Delirium is defined as a transient, usually reversible, cause of mental dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. The clinical hallmarks are decreased awareness and attention span and a waxing and waning type of confusion.
Thank you for reading this post, don't forget to subscribe!Delirium is not a disease but a syndrome with multiple causes that result in a similar constellation of signs and symptoms. Delirium can occur at any age, but it occurs more commonly in patients who are elderly and have a previously compromised mental status.
Delirium is often unrecognized or misdiagnosed as dementia, depression, mania, psychotic disorders, or a typical response of the aging brain to hospitalization. Disturbance of the sleep-wake cycle with insomnia, daytime drowsiness, or disturbing dreams or nightmares can also occur.
Delirium is a transient global disorder of cognition. The condition is a medical emergency associated with increased morbidity and mortality rates. Early diagnosis and resolution of symptoms are correlated with the most favorable outcomes.
Symptomes
Based on the level of psychomotor activity, delirium can be described as hyperactive, hypoactive, or mixed. Hyperactive delirium is observed in patients in a state of alcohol withdrawal or intoxication with phencyclidine (PCP), amphetamine, and lysergic acid diethylamide (LSD). These patients often exhibit agitation, restlessness, hallucinations, or delusions. Hypoactive delirium is observed in patients in states of hepatic encephalopathy and hypercapnia and may be more common in older adults. Hypoactive delirium presents with lethargy, drowsiness, apathy, decreased responsiveness, or slowed motor skills. In mixed delirium, individuals display either relatively normal levels of psychomotor activity or rapidly fluctuating levels of activity. Patients may have false beliefs or thinking (misinterpreting intravenous lines as ropes or snakes) or see or hear things that are not present (picking up things in the air or seeing bugs in the bedclothes).
Neurological symptoms may include the following: Dysphasia. Dysarthria. Tremor Asterixis in hepatic encephalopathy. Uremia. Motor abnormalities
Study
According to one study, delirium is associated with worse survival and greater resource consumption in those with cardiac critical illness. Nursing notes can be very helpful for documentation of episodes of disorientation, abnormal behavior, and hallucinations. Record accurate and specific findings in mental status as well as the particular time.
Delirium always should be suspected when (a new onset) or an acute or subacute deterioration in behavior, cognition, or function occurs, especially in patients who are elderly, demented, or depressed. Patients may have visual hallucinations or persecutory delusions as well as grandiose delusions. Some patients with delirium also may become suicidal or homicidal.
Delirium is mistaken for dementia or depression, especially when patients are quiet or withdrawn.
The mechanism of delirium still is not fully understood. Delirium results from a wide variety of structural or physiological insults. The neuropathogenesis of delirium has been studied in patients with hepatic encephalopathy and alcohol withdrawal. Research in these areas still is limited. The main hypothesis is reversible impairment of cerebral oxidative metabolism and multiple neurotransmitter abnormalities. The following observations support the hypothesis of multiple neurotransmitter abnormalities. Emotional disturbances leading to depression, anxiety, fear, and irritability.
Causes
Almost any medical illness, intoxication, or medication can cause delirium. Often, delirium is multifactorial in etiology, and the physician treating the delirium should investigate each cause contributing to it. Allopathic medications are the most common sometimes reversible cause of delirium.
Some of the other common reversible causes include the following:
- Hypoxia.
- Hypoglycemia.
- Hyperthermia.
- Anticholinergic delirium.
- Alcohol or sedative withdrawal
Other causes of delirium include the following:
- Infections.
- Metabolic abnormalities.
- Structural lesions of the brain.
- Postoperative states.
- Miscellaneous causes, such as sensory deprivation, sleep deprivation, fecal impaction, urinary retention, and change of environment.
- In persons who are elderly, medications at therapeutic doses and levels can cause delirium.
Although numerous risk factors have been described, a recent study identified 5 important independent risk factors.
- Use of physical restraints.
- Malnutrition.
- Use of a bladder catheter.
- Any iatrogenic event.
- Use of 3 or more medications.
Dementia is one of the strongest most consistent risk factors. Underlying dementia is observed in 25-50% of patients. The presence of dementia increases the risk of delirium 2-3 times. Low educational level, which may be an indicator of low cognitive reserve, is associated with increased vulnerability to delirium.
Dysphoric mood and hopelessness are also risk factors for incident delirium.
Structural changes that may contribute to delirium include the following:
- Closed head injury or cerebral hemorrhage.
