Mental disorders

Manic depressive disorder


Manic disorder is manifested by shouting, violent behavior, restlessness whereas depressive disorder is manifested by incoherent speech and mental depression.


Depressive disorder is due to stagnation of phlegm combined with Qi while manic disorder is due to phlegm fire. A prolonged depressive  disorder in which fire is produced by phlegm stagnation may change into manic disorder in which stagnant fire is gradually dispersed but some phlegm is still existing can change into depressive disorder so both are termed together. This disorder has a hereditary trend.


Etio-pathogenesis


Depression


Over contemplation and emotional depression lead to dysfunction of the liver and spleen. Impaired transportation leads to stagnant liver Qi and accumulated fluid which turn into phlegm and goes upward to 

invade the mind.


Mania


Anger injures the liver which fails in dispersing. The stagnant qi transforms into fire which evaporates the body fluid to produce phlegm fire which rushes upwards and disturbs the mind.


Anxiety neurosis


Anxiety neurosis is a common problem. Majority of the cases that come to us for treatment belong to the age group of 20-30 years. Male outnumber females.


Clinical features


Anxiety, tension, palpitation, excess sweating on the palms & soles and fine tremors are common symptoms. If the patient meets some V.I.P. are appears for some interview the symptoms are aggravated at that time. Patient is normal when he is alone. In crowd, the symptoms are aggravated. All investigations are normal.


Melancholia, hysteria


Melancholia results from emotional depression leading to disharmony of the Zang-Fu organs.


Etio-pathogenesis


According to miraculous pivot “Grief, sorrow, worry and anxiety disturb the mind which further affects the five Zang and six Fu organs”. Depressed anger injures liver impairing free flow of Qi so liver Qi goes down to intestine leading to various illness. Too much worry depresses the liver and suppresses the spleen causing it’s failure in transportation and transformation. It results in accumulation of phlegm, dampness and retention of undigested food which in long run may produce fire. Over anxiety also leads to dysfunction of the Qi and consumes yin producing many symptoms.


Sleep disorders


Sleep has a restorative function and is important for conservation of energy and growth. 

There are two physiological states Non Rapid Eye Movement(NREM) and Rapid Eye Movement(REM). 

In a typical normal night sleep NREM lasting for about 90 minutes followed by REM lasting for about 15 minutes occur alternately NREM sleep is quiet and stable. 

Heart and respiratory rate is slow and muscles are relaxed, but have tone. During REM sleep, many physiological events occur. Heart rate, respiratory rate and B.P. may be irregular. Dreaming is a characteristic feature of REM sleep. 

In males, occurrence of penile tumescence during sustained REM sleep is clinically important. It’s absence is diagnostic of organic impotence. Gradually the duration of NREM sleep goes on decreasing and that of REM sleep goes on increasing as the sleep progresses so the first half is dominated by NREM while the second half is predominated by REM sleep. The average duration of required sleep is 7 ½ hours, varying between 5-9 hours. Infants sleep for longer duration common sleep disorders are Insomnia and 


Parasomnias


Insomnia


Inadequate quantity and quality of sleep is labeled as insomnia. It may be difficulty in falling asleep the commonest complaint followed by difficulty in maintenance of sleep and early wakening. Psychiatric conditions, psycho-physiological disturbances, use of drugs or alcohol and excess worry are common causes of insomnia. It has been observed that insomnia or dream disturbed sleep is common in patients having excess of wood element.


Insomnia may be due to periodic leg movements characterized by dorsiflexion foot with flexion of knee and hips occurring during NREM, periodically at the rate of 1-3 minute. Insomnia may also be characterised by restless leg syndrome causing “ants crawling” deep in the calves ushered by relaxation or lying in the bed relieved by moving the legs or walking. Restless legs syndrome may be due to polyneuropathy, anaemia, motor neuron disease or cancer.


Parasomnias


These include night terrors, occurring during first 2 hours of sleep in children, nightmares occurring in later part of sleep in teenagers or Somnambulism (sleep walking) common in children and adolescents. Sleep walking occurs in first 1-2 hours of nocturnal sleep; vision and co-ordination are intact. This patient can walk avoiding the objects but may fail out of a window or, fall off from roof top. During first sleep walk the child may dress, eat or go to toilet. Sleep related enuresis (bed wetting) is common in 10-15% of children during first third of nocturnal sleep. About 1% of total epileptics get nocturnal epileptic seizure. Nocturnal paroxysmal dystonia or athetoid movement is rare.