Post Graduate Researchcentre, Belgaum-590016, Karnataka

Post Graduate Researchcentre, Belgaum-590016, Karnataka

BHARATESH HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,

POST GRADUATE RESEARCHCENTRE, BELGAUM-590016, KARNATAKA.

Recognized by

CENTRAL COUNCIL OF HOMOEOPATHY, NEW DELHI.

Affiliated to

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGLORE.

SYNOPSIS

M.D (HOMOEOPATHY)

“PUERPERIAL BLUE A REPERTORIAL APPROACH”

By

Dr. RAJASHREE MORE

Dr. P A. CHOWDHARY. MD. (HOM)

H O D, Professor & Guide

Department of Repertory,

Bharatesh Homoeopathic Medical College & Hospital Belgaum

From,

Dr. RAJASHREE MORE

To,

Dr. P A. CHOWDHARY. MD. (HOM)

H O D,Professor & Guide,

Department of Repertory,

Bharatesh Homoeopathic Medical College & Hospital,

Belgaum.

Sub: - Application to accept my synopsis for the dissertation.

Respected Sir,

I Dr. RajAshree MORE would like to forward my application for the approval of my synopsis under your guidance for the following topic, “PEURPERIAL BLUE - A REPERTORIAL APPROACH”.

Hope you will approve the same.

Thanking you.

Date:

Place: Belgaum

Yours sincerely

Dr. RAJASHREE MORE

Department of Repertory,

Bharatesh Homoeopathic Medical College

& Hospital, Belgaum.

From,

Dr. P A. CHOWDHARY. MD. (HOM)

H O D,Professor & Guide,

Department of Repertory,

Bharatesh Homoeopathic Medical College & Hospital,

Belgaum.

To,

Dr. RAJASHREE MORE

Sub: - Acceptance of synopsis for the dissertation.

Dear Doctor,

I have accepted your topic “PEURPERIAL BLUE - A REPERTORIAL APPROACH” for the dissertation. Your synopsis will be forwarded to RGUHS.

Date:

Place: Belgaum

Dr. P A. CHOWDHARY. MD. (HOM)

Professor & Guide,

Department of Repertory,

Bhartaesh Homoeopathic Medical College

& Hospital, Belgaum.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA, BANGLORE.