- Cerebrovascular accidents, such as cerebral infarction, subarachnoid hemorrhage, and hypertensive encephalopathy.
- Primary or metastatic brain tumors.
- Brain abscess
Metabolic causes may include the following:
Hypoperfusion states such as shock congestive heart failure, cardiac arrhythmias, and anemias may contribute to delirium.
Infectious causes may include the following:
- CNS infections such as meningitis.
- Encephalitis.
- HIV-related brain infections.
- Septicemia.
- Pneumonia.
- Urinary tract infections
Substance intoxication with alcohol, heroin, Crystal methamphetamine (ice drug), cannabis, PCP, and LSD may cause symptoms of delirium. Withdrawal from these substances may also contribute.
Medication induced delirium
Medication-induced delirium can be caused by any of the following agents:
- Anticholinergics (Benadryl, tricyclic antidepressants).
- Narcotics (meperidine).
- Sedative hypnotics (benzodiazepines).
- Histamine-2 (H2) blockers.
- Corticosteroids.
- Centrally acting antihypertensives (methyldopa, reserpine).
- Anti-Parkinson drugs.
Other causes may include postictal state and unfamiliar environment.
Delirium may come about as a result of surgery or operation for example:
- Preoperative (dementia, polypharmacy, fluid and electrolyte imbalance).
- Intraoperative (meperidine, long-acting benzodiazepines, anticholinergics such as atropine; however, medications such as glycopyrrolate can be used because, in contrast to atropine, they do not cross the blood brain barrier).
- Postoperative (hypoxia, hypotension, drug withdrawal) {Mild cognitive impairment and vascular risk factors can be independent risk factors for postoperative delirium}.
Diagnosis
The diagnosis of delirium is clinical sign and symptoms. No laboratory test can diagnose delirium.
Laboratory Studies
Laboratory tests that may be helpful for diagnosis include the following:
-
Complete blood cell count with differential – Helpful to diagnose infection and anemia.
Electrolytes. Glucose – To diagnose hypoglycemia, diabetic ketoacidosis, and hyperosmolar nonketotic states. Renal and liver function tests. Thyroid function studies. Urine analysis. Urine and blood drug screen – to diagnose toxicological causes. Thiamine and vitamin B-12 levels.
Tests for bacteriological and viral etiologies including syphilis. Sedimentation rate. Drug screen including alcohol level. HIV tests
Serum marker for delirium: The calcium-binding protein S-100 B could be a serum marker of delirium. Higher levels are seen in patients with delirium.
Imaging Studies
Neuroimaging – Perform CT scan of the head. Magnetic resonance imaging (MRI) of the head may be helpful in the diagnosis of stroke, hemorrhage, and structural lesions. Electroencephalogram (In delirium, generally, slowing of the posterior dominant rhythm and increased generalized slow-wave activity are observed on electroencephalogram (EEG) recordings. In delirium resulting from alcohol/sedative withdrawal, increased EEG fast-wave activity occurs. In patients with hepatic encephalopathy, diffuse EEG slowing occurs.
Chest radiograph is used to diagnose pneumonia or congestive heart failure.
Lumbar puncture (if CNS infection is suspected as a cause of delirium or when the source for the systemic infection cannot be determined). Pulse oximetry is used to diagnose hypoxia as a cause of delirium. Electrocardiogram is used to diagnose ischemic and arrhythmic causes.
Pathophysiology
Acetylcholine
Data from animal and clinical studies support the hypothesis that acetylcholine is one of the critical neurotransmitters in the pathogenesis of delirium. A small prospective study among patients who have undergone elective hip replacement surgery showed reduced preoperative plasma cholinesterase activity in as many as one quarter of patients. In addition, reduced preoperative cholinesterase levels were significantly correlated with postoperative delirium.
Clinically, good reasons support this hypothesis. Anticholinergic medications are a well-known cause of acute confusional states, and patients with impaired cholinergic transmission, such those with Alzheimer disease, are particularly susceptible. In patients with postoperative delirium, serum anticholinergic activity may be increased.
Dopamine
In the brain, a reciprocal relationship exists between cholinergic and dopaminergic activities. In delirium, an excess of dopaminergic activity occurs. Symptomatic relief occurs with antipsychotic medications such as haloperidol and other neuroleptic dopamine blockers.
Other neurotransmitters
Serotonin: Human and animal studies have found that serotonin is increased in patients with hepatic encephalopathy and septic delirium. Hallucinogens such as LSD act as agonists at the site of serotonin receptors. Serotonergic agents also can cause delirium.
