
mind and disposition

Homeobook
 To this collection of symptoms belongs in the
first place the accurate description of all the
phenomena of the previous so-called
corporeal disease, before it degenerated into
a one-sided increase of the physical
symptom, and became a disease of the mind
and disposition.
 This may be learned from the report of the
patient's friends and relatives.

Homeobook
 During the lucid interval ,some physical
symptoms appear or become prominent .this
symptoms should be taken into account for
completing totality

Homeobook
 By adding to this the state of the mind and
disposition accurately observed by the patient's
friends and by the physician himself, construct
the complete picture of the disease, , a medicine
capable of producing strikingly similar
symptoms, and especially an analogous disorder
of the mind, must be sought for among the
antipsoric remedies, if the psychical disease have
already lasted some time.

Homeobook
 Second type of mental disease may arise
from sudden fright ,vexation ,grief etc .These
are the mental disease ,which have a sudden
onset and can be expressed as intense or
violent symptoms of mind

Homeobook
 In such cases ,all prominent symptoms at the
mental level along with physical
concomitants are taken into account to form
the totality.
 based on this acute totality an indicated
medicine should be found out.

Homeobook
 when it occurs in this acute manner it should
not be immediately treated with antipsorics
 treat with remedies like aconite, belladonna,
stramonium, hyoscyamus, mercury, ..etc. in
highly potentized, minute, homoeopathic
doses, in order to subdue it so far that the
psora shall for the time revert to its former
latent state, wherein the patient appears as if
quite well.

Homeobook
 after the patient recovers from this acute state a
detailed case taking should be done to ascertain
miasmatic background and no time should be
lost in attempting to free him completely, by
means of a prolonged antipsoric treatment, from
the chronic miasm of the psora, which, it is true,
has now become once more latent but is quite
ready to break out anew;
 if this be done, there is no fear of another similar
attack, if he attend faithfully to the diet and
regimen prescribed for him.
Homeobook
 But if the antipsoric treatment be omitted,
then we may almost assuredly expect, from a
much slighter cause than brought on the first
attack of the insanity, the speedy occurrence
of a new and more lasting and severe fit,
during which the psora usually develops itself
completely, and passes into either a periodic
or continued mental derangement, which is
then more difficult to be cured by antipsorics.

Homeobook
 the third type of mental disease
 Doubtfulcases
 If the mental disease be not quite developed, and if it
is doubtful whether it really arose from a corporeal
affection, or did not rather result from faults of
education, bad practices, corrupt morals, neglect of
the mind, superstition or ignorance
 the mode of deciding this point will be, that if it
proceed from one or other of the mental causes it
will diminish and be improved by sensible friendly
exhortations, consolatory arguments, serious
representations and sensible advice.

Homeobook
 whereas a real moral or mental malady,
depending on bodily disease, would be
speedily aggravated by such a course.
 the melancholic would become still more
dejected, querulous, inconsolable and
reserved
 the spiteful maniac would thereby become
still more exasperated, and the chattering
fool would become manifestly more foolish.
Homeobook
 Fourth type of mental
disease originate and
kept up by emotional
causes such as continued
anxiety ,worry ,vexation
,wrongs and the frequent
occurance of great fear
and fright .this kind of
emotional disturbances
in time ,destroys the
corporeal health often to
a great extent.

Homeobook
 In such cases by means of psychical remedies,
such as a display of confidence, friendly
exhortations, sensible advice, and often by a
well-disguised deception, be rapidly changed
into a healthy state of the mind and with
appropriate diet and regimen, seemingly into
a healthy state of the body also.

Homeobook
 a detailed understanding of the patients
environment becomes a great necessity for
the phycisian. He must explore the
circumstances in his family work and social
area to which the patient is constantly
reacting .

Homeobook
 The physician should acquire the details of
patient’s disposition ,his environment and the
characterstics of mental and physical
reactions in order to construct the totality.

Homeobook
 Fundamental cause in these cases also is a
psoric miasm, which was only not yet quite
near its full development, and for security's
sake, the seemingly cured patient should be
subjected to a radical, antipsoric treatment,
in order that he may not again, as might
easily occur, fall into a similar state of mental
disease.

Homeobook
Mental state examination(MSE)

 Mental state is concerned with symptoms

and behaviour at the time of interview
 It is cross sectional picture of a patients
functioning

Homeobook
 Appearance ,behaviour and attitude-
behaviour, bodybuild ,posture ,clothes
grooming ,hygiene,facial appearance
 Psychomotor behaviour-it includes all
nonverbal behaviour by the patient during
interview.this must complemented by
thorough neurological examination.

Homeobook
 Gait,
 level of activity-hyperactive
,agitated,fidgety,retarded etc.
 Movements-clumsy,
rigid,gestures,tics,mannerism,negativism etc.
 Interpersonal behaviour and attitude towards
examiner-cooperative,attentive,suspicious
etc.
 Level of rapport-eyecontact etc
Homeobook
2.Cognitive status
 Sensorium-
comatose,drowsy,stuporous,alert,hypervigila
nt
 Attention and concentration
 Orientation
 Memory-immediate,recent,remote etc.
 General information and intelligence

Homeobook
3.Mood
 Objective and subjective evaluation-
calm,depressed,irritable,anxious,fretful,angry
,happy,elated,euphoric,apathetic
 Changeability of mood

Homeobook
4.Perception
 Illusion,delusion,hallucination
5.Speech
 Reactiontime,spontaneity,pitch,speed,articulati
on
6.Thinking
 Sream,form,content,possession
7.Insight
8.Judgement.

Homeobook
Homeobook