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Dr. RAJASHREE MORE
PRESENT ADDRESS:
F01, SHREENIVAS RESEDENCY, AGARKAR ROAD, TILAKWADI, BELGAUM 590006
PERMANENT ADDRESS:
F01, SHREENIVAS RESEDENCY, AGARKAR ROAD, TILAKWADI, BELGAUM 590006
2. / NAME OF THE INSTITUTION / Bhartesh Homoeopathic Medical College & Hospital and research centre, Belgaum, Karnataka-590016
3. / COURSE OF STUDY AND SUBJECT / DOCTOR OF MEDICINE (HOMOEOPATHY) REPERTORY
4. / DATE OF ADDMISSION / 16 -06 -2010
5. / TITLE OF THE TOPIC / “PEURPERIAL BLUE -A REPERTORIAL APPROACH”
6. / Brief resume of intended work
6.1 NEED FOR THE STUDY
Since times in memorial a correlation has been noted between the various psychiatric illnesses and the postpartum period. Hippocrates wrote of a woman who became restless and sleepless 6 days after the birth of the baby. She later became delirious and died 3 weeks of postpartum. In the 1800’s over 300 references of this disorder appeared. These disorders were regarded as specific entities labeled puerperal.
The postpartum blues is the common disorder in 2.9% to 50% of women in the puerperal period. An Indian study found 36% of puerperal women suffering from depression.
The majority of women experience a sequence of marked emotional and behavioral changes following delivery. Remarkable changes in the status of women in modern life leads her to more risk. Some of the risk factors are:-
  1. Single women
  2. Young women
  3. Short relationship
  4. Early deprivation
  5. Long standing difficulties in life
  6. Social adversity
  7. Lack of confidence
  8. Past psychiatric history
  9. Ambivalence about pregnancy
For above problems in conventional system of medicine treatment is antidepressant medication. In severe cases psychotropic drugs are used which are known to be teratogenic. No psychotropic drug is proven safe.
As the conventional system failed to be safe for mother and new born homoeopathy can do better job. This study is a sincere effort to assess the utility of homoeopathic medicines in the treatment of postpartum blue and the use of repertory in selecting the appropriate similimum and use of various repertories in cases of postpartum blue.
HYPOTHESIS: Repertorial study of a peurperial blue may be inaffective.
6.2 REVIEW OF LITERATURE
People expect that having a baby is going to be a source of happiness,and of course it is but a new mother,may feel huge anxiety,a short period of feeling emotional and tearful mood,which is known as puerperial blue.1
The puerperium refers to the 6 weeks period following child birth, during which the body tissues especially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. 2
During this period majority of women experience a sequence of marked emotional and behavioral changes. For the 1st 24 to 48 hours following delivery it is very common for a woman to experience an elation of mood. Women who experience a marked elation of mood following delivery are more likely to experience a severe state of ‘The blues’ and are perhaps more likely to experience a postpartum mood disorder. 3
Between the 3rd and the 10th postpartum day the mother’s mood state changes to being low, tearful and labile. Frequently they experience irritability, insomnia and tendency to be over sensitive to criticism with transient bouts of despair and catastrophizing (Blowing things out of proportion.) this is known as Blues. The commonest day of onset is 5th day. The severity of blues various from being relatively mild to quite distressing. Tearful and anxious episodes may recurred on occasions for a number of weeks following child birth, Particularly when the mother is tired or when baby is difficult to settled. 3
During this period of physiological disturbances which may be aggravated by adverse social circumstances adequate understanding and support from her partner and family is crucial. Difficulty in coping with the new born infant occurs more frequently with the 1st baby and vigilant surveillance is there for necessary..4
Childbirth is a major psychological as well as physiological event, and this is reflected in the high morbidity from psychiatric disorder. It is in the following three months that a women is more liable to be admitted to a psychiatric ward than at any other time during her child bearing years while conditions less likely to lead to admission, but still troublesome, are exceedingly common. Crisis, arising from a major change in one’s life calling for new resources of adaption, may be unpleasurable or unpleasant. Child bearing is usually seen as a good experience, but some negative feelings are usually present and occasionally predominate. Even where pregnancy is planned and the baby much wanted, the sudden transition from the state of ‘two in one’ at the end of pregnancy to the considerable psychological adjustment. Then, not every mother finds her new baby immediately lovable. Some are deeply challenged by the primitive demands- the voraciously sucking, biting mouth; the angry crying; indiscriminate excretion. Others are threatened by the infant’s helplessness, fragility and utter dependency. The lack of communication from the newborn baby, its inability to say that it’s satisfied, or where it hurts, may be perplexing, and frustrating.5