Gamma-aminobutyric acid (GABA): In patients with hepatic encephalopathy, increased inhibitory GABA levels also are observed. An increase in ammonia levels occurs in patients with hepatic encephalopathy, which causes an increase in the amino acids glutamate and glutamine, which are precursors to GABA. Decreases in CNS GABA levels are observed in patients with delirium resulting from benzodiazepine and alcohol withdrawal.
Cortisol and beta-endorphins: Delirium has been associated with the disruption of cortisol and beta-endorphin circadian rhythms. This mechanism has been suggested as a possible explanation for delirium caused by exogenous glucocorticoids.
Disturbed melatonin disturbance has been associated with sleep disturbances in delirium.
Inflammatory mechanism
Recent studies have suggested a role for cytokines, such as interleukin-1 and interleukin-6, in the pathogenesis of delirium. Following a wide range of infectious, inflammatory, and toxic insults, endogenous pyrogen, such as interleukin-1, is released from the cells. Head trauma and ischemia, which frequently are associated with delirium, are characterized by brain responses that are mediated by interleukin-1 and interleukin-6.
Stress reaction mechanism
Studies indicate psychosocial stress and sleep deprivation facilitate the onset of delirium.
Structural mechanism
The specific neuronal pathways that cause delirium are unknown. Imaging studies of metabolic (eg, hepatic encephalopathy) and structural (eg, traumatic brain injury, stroke) factors support the hypothesis that certain anatomical pathways may play a more important role than others. The reticular formation and its connections are the main sites of arousal and attention. The dorsal tegmental pathway projecting from the mesencephalic reticular formation to the tectum and the thalamus is involved in delirium.
Disrupted blood-brain barrier can allow neurotoxic agents and inflammatory cytokines to enter the brain and may cause delirium. Contrast-enhanced MRI can be used to assess the blood-brain barrier.
Visuoperceptual deficits in delirium such as hallucinations and delusions are not due to the underlying cognitive impairment. Visual hallucinations during alcohol-withdrawal delirium are seen in subjects with polymorphisms of genes coding for dopamine transporter and catechol-O-methyltransferase (COMT).
Mortality/Morbidity
In admitted patients with delirium, with allopathic medication mortality rates are 10-26%, while with Homeopathic treatment mortality rate is less than 5% and didn’t show any complications.
Patients who develop delirium during hospitalization have a mortality rate of 22-76% and a high rate of death during the months following discharge. In a review of 28 studies of critically ill patients the rate of death with allopathic medication for patients with delirium was more than doubled; in elderly and patients in the postoperative period, delirium may result in a prolonged hospital stay, increased complications, increased cost, and long-term disability.
Allopathic treatment for delirium
When delirium is diagnosed or suspected, the underlying causes should be sought and treated. Components of delirium management include supportive therapy and pharmacological management.
Fluid and nutrition should be given carefully because the patient may be unwilling or physically unable to maintain a balanced intake. For the patient suspected of having alcohol toxicity or alcohol withdrawal, therapy should include multivitamins, especially thiamine.
Reorientation techniques or memory cues such as a calendar, clocks, and family photos may be helpful. The environment should be stable, quiet, and well-lighted. A meta-analysis of 7 studies that focused on the usefulness of interventions such as physical or occupational therapy, daily reorientation, and the avoidance of sensorial deprivation found a significant reduction in the development of delirium among elderly inpatients. Physical restraints should be avoided. These patients should never be left alone or unattended.
Medication Summary
The most common allopathic medications used are antipsychotic drugs; second-generation antipsychotics (SGAs) may treat delirium better than usual care, or haloperidol.
Interestingly a 2016 meta-analysis of 25 studies found that antipsychotic use was not associated with change in delirium duration, severity, or hospital or ICU length of stay.
Benzodiazepines often are used for alcohol and benzodiazepine withdrawal states.
Since decreased anticholinergic activity may be associated with delirium, anticholinesterase inhibitors have been tried (trials and systematic review did not support this use).
A randomized, double-blinded, placebo-controlled, multicenter trial in intensive care unit patients showed rivastigmine did not decrease duration of delirium and increased mortality in these patients. In this trial, the study group had more sicker patients with emergency admissions to the ICU, and this trial had used IV haloperidol, lorazepam, or propofol, in addition to rivastigmine, which might also have contributed to the delirium and increased mortality. A review of 27 trials of anticholinesterase inhibitors found that in 25 of the studies there was no benefit from the medications in either the prevention or management of delirium.
