Clinical Cases

A Case of Anxiety Neurosis

Last modified on October 20th, 2018

Ramkrishna Valaki

Dr. Ramkrishna Valaki presents a case of anxiety neurosis in a man of 24, that was triggered by the fear at his mother’s bypass surgery. The patient developed fear of having a heart attack.

INDEX

No.Name of Topic
1Introduction of Anxiety Neurosis
2Case Details
3Physical Generals
4Past History
5Physical Examination
6Systematic Examination
7Investigation
8Diagnosis
9Differential Diagnosis
10Analysis Of Case
11Rubric Selection
12Repererisation
13Explanation
14Remedy
15Potency Selection
16Follow Up
17Bibliography

 

  • Introduction
    • Anxiety neurosis is a mental condition characterized by feelings of anxiety and fear, where anxiety is worry about the future and fear about current situations. These feeling may cause physical symptoms like palpitation and shaking.

There are many anxiety disorders

  • Generalized anxiety disordered
  • Specific phobia
  • Social anxiety disordered
  • Separation anxiety
  • Agoraphobia
  • Panic disordered

 

  • Case details

A 24 year old man was suffering from anxiety neurosis. He had taken allopathic treatment without much improvement.

Chief complaints –Non specific chest pain since four months which started after his mother’s bypass heart surgery.

Case History :

  • He said that his complaint started after his mother’s bypass surgery.He had seen allthe treatment given to her.
  • Before bypass surgery his mother was on ventilation and riles tube.At that time he experiencedgreat fearand anxietyabout what will happen now. If his mother dies then who will take care of his family. Fear that his family will collapse.
  • While asking about critical situations in his life he narrated that after bypass surgery of his mother when the doctor called him , he suddenly got frightened (Dharsko). He felt anxiety in his chest. His heart started beating fast (palpitation). He felt that if his mother die than what will happen. He experiencedArerati(shock), goose flesh and trembling.
  • When doctor said your mother is all right and she is fine then he felt good and relaxed.
  • After one week he felt that he also had a heart attack and simultaneously all complaints started.
  • He had done all tests including ECG which were all absolutely normal.
  • He thought that if he got heart attack then he will also be operated on what will happen.
  • When his anxiety reached a peak, he experienced palpitation, perspiration, suffocation and chest pain.
  • Dream – he had a dream in which his father died because of an accident and suddenly he woke up from sleep with a frightened feeling.
  • At night usually he has fear of heart attack.
  • He is a very sensitive person and little things make him anxious.

 

  • Physical generals

Thirstless
Perspiration –”when frightened I perspire very much”
Appetite lost since four months
Weight lost since four months

  • Past history

No major past illness

  • Physical examination

Weight – 45kg

Blood pressure – 122/ 78 mmhg

Respiratory rate – 17/minute

Pulse – 72/minute

  • Systematic examination

CNS – NAD

CVS – NAD

RS – NAD

  • Investigation

ECG & echo – Normal

  • Diagnosis:Anxiety Neurosis
  • Differential diagnosis

OCD

Bipolar Disorder

  • ANALYSIS OF CASE
  • Reportorial analysis
  • Rubrics

  • Reperterisation

  • Explanation
  • Here the exciting cause is very prominent.
  • Soanchor of the case is,all complaints starts after bypass surgery of mother.
  • Mentally patient having great anxiety/fear about heart disease which he experiences physically as DHRASKO, trembling, gooseflesh and trembling.
  • Appetite, sleep and weight loss all physical generals are ALTERED after surgery of mother.
  • We can see very clearly expression of anxiety/fear on physical plan– PSYCHOSOMATISATION.
  • Basic nature of patient is fearful, anxious and sensitive.
  • Situation affects the patient indicating sensitivity and reactivity. PLANT KINGDOM
  • Reaction of patient in the situation is very sudden and panic indicates – ACUTE reaction/ PANIC

 

  • REMEDY – ACONITE NAP. 1M

 

  • Potency selection
  • Indication of high Potency –

Because of exciting cause, intensity of anxiety, characteristic mental

Symptoms and panic state of patient indicate higher potency.