Psychological reactions to this crisis range from transitory weepiness in the early puerperium at one extreme, to full- blown puerperal psychosis at the other.5
Puerperal blues – a state of mild depression, anxity and slight intellectual clouding in the early puerperium typically on the third day after delivery, is so common as to be taken for granted. The incidence has been shown in diverse studies to range from 50-80%. The weepiness, tension and sense of being slow on the uptake or ‘not quite with it’ last from an hour or two to several days. Circumstances seen to have little bearing on the presence of the blues, which may well be an emotional effect of the precipitate drop in hormonal levels after parturition, though unable to demonstrate this.5
Pregnancy affects mental illness in a complex way. Healthy women experience marked psychological and emotional changes during pregnancy and in particular after delivery. 3
The clinical features are similar to those of depression at other times. Although suicidal thoughts are less common and preoccupation (in terms of feeling guilt and inadequacy) with the baby is usual. About 50% of untreated cases will still be depressed a year later. There may be persistent abnormalities of mother-child interaction. Many cases are undetected and screening for depression is an important part of 6 weeks postnatal checkup. An etiology factors appear predominantly social (although a family history of depression parts postpartum is common). With marital conflicts and lack confiding relationship particularly implicated. 6
Hahnemann considers mental diseases as one sided diseases of the chronic type affecting the whole psychosomatic entity where the burnt of derangement has been shifted on to the mental aspect of the human organism after the physical disturbances has been suppressed by modern treatment or through (see 215-216 of Organon).
In aphorism 216 Hahnemann writes the cases are not rare in which so called corporeal disease that threatens to be fatal-a suppuration of the lungs, or the deterioration of some other important viscus, or some other disease of acute character, e.g., in childbed, and c.- becomes transformed into onsanity, into a kind of melancholia or into mania by a rapid increase of the physical symptoms that were previously present, where upon the corporeal symptoms lose all their danger; these latter 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. In the 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 major occupies the place of the other (corporeal) symptoms, whose intensity it subdues in a palliative manner, so that, in short, the affections of the grosser corporeal organs become, as it were, transferred and conducted to the almost spiritual mental and emotional organs, which the anatomist has never yet and never will reach with his scalpel.7
Mental symptoms of the drugs are all important in homoeopathy. Aphorism 210 and 213 of the Organon states changes in the state of mind and disposition are to be keenly observed and noted.
There is no dearth of potent medicinal substances in the world which do not vary notably or alter the state of disposition and mind in the healthy individual (Aphorisum 212)
Hahnemann declared 200 years back “Mind is the key to the man”. He could recognize the value of mental symptoms and emotional background in treatment of disease. 8
HOMOEOPATHIC MANAGEMENT:
As the conventional system of medicine fail to be safe for mother and new born homoeopathy can do better job. There are unique features of this system of medicine which make the system best suited for the treatment.
Important remedies from S. Lilianthal are Aco, Ars alb, Aur met ,Bell, Bry,Calcarb,Camph,Canth,China,Cicvir,Cimic,Cupmet,,Hyos,Ign,Kalicarb,Lach,Liltig, Lyc,Petr,Puls,Plat,Stram,Sul,Thuja,Ver alb,Vert v,Zinc.9
Repertories considered are:
  1. Kents repertory
  2. Synthetic repertory
  3. Boericke repertorty
Some rubrics from Kents repertory10
Main rubric – mind
Rubric – Sadness
Subrubric-labour
Some rubrics from Boerickes repertory11
Main rubric-mind
Rubric – Mania
Subrubric – puerperal
Some rubrics from synthetic repertory12
Main rubric – sadness
Sub rubric – puerperal.
Complications of postpartum blues;
Severity of postpartum blues varies from being relatively mild to quite distressing if it is untreated complications may arise.
Immediate:
  1. Physical morbidity
  2. Suicide/Infanticide
  3. Prolonged psychiatric morbidity
  4. Social attachment to infant
  5. Emotional development of infant.
Later:
  1. Social /cognitive effects on child.
  2. Psychiatric morbidity in child
  3. Marital breakdown
  4. Future mental health problems.3
6.3 OBJECTIVES OF THE STUDY
  1. To study clinical presentation of peurperial blues.
  2. Study the homoeopathic management in case of peurperial blues.
  3. To study the utility of different repertories in the treatment of peurperial blues.