Recent clinical trials showed that the melatonin supplement and its receptor agonist ramelteon may be useful in the prevention and management of delirium. Melatonin levels were found to be altered in delirium subjects.
Antipsychotics
This class of drugs are the medication of choice in the treatment of psychotic symptoms of delirium. Older antipsychotics such as haloperidol, a high-potency antipsychotic, are useful but have adverse neurological effects. Newer neuroleptics such as risperidone, olanzapine, and quetiapine relieve symptoms but also with severe adverse effects. Initial doses may need to be higher than maintenance doses. Use lower doses in patients who are elderly. Discontinue these medications as soon as possible. Attempt a trial of tapering the medication once symptoms are in control. Antipsychotics can be associated with adverse neurological effects such as extrapyramidal symptoms, neuroleptic malignant syndrome, and tardive dyskinesia. Longer term use is also associated with metabolic syndrome. Doses should be kept as low as possible to minimize adverse effects. Paradoxical and hypersensitivity reactions may occur.
Haloperidol
A butyrophenone high-potency antipsychotic. One of most effective allopathic antipsychotics for delirium. High-potency antipsychotic medications also cause less sedation than phenothiazines and reduce risks of exacerbating delirium.
Risperidone
Risperidone has fewer extrapyramidal adverse effects than Haloperidol. Binds to dopamine D2-receptor with 20 times lower affinity than for 5-HT2-receptor. Improves negative symptoms of psychoses and reduces incidence of adverse extrapyramidal effects.
Benzodiazepines
Reserved for delirium resulting from seizures or withdrawal from alcohol or sedative hypnotics. Coadministration with antipsychotics is considered only in patients who tolerate lower doses of either medication or have prominent anxiety or agitation. Benzodiazepines are preferred over neuroleptics for treatment of delirium resulting from alcohol or sedative hypnotic withdrawal. They also may be used when unknown substances may have been ingested and may be helpful in delirium from hallucinogen, cocaine, stimulant, or PCP toxicity.
Use special precaution when using benzodiazepines because they may cause respiratory depression, especially in patients who are elderly, those with pulmonary problems, or debilitated patients.
Lorazepam
Lorazepam is short acting and has no active metabolites. In addition, can be used in both IM and IV forms. When patient needs to be sedated for longer than 24 h, this medication is excellent. Commonly used prophylactically to prevent delirium tremens.
Vitamins
Patients with alcoholism and patients with malnutrition are prone to thiamine and vitamin B-12 (Cyanocobalamin) deficiency, which can cause delirium. Vitamin B-12 deficiency can cause confusion or delirium in patients who are elderly. Deoxyadenosylcobalamin and hydroxocobalamin are active forms of vitamin B-12 in humans. Vitamin B-12 deficiency may result from intrinsic factor deficiency (pernicious anemia), partial or total gastrectomy, or diseases of the distal ileum.
Hypnotic, Miscellaneous
Agents in this class may be useful in the prevention and management of delirium for example:
Melatonin
Melatonin is a naturally occurring hormone secreted by the pineal gland. The concentration of melatonin is highest in the blood during normal times of sleep and lowest during normal times of wakefulness. The general consensus is that melatonin given during normal waking hours has hypnotic properties.
Ramelteon
Ramelteon is a melatonin receptor agonist with high selectivity for human melatonin MT1 and MT2 receptors. MT1 and MT2 are thought to promote sleep and be involved in maintaining circadian rhythm and a normal sleep-wake cycle. Ramelteon does not cause rebound insomnia or withdrawal symptoms at discontinuation. It is indicated for insomnia characterized by difficulty with sleep onset.
It is not unusual for patients who are elderly to require 6-18 months or longer for full recovery. In particular, elderly patients with postacute care complications are at risk for prolonged and persistent delirium.
Prognosis for delirium with allopathic treatment
Delirium significantly worsens prognosis and is associated with increased mortality at discharge and at 12 months. A significant proportion of patients with delirium during their hospital admission continued to demonstrate symptoms of delirium at discharge, 6-month, and 12-month follow-up.
Resolution of symptoms may take longer in patients with poor premorbid cognitive function, incorrect or incomplete diagnosis of contributing factors, and structural brain diseases treated with large doses of psychoactive medications prior to the onset of acute medical illness.
For some patients, the cognitive effects of delirium may resolve slowly or not at all, because To date, no treatment which can reverse the process of Alzheimer’s disease, delirium, dementia etc, has been identified.
