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EVALUATION OF THE ROLE OF HOMOEOPATHIC MANAGEMENTIN PSYCHIATRIC DISORDER IN POST AGE AND IN MEDICALLY ILL PERSONS
Dr A B Jadhav, Dr R R Bhoite, Dr Manoj Patil, Dr D B Girase, Dr B J Tambe, Dr Jay B Patel, Dr Sushmita Das
Introduction:
With radical development in medical science & improvement in standard of living , life expectancy have gone up considerably & the resultant consequence is rapidly growing ageing population and associated psychiatric disorder in late life. If mental health problem increases substantially as people get older then the focus is shifted to factors that are encountered in late life. With gradual transition from energetic and healthy to old age , individuals may find it difficult to accept physical limitations & dependency individuals may find it difficult to accept physical limitations & dependency , leaving them with little direction & definition of self. Physical limitations and loss of near and dear ones are frequently associated with restricted mobility which leads to further social isolation.

It is not possible to develop a single conceptual framework that explains all of the variance in mental health problem among adults in late life. These problems have been found to be associated with the development of depression in the elderly. The elderly are also prone to suffer from serious consequences of depression like deterioration of health due to decreased intake of food, decreased self-care, and loss of adherence to medications for other physical disorders such as diabetes and hypertension, which may lead to serious repercussions. Suicidal attempts in the elderly are known to be more lethal than in the younger population. Education is widely regarded as one of the key factors. It is revealed that elders with limited educational exposure experience considerably more depressive symptoms than older adults who are exposed to good education.

The majority psychiatric disorder in late life is Alzheimer's disease, various types of dementia, depression, mood disorders and delusion. Common end-of-life concerns included financial and emotional burdens on family, pain and suffering, interpersonal issues such as saying "goodbye," spiritual issues, and funeral arrangements.

It has been observed that many surgico-medical patients suffer from psychotic morbidity. Patients with cardio vascular disease develop anxiety & depression which is generally termed as Cardiac Neurosis. Diabetes & some pulmonary diseases such as asthma may also be related to psychosomatic illness. Panic disorder & emotional stress are related to gastrointestinal diseases. Patient with irritable bowl syndrome develop hypochondriasis. Psychological factors play an important role in eating disorders like anorexia nervosa, bulimia & obesity. Poor physical condition, pain & prolonged medication in cancer patients are also are also known to induce depression & psychiatric disorder.

Individuals who have tested positive for HIV or cases of full blown AIDS develop major depression, mania & anxiety disorders. Patients suffering from end stage renal disease are known to develop psychiatric disorder. Fear and other emotions play an important role in the genesis of myocardial infarction, hypertension, asthma and other bodily illnesses, and bodily changes such as fatigue, anorexia and weight loss are commonplace in psychiatric disorders. That most characteristic of all psychiatric disorders, depressive illness, illustrates the impossibility of distinguishing between physical and mental symptoms.
MATERIALS AND METHODS:
Homoeopathy is the humanistic medicine based on totalistic, dynamistic and individualistic substratum.
Clinical study:
1. Period of study:
The study on psychiatric disorders in late life and in medically ill persons and its homoeopathic management was conducted on the cases from OPD of the college as well as from various Critical Care Hospitals and Psychiatric OPDs between December 2010 and December 2011.

2. Inclusion criteria:
Patients diagnosed with psychiatric disorders such as Depression, anxiety neurosis, etc. Males aged between 55 to 87 yrs of age & females also of age group between 55 to 87 yrs of age. Males of medically ill persons between 55 to 65 yrs of age & females between 55 to 65 yrs of age.

3.Exclusion criteria:
The cases with present complaints of severe complications were excluded from the study.