Mechanism of action – Aconite Nap.1

  • Aconite can interact with the voltage – dependent sodium-ion channel which are proteins in the cell membrane of excitable tissue such as cardiac and skeletal muscles and neurons.
  • These proteins are highly selective for sodium ions. They open very fast to depolarize the cell membrane potential causing the upstroke of an action potential.
  • Normally sodium channel closes very rapidly but depolarization of membrane potential causes opening of potassium channel and potassium efflux, which results in repolarization of membrane.
  • Aconite binds to the receptor at the neurotoxin binding site 2 alfa subunit of channel protein. This binding results in a sodium ion channel that stays open for longer.
  • Aconite suppresses conformation change of sodium ion channel from the activated state into inactivated state. The membrane stays depolarized due to constant sodium influx. As a result membrane cannot repolarize.
  • The binding of Aconitine to the channel also leads to the channel change from the inactive state to active at a more negative voltage.
  • In neurons Aconitine increase the permeability of the membrane for sodium-ions. Resulting in huge sodium – influx in the axonal terminal.
  • As a result, the membrane depolarizes rapidly.
  • Due to strong depolarization, the permeability of membrane for potassium-ions increases fast, resulting in a potassium-reflux to release the positive charge out of the cell. Not only the permeability for potassium ions but also the permeability for calcium ions increases as a result of depolarization of membrane.
  • The calcium influx takes place. The increased calcium concentration in the cell stimulates the release of the neurotransmitter acetyl choline into synaptic cleft. Acetyl choline binds to ACReceptor at post synaptic membrane to open the sodium channel there, generating a new action potential and cause muscle tension.
  • At higher concentrations,Aconitine decreases the electrically evoked acetyl choline release, resulting in decrease muscle tension.
  • At high concentration the sodium ion channel is constantly activated, transmission of action potential suppressed, leading to non-excitable organ or paralysis.

 

  • Follow up
DateSymptoms         Prescription
13/10/2015Full case takenACONITE NAP. 1M Placebo(TDS) for 2 days
15/10/2015

After two days

50% improved in thoughts

Appetite is good

Mood is good

Feeling fresh

 

 

 

 

Placebo(TDS) for 7 days

13/10/2015No anxiety

Numbness in right leg

Vertigo

 

 

Aconite 1M

Placebo (TDS) for 7 days

26/10/2015Improved in all complaintPlacebo (TDS) for 30 days

 

26/11/2015No complaint at allPlacebo  (TDS) for 30 days
01/01/2016Placebo (TDS) for 30 days

 

02/02/2017ImprovedPlacebo(TDS) for 3 months

 

05/05/2017Improved

 

Placebo(TDS) for 3 months

 

23/06/2018No complaint at allNO MEDICINE

Mechanism of action of Aconite in this case:

  • Our patient is suffering from anxiety neurosis
  • Aconite can interact with the voltage – dependent sodium-ion channels which are protein in the cell membrane of excitable tissue such as cardiac and skeletal muscles and neurons.
  • When patient feels anxious and fears that he will get a heart attack, voltage channels are open which excite cardiac muscle, skeletal muscles and thermoregulatory systems.
  • Therefore he feels palpitation, perspiration, suffocation, chest pain and trembling.

Reference:   1.

  • Bibliography

Harrison’s 15th edition Principalsof Internal Medicine (Page 1456)

Material Medica Of Homoeopathic Medicine by Dr S.R.Phatak (2nd edition) (Page 359)

Complete Repertory by Roger van Zandvoort  (First edition)

Homoeopathic posology by Dr AjitKulkarni

Physical diagnosis by RustumJalVakil and Aspi f. Golvala (12th edition, page 329)

Homoeopathic medical repertory by Dr Robin Murphy (3RD edition)

About the author

Ramkrishna Valaki

Ramkrishna Valaki

Dr. Ramkrishna Valaki (B.H.M.S.) has been practicing for the last four years at Dhara Homoeopathic Clinic Bhavnagar, State – Gujarat. India, working as Medical Officer at Swami Vivekanand Homoeopathic Medical College and Hospital.

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