Homeopathic treatment for delirium
Anacardium Orientale
Neurasthenics patients; who have nervous dyspepsia, relieved by food; impaired memory, depression, and irritability; diminution of senses (smell, sight, hearing). Fears. Weakening of all senses, sight, hearing, etc. Aversion to work; lacks self-confidence; irresistible desire to swear and curse. Sensation of a plug in various parts-eyes, rectum, bladder, etc; also of a band. Empty feeling in stomach; eating temporarily relieves all discomfort. Alzheimer’s disease. Dementia. Delirium. Intermittency of symptoms.
Fixed ideas. Hallucinations; thinks he is possessed of two persons or wills. Anxiety when walking, as if pursued. Profound melancholy and hypochondriasis, with tendency to use violent language. Brain-fag. Impaired memory. Absent mindedness. Very easily offended. Malicious; seems bent on wickedness. Lack of confidence in himself or others. Suspicious. Clairaudient, hears voices far away or of the dead. Senile dementia. Absence of all moral restraint. Vertigo. Pressing pain, as from a plug; worse after mental exertion-in forehead; occiput, temples, vertex; better during a meal. Itching and little boils on scalp.
Rhododendron
Dread of a storm; particularly afraid of thunder. Forgetful. Delirium; staggers; falls asleep on his knees. Frightful visions. Sombre, morose humour. Excessive indifference. Sudden loss of ideas. Leaves out whole words when writing. While talking forgets what he is talking about. Reeling sensation in head; brain feels as if surrounded with a fog.
Helleborus Niger
Melancholy taciturnity. Excessive, and almost mortal anguish. Home-sickness. Hypochondriacal humour. Taedium vitae; envious seeing others happy. Delirium. Suicidal. Indolence. Sobbing lamentation. Obstinate silence. Irritable – feel better from consolation. Suspicious. Dullness of the internal senses. Stupidity and want of reflection, with (thoughtless) fixedness of look on one single point, much moaning, and inability to think. Weakness of the memory. The mind seems to lose command over the body; the muscles refuse their office as soon as the attention is diverted (if the will is not strongly fixed upon their action; if he talks he lets fall what he holds in his hand). Giddiness on stooping. Stupefying headache. Face pale – dropsical swelling of the face and body.
Absinthian
Forgets what has recently happened. Insane; idiotic; brutal. Idiotic manner, doesn’t care whether she dies or not. Wants nothing to do with anybody. Delirium. Frightful visions and terrifying hallucinations. Stupor alternating with dangerous violence. Insensible with the convulsions. Vertigo – when he/she rises up; tendency to fall backward. Confusion in head. Headache. Wants to lie with the head low. Congestion of the brain and spinal cord.
Causticum
Does not want to go to bed alone. Least thing makes cry. Sad, hopeless. Intensely sympathetic. Ailments from long-lasting grief, sudden emotions. Thinking of complaints, aggravates, especially haemorrhoids. Delirium. Sensation of empty space between forehead and brain. Pain in right frontal eminence.
Hyoscymaus Niger
Disturbed nervous system. It is as if some diabolical force took possession of the brain and prevented its functions. Mania of a quarrelsome and obscene character. Inclined to be unseemly and immodest in acts, gestures and expressions. Very talkative, and persists in stripping herself, or uncovering genitals. Is jealous, afraid of being poisoned, etc. Its symptoms also point to weakness and nervous agitation – Alzheimer’s disease. Tremulous weakness and twitching of tendons. Subsultus tendinum. Muscular twitchings, spasmodic affections, generally with delirium. Non-inflammatory cerebral activity. Toxic gastritis. Very suspicious. Obscene, lascivious mania, uncovers body; jealous, foolish. Great hilarity; inclined to laugh at everything. Delirium, with attempt to run away. Low, muttering speech; constant carphologia, deep stupor.
Head feels light and confused. Vertigo as if intoxicated. Brain feels loose, fluctuating. Inflammation of brain, with unconsciousness; head is shaken to and fro. Alzheimer’s disease.
Alumina
Low spirited; fears loss of reason. Confused as to personal identity. Hasty, hurried. Time passes slowly. Variable mood. Better as day advances. Suicidal tendency when seeing knife or blood. Alzheimer’s disease. Stitching burning pain in head, with vertigo relieved by food. Pressure in forehead. Inability to walk closed eyes. Throbbing headache, with constipation. Vertigo, with nausea; better after breakfast. Falling out of hair; scalp itches and is numb.