7. / MATERAIALS AND METHODS
7.1 SOURCES OF DATA:
The subjects for this study will be taken from the OPD/IPD/village health camps of BHMC and BHMC hospitals.
7.2 METHODS OF COLLECTION OF DATA:
  1. Patient will be selected on the bases of inclusion and exclusion criteria.
  2. Minimum sample size will be 30.
  3. Cases will be separated as per the performa prepared for the study.
  4. All separated cases registered between 30th October 2010 to30th June 2012 will be selected for the study.
INCLUSION CRITERIA:
Subjects with adjustment reaction with depressed mood 1
  1. All cases, Primi and multigravida
  2. Working or housewife irrespective of age and socio economic condition will be assessed as per the Edinburgh postnatal depression scale.
EXCLUSION CRITERIA:
  1. 1.Subjects with postpartum psychosis (schizophrenia or bipolar diseases)
  2. Subjects with major mood disorders (postpartum neurosis)
  3. Subjects with past history of major psychiatric disorder.
  4. Subjects with underline organic aetiology.
RESULT CRITERIA:
  1. Recovered
  2. Improve
  3. Not improved
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON THE PATIENTS HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY
The diagnoses of the case will be done on eliciting or on the basis of the case history and clinical findings according to Edinburgh scale for postnatal depression. Special investigations will be done as and when required.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF
Yes, ethical clearance has been obtained from the institution.
8. / LIST OF REFERENCES
  1. conditions/post natal-depression.
  2. Dutta D. C.Text book of Obstetrics including Perinatology and contraception. 6th edition. Published by New Central Book Agency (P) Ltd;2004.,pp145.
  3. Campbell Stuart and Lees Christoph Obstetrics by Ten Teachers. 17th edition.New D: Ajanta offset andPackaging Ltd;2000., pp319
  4. Ahuja Niraj MD Vyas J N DPM NNAMS ANDText book of post graduate psychiatry.IInd edition.New D:Published by – JAYPEE Brothers, Medical Publishers (P) Ltd;1999.,PP369.
  5. Daftary N. Shirish MD, DGO and Chakravarti Sudip DGO. Holland and Brews Manual of Obstetrics. 15th edition. Published by B.I. Churchill Livingstone (P) Ltd; 1991.,pp530,531.
  6. Katona Cornelius MD and Robertson Mary MD Psychiatry at a glance. IInd edition: Published By - MPG Books Ltd. Brdmin, Cornwall;2000., pp 37
  7. Sarkar B.K. DMS Organon of Medicine. 8th Indian edition. Published by M. Bhattacharyya & Co.(P) Ltd. Calcutta; reprint1984.,pp.225.
  8. Balkrishanan Homoeopathy in psychiatry 1st edition.New D:Published by- Indian Books and Periodical Publishers, Karol Bag; 2004. ,pp 33.
  9. Lilienthal S Homoeopathic Therapeutics Reprint Edition New Delhi : B Jain Publishers (P) Ltd 2001. pp 220, 221.
  10. Kent J T.Repertory of Homoeopathic Materia Medica.Reprint edition.New D:B Jain publishers(p)ltd;1998.,pp77
  11. Boericke w.Pocket manual of Hom MM & Rep.revised 9th edition.New D.:Indian Books& Periodicals Publisher;,March2005.,pp693.
  12. Barthel Horst,Wilhelmsfeld Synthetic repertory.4th improved edition.New D: B. Jain Publishers(p)Ltd;2001.,pp887

9. / Signature of Candidate
10. / Remarks of the Guide
11. / Name & Designation of
( in block letters)
11.1 Guide / Dr. P A. CHOWDHARY. MD. (HOM)
PROFESSOR & GUIDE,
DEPARTMENT OF HOMOEOPATHIC REPERTORY,
BHARATESH HOMOEOPATHIC
MEDICAL COLLEGE & HOSPITALS & P.G. RESEARCH CENTRE, BELGAUM, KARNATAKA.
11.2 Signature
11.3 Co-Guide
11.4 Signature
11.5 Head of Department / Dr. P A. CHOWDHARY. MD. (HOM)
PROFESSOR & GUIDE,
DEPARTMENT OF HOMOEOPATHIC REPERTORY,
BHARATESH HOMOEOPATHIC
MEDICAL COLLEGE & HOSPITALS & P.G. RESEARCH CENTRE, BELGAUM, KARNATAKA .
11.6 Signature
12. / 12.1 Remarks of Chairman
& Principal
12.2 Signature
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