4. Clinical protocol
The data is collected by sampling method and analysed in a standardized format with the following steps: Patients are selected from among those having a nosological diagnosis of geriatric psychic disorders of medically ill persons.The purpose and details of research work are explained to the patients and their consent is taken.All cases are taken in the standardized case record. Processing of the case is based on the analysis, evaluation and totality of the same,according to the prescribed format.
The selection of the Homoeopathic remedy on the basis of its similarity is based on references from Materia Medica and Complete Repertory. As per guidelines from Organon of Medicine and Homoeopathic Philosophy.all the cases are followed to the conclusion.
Selection of the Remedy:
A complete study of the psychodynamics has been made in each case.The constitution of the patient, intrinsic miasmatic background, characteristic reaction patterns and the type of associated co-morbid affections were taken into account while establishing the nature of disease.The selection of remedy was based on the similarity of the complete disease rather than mere symptom similarity.

RESULTS:
Results shows that 33% patient has shown excellent improvement , 26% patient showed moderate improvement, 20% have shown mild improvement , 20% patient have shown no improvement..

DISCUSSION
Psychiatric disorders in geriatric groups specially depression were found to be mostly common to occur in this group. And this was found to be predominant in females. But depression is also most commonly found to make victim of medically ill patients. Specially in chronic medically illnesses such as high blood pressure , diabetes mellitus , cancer patients etc they are mostly found to suffer from specially depression & anxiety neurosis..The current study has made an attempt to provide statistical data on a large sample of geriatric patients belonging to a district in India & in the countries out of India . Cases were analyzed on the basis of miasms, susceptibility, remedy, potency, co-morbidity, pre and post treatment grading assessment and percentage wise improvement.

For the purpose of selecting a sample, for making the picture of psychiatric disorders in geriatric groups & medically ill persons and arriving to a statistical data, screening of old aged & medically ill persons from various OPDs of various hospitals & psychiatric clinics were conducted. In order to report the assessment of the cases under study, a pattern parallel to the one prevalent in repertorization has been adopted. In repertorization we assess the importance of a remedy by the number as well as the weightages of rubrics covered. The cases were further analyzed based on miasm and susceptibility, repertorized and selection of remedy and potency was done, based on homoeopathic principles and fundamental laws. Effective Psychotherapy was also given and their outcomes assessed in the succeeding follow ups.

CONCLUSION
A total number of 30 cases are taken for the study after diagnosis of the cases. All the 30 cases were studied in detail to draw conclusion.

In this study the geriatric group ranging from 70 to 87 are included. Out of that 30 patients were choosed for the study. Out of this 8 patients were from higher backgrounds. 10 patients were from highere-middle class background, 7 patients were from middle class background & 5 patients were from lower-middle class or lower class back-ground.

Same in the case of medically ill persons that means the patients who are suffering from chronic diseases like high B.P. , diabetes, cancer, chronic liver failure , Chronic kidney failure etc. Here also 30 patients were choosed . Out of these 10 patients were from higher-middle class family, 8 patients were from middle class family , 6 patients were from lower- middle class family & 6 patients were from lower class family.

During the study 16 patients come with severe illness, 8 patients come with moderate illness , 4 patients come with mild illness & 2 patients come with fake ill ness. After taking treatment out of 16, 10 persons becomes completely cured , Out of 8 moderately ill patients 8 patients gets completely cured , Out of 4 mild ill patients only 2 patients gets cured.

CONFLICT OF INTEREST:
We declare that the research involved in the above manuscript has been carried out at an educational institute as a part of dissertation work. We did not receive any funds that could influence our work. We also state here that the institute where we are working have not paid us any honoraria, consultancy fees and the findings of this study have not been submitted as a part or as a whole to the patenting authorities of any country.
ACKNOWLEDGEMENTS
It is a matter of profound honours and privilege for us to receive constant encouragement, inspiration, advice and guidance from Dr Shivajirao Kadam, Vice Chancellor, Bharati Vidyapeeth, Pune, Dr.ARUN BHASME Principal, S.K.H. Medical College, Beed. & DR. MEENA BHASME incharge of PG S.K.H medical college , Beed, DrRavi Bhosale,Principal Sawkar HMC, Satara, Dr Limbekar P B,Principal, HMC,Shirpur, Dr Sunil Pawar,Principal, Ahmadnagar HMC, Ahmadnagar, Dr Neeraj Goel, Principal, CMP HMC,Mumbai.

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