Rauwolfia Serpentina
Melancholia include are Abasement, Abaser, Abjection, Abjectness, Bleakness, Bummer, Cheerlessness, Delirium, Dejection, Desolation, Desperation, Despondency, Disconsolation, Discouragement, Dispiritedness, Distress, Dole, Dolor, Dreariness, Dullness, Dumps, Ennui, Gloom, Gloominess, Hopelessness, Lowness, Melancholy, Misery, Mortification, Qualm, Sadness, Sorrow, Trouble, Unhappiness, Vapors, Woefulness, Worry, Downheartedness, Dolefulness, Blue Funk, Blahs, Heaviness Of Heart and Lugubriosity. Paranoia, Paranoea. Alzheimer’s disease.
Vicum Album
Incoherent talk and spectral illusions; inclined to be violent. Insensibility. Stupor, succeeded by almost entire insensibility, lying motionless, with eyes closed, as if in a sound sleep, but easily roused by a loud noise, and then would answer any question, but when he/she relapsed into his/her former condition there was a slight disposition to stertorous breathing. Feels as if going to do something dreadful while the tremblings are on. Delirium. Keeps waking in night thinking the most horrible things imaginable. If awake seemed to be dreaming, if asleep she was dreaming. Felt in bad temper. Great depression.
Giddiness. Intense throbbing headache. Sharp pain in head and face. Numb feeling in head. Tightening sensation of the brain once or twice. Sharp shooting in occipital bone.
Lac Caninum
Very forgetful; in writing, makes mistakes. Despondent; thinks her disease incurable. Attacks of rage. Visions of snakes. Thinks himself of little consequence. Alzheimer’s disease. Sensation of walking or floating in the air. Pain first one side, then the other. Blurred vision, nausea and vomiting at height of attack of headache. Delirium. Occipital pain, with shooting extending to forehead. Sensation as if brain were alternately contracted and relaxed. Noises in ears. Reverberation of voice.
Medorrhinum
Severe disturbance and irritability of nervous system. Dwarfed and stunted. State of collapse and trembling all over. History of sycosis. Alzheimer’s disease. Delirium. Intensity of all sensations. Weak memory. Loses the thread of conversation. Cannot speak without weeping. Time passes too slowly. Is in a great hurry. Hopeless of recovery. Difficult concentration. Fears going insane. Sensibility exalted. Nervous, restless. Fear in the dark and of some one behind her. Melancholy, with suicidal thoughts. Burning pain in brain; worse, occiput. Head heavy and drawn backward. Headache from jarring of cars, exhaustion, or hard work. Weight and pressure in vertex.
Macinela
Silent mood, sadness. Wandering thoughts. Sudden vanishing of thought. Bashful. Fear of becoming insane. Delirium. Vertigo; head feels lights, empty. Scalp itches. Hair falls out after acute sickness. Fear: of getting crazy; of evil spirits. Alzheimer’s disease. Averse to work and answering questions. Sadness. Anxiety; before menses. Homesick. Bashful and taciturn; timid look.
Datura Metel
soporose condition, and later delirium and spasms. The soporose state may be absent. Delirium may be vociferous, or merely garrulous. Patient usually manifests excessive timidity. Picks at real or imaginary objects. Performs ridiculous antics. Several movements appear due to perverted vision, and inability to judge distances. After the delirium, patient remembers nothing of what has occurred. Extreme dilatation of pupils. Flickering before eyes with photophobia. Pulse and temperature undergo extremes of exaltation and depression. Alzheimer’s disease. Convulsions. Delirium. Epilepsy. Eye affections. Mania. Timidity.
Aethusa Cynapium
Incapacity to think; confused. Loss of comprehension. Idiocy, in some cases alternating with furor. Great anxiety and restlessness, followed by violent pains in head and abdomen. Bad humour; irritability. Irritability, especially in the afternoon, and in the open air. Delirium: sees cats and dogs; tries to jump out of the window. Loquacious gaiety.
Confused; brain feels bound up. Vertigo, with sleepiness, can’t raise the head. Headache in whole front part of head. Sensation, as if both sides of the head were in a vice. Distressing pains in the occiput, down nape of neck, and spine. Heat rises to the head; the body becomes warmer; the face becomes red and the giddiness ceases. Stitches and pulsations in the head. Can’t hold head up, or sit up. Sensation as if constantly pulled by the hair.
Argentum Metallicum
Restlessness – which forces him to walk quickly. Ill-humour and aversion to talking. When pleased, excessively merry, but cries a long time about a trifle. Delirium (mania; after epilepsy). Dulness, and sensation of emptiness in the head. Dizziness, with obscurity of vision, or with drowsiness, and falling of the eyelids. Migraine. Compression in the brain, with nausea and burning in the epigastrium, on reading and stooping for any time.
Argentum Nitricum
The neurotic effects of Argentum Nitricum are very marked, many brain and spinal symptoms presenting, head symptoms often determine the choice of this remedy. Symptoms of incoordination, loss of control and want of balance everywhere, mentally and physically; trembling in affected parts. Alzheimer’s disease. Gastroenteritis. Great desire for sweets, the splinter-like pains, and free muco-purulent discharge in the inflamed and ulcerated mucous membranes. Sensation as if a part were expanding and other errors of perception are characteristic.
Withered up and dried constitutions present a favorable field for its action, especially when associated with unusual or long continued mental exertion. Pains increase and decrease gradually. Flatulent state and prematurely aged look. Explosive belching especially in neurotics. Upper abdominal infections brought on by undue mental exertion. Paraplegia Myelitis and disseminated sclerosis of brain and cord. Intolerance of heat. Sensation of a sudden pinch. Destroyed red blood corpuscles – anaemia.
Thinks his understanding will and must fail. Fearful and nervous; impulse to jump out of window. Faintish and tremulous. Melancholic; apprehensive of serious disease. Time passes slowly. Memory weak. Errors of perception. Impulsive; wants to do things in a hurry. Peculiar mental impulses. Fears and anxieties and hidden irrational motives for actions. Delirium.
Headache with coldness and trembling. Emotional disturbances cause appearance of hemicranial attacks. Sense of expansion. Brain-fag, with general debility and trembling. Headache from mental exertion, from dancing. Vertigo, with buzzing in ears and with nervous affections. Aching in frontal eminence, with enlarged feeling in corresponding eye. Boring pain; better on tight bandaging and pressure. Itching of scalp. Hemicrania; bones of head feel as if separated.
Arsenicum Album
Melancholy, sometimes of a religious character, sadness, care, chagrin, cries and complaints. Anguish. Restlessness. Great fear of being left alone. Anger, with anxiety, restlessness and sensation of coldness. Anxiety of conscience, as if a crime had been committed. Inconsolable anguish, with complaints and lamentation. Hypochondriacal humour. Fear of solitude, of spectres, and of robbers, with desire to hide oneself. Indecision and changeable humour, which demands this at one time, that at another, and rejects everything after having obtained it. Despair; he finds no rest with anguish. Despondency, despair, weariness of life, inclination to suicide, or excessive fear of death, which is sometimes believed to be very near. Too great sensibility and scrupulousness of conscience, with gloomy ideas, as if one had offended all the world. Ill-humour, impatience, vexation, inclination to be angry, repugnance to conversation, inclination to criticise, and great susceptibility. Caustic and jesting spirit. Extreme sensibility of all the organs; all noise, conversation, and clear lights are insupportable. Great apathy and indifference. Great weakness of memory. Delirium. Stupidity and dullness. Delirium, with great flow of ideas. Loss of consciousness, and of sensation; dotage; maniacal actions and frenzy. Madness; loss of mind (from the abuse of alcoholic drinks).
Heaviness, sensation of weakness, and confusion in the head. Vertigo on shutting the eyes, on walking, or in the open air, and sometimes with tottering, with danger of falling, intoxication, loss of sense, obscuration of the eyes, nausea, and headache. Tearing in the head, with vomiting, when raising up the head. Cracking or buzzing in the head. Excessive swelling of the head and face. Erysipelatous burning, swelling of the head (face and genitals) with great weakness and coldness.
Cannabis Indica
A condition of intense exaltation, in which all perceptions and conceptions, all sensations and all emotions are exaggerated to the utmost degree.
Subconscious or dual nature state; Dual personality disorder. Apparently under the control of the second self, but, the original self, prevents the performance of acts which are under the domination of the second self. Apparently the two natures cannot act independently, one acting as a check, upon the other. Delirium.
Most remarkable hallucinations and imaginations, exaggeration of the duration of time and extent of space. Conception of time, space and place is gone. Extremely happy and contented, nothing troubles. Ideas crowd upon each other. Epilepsy, mania, dementia, delirium tremens, and irritable reflexes. Exophthalmic goitre. Catalepsy. Alzheimer’s disease.
Excessive loquacity; exuberance of spirits. Constantly theorizing. 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, chronic vertigo as of floating off. Feels as if top of head were opening and shutting and as if calvarium were being lifted. Shocks through brain. Uraemic headache with flatulence. Involuntary shaking of head. Migraine attack preceded by unusual excitement with loquacity.
Ignatia Amara
Hyperaesthesia of all senses. Tendency to clonic spasms. Mentally, the emotional element is uppermost, and co-ordination of function is interfered with. It is one of the chief remedies for hysteria. Nervous temperament-women of sensitive, easily excited nature, dark, mild disposition, quick to perceive, rapid in execution. Rapid change of mental and physical condition, opposite to each other. Alzheimer’s disease. Delirium. Alert, nervous, apprehensive, rigid, trembling patients who suffer acutely in mind or body, at the same time. Effects of grief and worry. Cannot bear tobacco. Pain is small, circumscribed spots. The plague. Hiccough and hysterical vomiting.
Changeable mood; introspective; silently brooding. Melancholic, sad, tearful. Not communicative. Sighing and sobbing. Aftershocks, grief, disappointment. Head feels hollow, heavy; worse, stooping. Headache as if a nail were driven out through the side. Cramp-like pain over root of nose. Congestive headaches following anger or grief; worse, smoking or smelling tobacco, inclines head forward.
Coca
Melancholy. Hypochondriasis. Mental depression with drowsiness. Bashfulness. Prefers solitude and darkness. Alzheimer’s disease. Muddled feeling in brain. Loss of energy. Great mental excitement. Delirium. Vertigo and fainting. Tension over forehead. Headache just over eyebrows. Shocks in head; dull, full feeling in occiput with vertigo, the only possible position is on the face.
Kali Phosphoricum
One of the greatest nerve medicine. Prostration. Weak and tired. Marked disturbance of the sympathetic nervous system. Conditions arising from want of nerve power, neurasthenia, mental and physical depression. Alzheimer’s disease. The causes are usually excitement, overwork and worry. Adynamia and decay, gangrenous conditions. Suspected malignant tumors. After removal of cancer when in healing process skin is drawn tight over the wound. Delayed labor.
Anxiety, nervous dread, lethargy. Indisposition to meet people. Extreme lassitude and depression. Very nervous, starts easily, irritable. Brain-fag; hysteria; night terrors. Somnambulance. Delirium. Loss of memory. Slightest labor seems a heavy task. Great despondency about business. Shyness; disinclined to converse.
Occipital headache. Vertigo, from lying, on standing up, from sitting, and when looking upward. Cerebral anaemia. Headache of students, and those worn out by fatigue. Headaches are relieved by gentle motion. Headache, with weary, empty, gone feeling at stomach.
Aurum Metallicum
Feeling of self-condemnation and utter worthlessness. Profound despondency, with increased blood pressure, with thorough disgust of life, and thoughts of suicide. Talks of committing suicide. Fear of death. Peevish and vehement at least contradiction. Delirium. Alzheimer’s disease. Anthropophobia. Mental derangements. Constant rapid questioning without waiting for reply. Cannot do things fast enough. Over sensitiveness; to noise, excitement, confusion.
Violent pain in head; worse at night, outward pressure. Roaring in head. Vertigo. Tearing through brain to forehead. Pain in bones extending to face. Congestion to head. Boils on scalp.
Nux Moschata
Tendency to fainting fits, with heart failure. Cold extremities, extreme dryness of mucous membranes and skin. Strange feeling, with irresistible drowsiness. Indicanuria. General inclination to become unconscious during acute attacks. Alzheimer’s disease. Lypothymia. Staggers on trying to walk.
Delirium. Mind changeable; laughing and crying. Confused, impaired memory. Bewildered sense, as in a dream. Thinks she has two heads. Vertigo when walking in open air; aches from eating a little too much. Feeling of expansion, with sleepiness. Pulsating in head. Cracking sensation in head. Sensitive to slightest touch in a draught of air. Bursting headache; better hard pressure.
For consultation; Feel free to whatsapp us or visit our clinic.
P. S : This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).
For proper consultation and treatment, please visit our clinic.
Location, address and contact numbers are given below.
NoN of above mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.
To order medicine by courier, please send your details at WhatsApp– +923119884588
Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
Location: Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.
Find more about Dr Sayed Qaisar Ahmed at :
https://www.youtube.com/Dr Qaisar Ahmed